Tuesday, October 19, 2004

More Dollars for the Healthcare IT Sinkhole

I see that the U.S. Department of Health and Human Services (HHS) is making grants of $139 million “to speed adoption of health IT.” (AHA News Now, October 13, 2004) Awards will include “more than 100 grants totaling $96 million over three years to communities, hospitals, health care systems and providers in 38 states to support health information technology use and development, particularly in small and rural hospitals and communities.”

IT is a useful tool because it allows things to be done better and cheaper. That being the case, one might suppose that the health care system wouldn’t need any subsidies or governmental encouragement to take advantage of it. The little country bank in Harlan, Iowa where I have had an account since childhood recently offered me on-line bill paying capabilities. Free. I assume it did that to eliminate the cost of processing paper checks. So far as I know, it didn’t wait until the government gave it some money to do it.

Doing things better and cheaper means changing the way you operate. But change creates winners and losers, which involves a certain amount of pain. In the case of health care (which operates in much the same way it did 50 years ago) it involves a lot of pain, and so there is great resistance to doing it.

Creating an IT application requires a financial investment, which adds the pain of paying to the pain of change. Not wanting to look inefficient and backward, health care has been willing to endure the pain of paying, but not the pain of change. So there have been a number of grand announcements of major IT projects, with few reports of positive outcomes and the occasional embarrassment of major failure.

HHS’s IT grants will certainly alleviate the pain of paying but is unlikely to do much to induce the health care system to endure the pain of change.

I believe the first IT project of this kind of which I was aware took place sometime around 1960 at the University of Arkansas Medical Center. As best I can recall, it was a grant-supported attempt to automate pharmacy operations. So far as I know, not much came of it.

Maybe it will be different this time, but I doubt it.

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