Benefits of Health IT

In February 2009, President Obama and the Congress launched a vast, ambitious program to improve the health of Americans, and the performance of their health system, by building a nationwide, interoperable, private and secure, electronic health information system.  This vision – of health care empowered by a modern information system, serving each and every American according to their needs and preferences – reflects decades of study and thinking by health care experts, health professionals, and average citizens.  Typical of the consensus underlying the nation’s new health information technology (HIT) program is this recommendation by the Institute of Medicine from its seminal 2001 report, Crossing the Quality Chasm:

“Congress, the executive branch, leaders of health care organizations, public and private purchasers…should make a renewed national commitment to building an information infrastructure to support health care delivery, consumer health, quality measurement and improvement, public accountability, clinical and health services research, and clinical education.  This commitment should lead to the elimination of most handwritten clinical data by the end of the decade.”

Similar recommendations have come from many other non-partisan, independent authoritative sources such as the Commonwealth Fund, the Markle Foundation, and the Robert Wood Johnson Foundation.  These recommendations reflect not only academic studies showing the benefits of HIT, but also experience and common sense.  We live in a digital age.  We have seen technology improve virtually every facet of our lives.  But medicine still relies on cumbersome paper charts.  We manage information the same way Hippocrates did 2400 years ago.  It’s time to move medicine into the 21st century.

Many health care organizations, big and small, public and private, have installed electronic health record systems and are reaping their benefits daily.  Examples include not only national systems like the Veterans Administration and Kaiser Permanente, but regional groups like Geisinger Health System, and individual hospitals like the Beth Israel Deaconess Hospital in Boston, and Lakeland Hospital, a 77-bed facility outside of Omaha Nebraska.  These organizations show that the vision is feasible – health care can be made higher in quality and lower in cost through the best existing HIT.

From a common sense perspective, it is impossible to imagine a 21st century American health system deprived of the electronic methods of collecting, managing, and moving data that have revolutionized virtually every other area of human endeavor.  Information is the lifeblood of medicine.  HIT is its circulatory system.  A health care system without an electronic health information system simply cannot achieve its potential, anymore than an Olympic athlete could compete with a failing heart.  This is the vision that President Obama and the Congress embraced in February 2009.

Nevertheless, any bold new goal has to be reduced to practice, and skeptics are now asking appropriately whether the HIT program can succeed.  A few recent studies have raised questions about whether health care organizations that have installed electronic health records are actually realizing the expected benefits.  Perhaps existing examples of success are atypical, and can’t be reproduced in the rest of our health system?  Perhaps we are moving too fast?  Perhaps the risks are too great?

As a scientist myself, I take the academic literature very seriously.  I believe that policy should be based on the best available information, carefully analyzed and considered. However, recent studies raising questions about the benefits of EHRs are informative, but limited in their applicability to our HIT program.  To the extent that they accurately capture past experience with EHRs, these studies illustrate something that the Congress and the President understand and have allowed for:  namely, that having an EHR alone is not sufficient.  Doctors and hospitals have to use this technology effectively, have to employ its extraordinary power to improve clinical decisions, in order to achieve its potential benefits.  The federal government’s new programs of incentives and penalties are totally focused on encouraging the meaningful use of EHRs.  The resources set aside by the Congress to encourage the adoption of EHRs will go only to physicians, hospitals, and other providers who meet carefully designed new requirements for the use of EHRs that will translate into health improvements and cost reductions for the American people.  And the plan passed by Congress includes new resources and support that will help make it possible for providers and hospitals to meet these requirements.  We have already announced the availability of grants that will help providers adopt and use EHRs, and we will be making additional announcements in the weeks and months ahead.

Sometimes bold steps are required to improve the human condition.  Among the most successful health and social programs in American history are Social Security, Medicare, Medicaid, the Community Health Center Program, and the State Children’s Health Insurance Program.  It would have been a tragic mistake, costing untold thousands of lives and enormous suffering, if we had foregone or delayed these programs.  I believe the HIT initiative will rank with these huge successes in the value it will bring to the American people over the years to come.

