Apogee Group LLC Blog

Trials and Tribulations of Business & Healthcare

E-Health is No Panacea

Posted by Jay Kingley • Jan 30, 2011 • Category: IT

Jay Kingley

E-Health doesn't seem to add a lot of value according to a study published in the January 2011 edition of PLoS Medicine.  It seems that the net of looking at electronic medical records, computerized provider order entry, and computerized decision support systems is that the claims for cost savings, efficiency, and improved outcomes are not supported by the evidence to date.  This shouldn't be surprising for two reasons:

  1. It often takes time for new technology to change the way and how we work as opposed to increasing the efficiency of the old way of doing things (this being the optimistic view of the world).
  2. Many of our healthcare problems today (and an increasing amount of the cost) are related to poor lifestyle (diet and physical activity) and these are a set of problems that technology will not easily if ever solve.

One of the things that I have found interesting since the explosion of the internet age into society at large starting in the 1990s is the misconception of how business or the economy as a whole benefits from the introduction of new technology.  In the first instance, new technology is applied to try to make the way we currently operate more efficient.  This typically results in little if any cost savings.  The cost of implementing the new technology (systems and training) offset most if not all the costs of the efficiency improvement.  True savings don't come until many years later when the technology enables true innovation thereby changing the entire process of work resulting in new ways of doing things not just doing the old ways more efficiently.  A great read on this topic is Unleashing the Killer App by Downes and Mui.  (Self promotion note - I knew and worked with both authors when they were writing the book and even got a mention on page 155).

Healthcare defies the logic of most businesses and industries.  Consumers pay a small fraction of the true costs, there is an enormous knowledge gap between the providers and consumers, the payors and providers have virtually no dialog, and the majority of the industry for those under 65 is intermediated by completely dysfunctional, oligopolistic health insurers.  The majority of the healthcare costs for those under 65 is related to chronic lifestyle diseases like overweight and obesity, high blood pressure, high lipids, diabetes, heart disease, orthopedic problems, GI complaints, and so forth.  The bulk of these medical conditions are either caused by or exacerbated by poor lifestyle.   Lifestyle in this case meaning diet, physical activity, mental health, stress, smoking, et al.

For those of us working in healthcare focused on the treatment of these chronic lifestyle conditions, it is not an easy task.  At the end of the day, the only real answer to cost effectively treating these conditions is to have the majority of our adults and children change their lifestyle.  That means changing well ingrained habits and behaviors.  It is not easy but it can be done.  It takes the ability to find each client's particular motivating forces and being able to provide a strong support system. This requires a high touch system while eHealth technology are decidedly low touch.

If changing lifestyle were so easy, then we would not have the overweight and obesity rates we do that have steadily increased for generations and are now at all time highs.  If it were that simple, the millions of web pages and thousands of smart phone apps would be working their magic and reducing the incidence and cost of chronic lifestyle diseases.  I'm afraid where technology is concerned, there are no magic answers for solving the chronic lifestyle disease problem - just good old fashion hard work delivered by a high touch, supportive healthcare team.

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  1. E-health should not be used as a loose term. And "value" should be defined in the context of each clinical setting. No matter how much we try, it will not be possible to document value to e-health because criteria cannot be pre-determined.

    In my opinion, the value of e-health will be the following:
    1) Improve efficiency of a medical practice, so that the staff can respond optimally to patient needs in real time
    2) Reduce costs over time
    3) Ability to transfer some of the costs of IT to the consumer/payer
    4) Allow access to records to patient and all other clinicians involved in patient's care

    Unfortunately, we may never see real value with e-health because current criteria are far too rigid and one size does not fit all; and innovation will not occur in health care until it becomes a true free market system with appropriate "incentives" for innovation. Current price-fixed structure will only promote mediocrity.
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