In this regard, caution should be exercised when applying the standard HMO model, as HMOs do not bear all the costs or realize all the benefits of the technologies they use. Therefore, any decentralized global budgeting system must give managers financial responsibility for external and induced costs and savings. The role of information and guidance for cost-effective care would be strengthened in such an environment and the research base should be broadened to provide such information in real time.
Comparisons of laboratory use with other non-EHR sites in the network were not included in the analysis. The number of telephone meetings with patients scheduled by doctors increased significantly after the implementation of EHR, from 1.3 telephone meetings per member per year to 2.1 telephone meetings per year. According to the authors, doctors qualitatively reported that phone meetings were more effective because their ability to solve patients’ problems improved by accessing the EHR. A small amount of literature supports the claim that the use of HIT in pediatrics is beneficial in terms of drug safety, immunization adherence, and disease-based guidelines, supporting patient decision-making in diabetes management, clinical documentation, patient appointments, and hospital order processing.
Paper immunization records do not allow for rigorous population-based monitoring or quality control. Therefore, automated immunization registries, as separate or integrated systems with clinical decision support or reporting capacity, offer tremendous potential to track and improve compliance with recommended immunization guidelines. In society, the reminder system saves money and improves health, making it a win-win program.
Finally, we outlined features of the U.S. healthcare reimbursement and management system that don’t always lead to the application of the most cost-effective combination of new and old technologies. The creation of a resource-based relative scale of value with a spending cap on medical services, recently approved by Congress, will affect the adoption of new technologies in several ways. The new reimbursement scheme aims to create a “level economic playing field” for doctors based on the resources medical device news used in the provision of services. Ideally, the effect will be to make medical decision-making revenue neutral for the physician, leaving clinical benefit as the basis for resource allocation. However, keeping the RBRVS up to date with current physician resource costs can lead to short-term disruptions that affect the use of new technologies. The perspective of care maintenance organizations is similar to the social perspective in cost-effectiveness analysis in several important respects.
Pharmaceuticals have probably received the most attention in cost-effectiveness analyses. Analyses of the drug cimetidine for stomach ulcers showed that it is not only cost-effective, but even provides net savings compared to the standard treatment. A study on the use of third-generation cephalosporins for hospital-acquired pneumonia also showed savings compared to standard multi-drug regimens, largely due to lower costs of drug preparation and administration, monitoring and side effects.
To determine appropriate use measures to assess the impact of EHR implementation, interviews were conducted with 100 people with a wide range of organizational roles. The interviews led the researchers to hypothesize that the provision of outpatient care had become more efficient by making the necessary information available during the first episode of care, reducing the need for follow-up visits and unnecessary services. These hypotheses formed the basis for the selection of metrics and the quantitative evaluation carried out in the study. No further details were provided about the data obtained from these interviews or the methodology used to conduct them. While a growing body of literature suggests that the use of HIT in pediatrics may be a key ingredient in reducing medication errors, a major challenge for pediatric health care providers lies in maximizing compliance with vaccination recommendations.
Other drugs, while not cost-effective, have been shown to have extremely favorable cost-effectiveness ratios in certain clinical applications. For example, beta-blockers after myocardial infarction have been shown to have a cost per year of life of $2,400 for patients at high risk of a subsequent infarction up to $13,000 in low-risk patients. For other drugs, the effects on quality of life are crucial, which has led to the use of quality-adjusted life years1 as a measure of health outcome. For example, cost-effectiveness assessments of antihypertensive drugs include assessments of their effects on both quality of life and longevity. Unfortunately, many key imaging technologies, such as magnetic resonance imaging, have not undergone formal cost-effectiveness analyses due to the difficulty of attributing health benefits to the use of individual diagnostic modalities. Another caveat is that the economic impact of a technology is often confused with the purchase price of equipment or a drug, or the fee paid to a surgeon.