David Blumenthal, M.D., M.P.P. – National Coordinator for Health Information Technology


  1. john haughton, MD, MS - docsite says:

    Nice post.
    From an academic standpoint / study standpoint – you bring up a great point – acquiring EMR/EHR HIT systems alone without meaningfully using them will NOT equal improved care.

    Another facet worthy of consideration is that EMRs/EHRs are not homogenous entities – in fact, there are some that emphasize interoperable team oriented workflow, others communication and still others billing and administrative coding.

    Each “works” for its intended purpose, but the purpose itself may not be to improve care, emphasizing “known” methods (see for example Kawamoto Lobach et al article – meta analysis on improving care with decision support —

    Studies in the literature showing EHRs as ineffective may highlight a lack of “meaningful use”.

    Additionally, such studies may highlight design elements, what works and what doesn’t work, in terms of features, functions and capabilities. And clearly, if “what works” means what makes care accessible, affordable and effective then patients and the healthcare sysetm will be well served.

    A billing calculator that emphasizes (counts) elements of social, past and other history elements, along with problem counts, etc may have historically been a key reason for a user to purchase an EMR.

    With “recovery act payments” – it is now possible to emphasize (and pay for) elements and function that improve care – such as structured data, team (with each other and with the patient) communication, decision support, population (performance) reporting and safety checking orders and prescriptions

    great conversation.

    John Haughton

  2. Brian Wagner says:

    Many of the current challenges exist because of the lack of systemic incentives that will encourage the adoption, use, and incorporation of EHRs and other forms of HIT into medical practice. As the eHealth Initiative noted back in June to Congress:

    “In order to realize the complete benefits of the collection, use and exchange of electronic health information, the implementation of ARRA’s health IT section—known as the HITECH Act—must be interwoven with House and Senate reform efforts.

    “The HITECH Act’s key mission is to promote the meaningful use of health information technology, moving the debate beyond technology adoption by a physician or hospital, and instead challenging health care stakeholders to use and exchange the information contained in such systems to improve health care in the U.S.

    “Health information technology is crucial to the management of information, noted Dr. David Blumenthal, the National Coordinator for Health Information Technology, in May 2009, “and we are above all in the health care industry about using information to make decisions. Anything we can do to make the management of information more effective to get better information to the point of key decisions at the right time is going to ultimately improve the quality of those decisions and the products that our health care system produces.”

    “We wholeheartedly agree with the sentiments that Dr. Blumenthal expressed. Due to the highly fragmented nature of our current system, clinicians often do not have the information they need for decision-making, nor do those responsible for improving the health of the American population. And patients, the focus of the system, do not have ready access to the information they need to effectively manage their health. The meaningful use and exchange of electronic health information will help reduce medical errors, improve the state of preventative care, enable comprehensive comparative effectiveness research, engage consumers more fully in their own health and treatment, and ultimately galvanize savings and revitalize the provision of care across the delivery system.

    “But meaningful use cannot occur in a vacuum. In 2008, the Congressional Budget Office noted that the clearest benefits of using health IT had been identified and measured in integrated care systems where health IT was already tied into the functions of the system. Any major redesign of our health care system must be grounded in a well-defined relationship with the meaningful use of health information technology in order to achieve that advanced level of interconnectivity and interoperability. A few of the key areas to focus on the integration of HITECH Act provisions include:

    • Payment reform that incentivizes quality of care over quantity of care, so that providers begin to directly realize financial benefits from utilizing health IT.
    • Promoting preventive care that relies upon the abilities of health IT to aid providers in identifying potential conditions in their early stages and support the provider and the patient in pursuing positive health behaviors.
    • Utilizing electronic data gathered through health IT to advance the vast amount of work needed to better understand and then address the causes of disparities, both in the cost and in the provision of care.

    “Congress’ support for reform policies that holistically incorporate health IT and the provisions of the HITECH Act will lay the foundation for a higher quality, safer, more accessible, and more efficient health care system. But if the adoption and meaningful use of health IT is viewed as a separate endeavor from health reform, the likelihood will only increase that the money spent to encourage health IT adoption and information exchange will be squandered due to our failure to leverage the capacity of electronic health information and tools to enable and accelerate health reform that is built on the foundation of health information.

    “Ultimately, meaningful use of health IT will dictate whether long-term health reform in the U.S. succeeds or fails. Speaking before the House Ways and Means Committee in July 2008, Peter Orszag, then-director of the Congressional Budget Office, testified that the U.S. annually spends up to $700 billion on health care which may constitute unnecessary or duplicative spending, and that reducing such nonessential spending will require the full use and integration of health IT into broader health reform. “One can think of health information technology as the foundation or the gateway to capturing that $700 billion opportunity,” Orszag explained. “It will not be sufficient by itself, but it is necessary to put in place a more universal system of health information technology in order to capture the opportunities that we have before us.”

    We have a huge task ahead of use, but Dr. Blumenthal is sounding the right notes when he talks about effective use as a precursor to realizing the full benefits of HIT. And achieving that effective use on a national scale will require the realigning of incentives to support eHealth in every facet of health care in the U.S.

  3. William Haslett says:

    The best review that I know of on this topic, Chaudry et al 2006 is far from making a compelling case. Garg et al 2006 is also well done and also equivocal. Are there other high quality reviews or original research papers that I should be aware of which demonstrate real world improvements?

    Here’s a more important question: who is going to conduct RCT’s of implementation projects? I don’t know of any, and that’s where we get strong causal stories. This can be done using wait list controls when multi-clinic agencies roll out HIT. I’m thinking of the Cleveland Clinic in particular, who’s impressive activities could be being paired with rigorous implementation research. In the absence of such research, we have to rely on people who’s livelihood depends on these technologies to tell us how well they work.

  4. Jeremy Engdahl-Johnson says:

    Federal funding may be encouraging a move toward EHR, but there’s more to it than just installing systems. How can healthcare data pooling lead to a better system? More at

  5. Margalit Gur-Arie says:

    I just finished reading the Himmelstein et al paper, which I assume triggered this post. While the study seems nicely done, its most compelling feature is the rampant use of language denoting inconclusiveness (perhaps, probably, uncertain….). This should not come as a surprise since, according to other studies from RWJF, comprehensive computerization in hospitals is at an abysmal 1.5% (8% for basic computerization). There is simply not enough data to draw meaningful conclusions at this point in time.

    As tempting as it may be to therefore discard such pessimistic studies, we should not. What Himmelstein and his colleagues documented is a lack of “big bang for the buck” in the way we are currently building, implementing and using HIT. It should give us pause. I am not sure how to conduct RCTs for EHR implementations, since blinding is not an option and the controls will never be satisfactory, but we should spend some time thinking about ways to first analyze and measure the process as we go and then engage in quality improvements.
    It is possible that meaningful use will accomplish that, but I haven’t seen the rigorous analysis concluding that meaningful use of existing systems will actually provide the proverbial big bang.
    One observation in the study that caught my attention was that several hospitals that built their own custom system seemed to do better than most. I will not attempt to provide interpretation to this observation.

    Finally, it should be obvious to all involved that computerization of health care systems, for better or worse, is inevitable. Paper as a medium for conducting business is on its way out and anyone visiting a grade school classroom in this country knows that. However, technology adoption, just like the larger health care transformation, is a process, not an event.
    We are currently trying to hasten the process in an attempt to extract benefits sooner rather than later. The danger in doing that is that we may inadvertently set up a course that will have the opposite effect of slowing the natural progress. Studies like the one discussed here, should serve as reminders that we are charting unknown waters and should be constructively used to make adjustments if necessary.

  6. Brian Ahier says:

    It is only through the widespread and effective use of health IT that we will achieve the goals of lowering costs and improving quality and clinical outcomes. The Himmelstein et al report really only strengthens the argument for the current path.


  7. Evan Steele, CEO SRSsoft says:

    There is little dispute regarding the need to eliminate paper charts and move medicine towards the electronic management of health care records. The problem, however, is not limited to the recent studies to which you refer that have questioned the benefits of EHR technology. As summarized by the Implementation Workgroup, “substantial concern exists about the state of EHRs—which led them to conclude that “we are not building on a firm legacy of success.” 57 of the initial 60 FACA blog comments that related to implementation of traditional EHRs relayed negative experiences. The majority of these comments identified the impact on physician productivity as the overriding obstacle to successful adoption, or even consideration, of “certified” EHRs.

    Productivity losses of up to 40% were reported by physicians who attempted to use EHRs and perform the required data entry. These estimates may or may not be representative of all practices, but even small increases in physician time per patient exam have significant negative financial impacts. As illustrated in the cost-benefit analysis chart for primary care physicians ( and the cost-benefit analysis chart for specialists (, even a one minute increase causes revenue losses that dwarf the potential EHR incentives.

    If these underlying problems which are inherent in the software and the data entry/reporting requirements are not addressed, widespread implementation will not take place.

  8. Michael Milne says:

    This is spam from CCHIT

  9. Dyck Dewid says:

    It is exciting to consider what HIT might someday accomplish. Being in the midst of a health care system catastrophe it truly challenges my social diagnostic abilities. But, I am an optimist. And it is not because I’m hopeful, but because the unfoldment is real, sustained by persistence of life.

    So what is not apparent is that there’s been meaningful consideration/debate of what’s the purposes of HIT. And what’s driving the purpose. For example, if better productivity is a purpose, what has happened to health care productivity in the past decade. If it’s suffered at the hands of insurance requirements then that’s something to note. If it were due to adaptation to advancing technology that would be good to note. If it were due to patients demanding more time that would be something (!) to note. And what is the likelihood that these will persist?

    Related is the Health Care Reform debates. It looks like there is little attention given to understanding the causes of the mess. I know this is the result of politics and preoccupation with the self, not lack of intelligence.
    Is there any doubt that at the heart of this complex matter is insurance? It appears to be the fox guarding the hen house. If I have my way (not very likely) there would be an open and free market driven health care environment and private insurers would be allowed, but required to have policies understandable by an average 82 year old person.

    Excerpt from A business that has first loyalty to its investors or principals does not seem a likely choice to make personal health decisions. It is not difficult to see how or why there would be gigantic overhead imposed on all parties in the continuous quest for higher margins: duplicating, protecting, sending, tracking, receiving, tracking and verifying medical information from the patient, the doctor, the lab, the hospital, multiple government agencies, disputes, claims, limitations, rules, deductibles, co-pays, pre-pays, authorizations, penalties… to name some of what’s obvious. This morass imposes costs and human stress beyond reason.

    So, I give this scenario because it illustrates how a single large force (insurance) could be a primary cause of our productivity problems. And if we handle that in another way (removing or modifying the influence of insurance) it would change the whole equation.

  10. Foster Kerrison says:

    I have not read the full Himmelstein paper, (I have just seen the abstract), but findings of this kind should not be a surprise. There is plenty evidence that there is an initial loss of productivity in implementing an EHR and not all e-health related initiatives will be successful in every situation.

    At the same time, there are many other studies and experiences confirming improved outcomes and performance, as the good Doctor referred to. That is true in the US and particularly true in the UK, which seems to have been overlooked as a source of very relevant EHR experience over a long period of time. A lengthy report published last year by the University of Edinburgh and the Imperial College London, (The Impact of eHealth on the Quality & Safety of Healthcare), sets out some of the complexities, shortcomings and advantages. Overall, that report concluded that there was merit in proceeding.

    I think that professional informaticians should continue to support the program, and not get distracted or side-tracked here. If we truly believe, (and I certainly do), that EHRs improve healthcare, then let’s continue to support ONC in their direction of this program. I have confidence in that administration and think that this posting was appropriate in tone and rational content. We should not be insensitive to criticism of the ONC plans, but neither should we panic when there is some criticism.

    Once we start to see the roll out happen, then we need to be supportive, with sound advice, based on good science, for those implementing organizations, whilst acknowledging that some of them will struggle and fail.

    Foster Kerrison

  11. Leonard Kish says:

    I believe you are right that HITECH has the opportunity to be one of the greatest achievements of our lifetime, but it will be extremely difficult without fixing the underlying economic misalignments that are at the root of the health care problems in this country and the lack of physician adoption of HIT.

    It’s great to see that there does seem to be a deep understanding of these problems, if not their solutions at this office’s director level. The path won’t be easy, but it is the right path.

    For a good discussion of this topic, the Harvard EHR study and more, please visit Dr. Howard Luks’ blog:

  12. Evan Partridge says:

    Well a good post indeed!
    When talking from an academic point of view, you do bring up a great issue. As one of my previous blog commentators said, without proper usage of the EMR/EHR HIT systems, it will not have any vital improvements in the care as a whole.

  13. Sharon Baskerville says:

    Individual implementation of health information technology certainly improves the efficiency and effectiveness of the delivery of care but not the entire ecosystem. While I agree with Congress, the President and most Americans that health IT will dramatically improve our health care system at all levels if implemented correctly and across all platforms of care.
    Patients currently receive care across multiple providers and platforms. For example, someone who needs an x-ray typically will need to see their primary care physician before traveling to specialist and then an x-ray technician’s office. Without a comprehensive integrated EMR system, records will change from office to office as they often do in the pen and paper system leaving errors and often times duplicate testing. The coordination between multiple practices and areas of care is the ultimate vision of health information technology not just individual adoption of EMR’s.
    DC Primary Care Association is on the front lines of health information technology. We seek to strengthen the public health system by ensuring that health care providers have better access to clinical information in primary care settings, as well as during emergencies. When Health IT is integrated on a uniform, interoperable platform patients will have access to efficient, effective and lower cost health care.

    Sharon Baskerville
    D.C. Primary Care Association

  14. Gino Siller says:

    I agree with Leonard. Its great that steps are being made. However, the road is going to be long and challenging. At least we are on the right track.

  15. William E. Beck says:

    Nice review here, thanks to bring me new information about HIT. Aside from the pros and cons out there, I’m sure its gonna make improvements on the health field especially from the effectiveness and efficiency point of view.

  16. dnz says:

    Thanks for article Dr.
    Im using this method for be healthy man 🙂

    It’ s my method;

  17. Corbin Santo says:

    I am very pleased to see that the years of research that have gone into health IT are finally paying off. It is important to lay the groundwork for the infrastructure investment and follow through with training procedures that will harness the power of the technology. I hope that this can continue to be an area that is supported by those in the legislature. Funding technology that will lead to better coordination of care and treatment for patients is a nonpartisan issue that every legislator can be proud of.

  18. stop bullying says:

    No one is arguing that HIT is the next logical step towards medical records management. The issue is putting the government in charge of it.

    When I look at each and every single government agency and program, I see massive fraud, abuse, waste and incompetence. If you can point to just half a dozen examples to prove me wrong (and there are thousands of programs to choose from), I’ll change my opinion.

    HIT may be a good idea. If you want to kill it, hand it over to Obama.

  19. sam says:

    Hi a very interesting review – implementing this can only bring benefits, however, it has to be managed correctly. I agree with the statement by John Haughton that if these systems are not used meaningfully then there will be no improved care.

  20. Mr Cure Anxiety Attacks says:

    I truly feel that it was a great thing for President Obama and Congress to launch an ambitious program to assure that all Americans have some sort of health care. Because it’s ridiculous that here in America all Americans can’t afford to go to the doctor for a regular check up on their health. We spend to much time and money worrying about other countries well-being, when Americans are in need of help and services. You have to be able to take care of home before you can go out and start helping others. So it’s about time that we got a real president who takes care of home first, before he decides to go out and help others. We must remember that everybody in America is not rich!

  21. Scott says:

    Technology is so important. We have gone so far especially in the medical field. Thanks for the article from a 20 year IT guy!

  22. fitness and health says:

    This was a great post Dr., keep up the good work!

  23. company formation cyprus says:

    i really think that president Obama made a smart decision, as far as i know one big medical issue in US is Obesity. So i guess this program is only the first step in getting rid of this issue!

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