Health care reform has become quite the buzzword over the last year. Several states have tackled the issue, and most of the presidential candidates have prescribed their own solutions to rising spending and increasing numbers of uninsured. However trendy the topic of health care has become, experts are skeptical that any real changes to the nation's health system -- including significant investment in health IT -- will take place before the election-year rhetoric dies down and a new president takes office.
Six months ago, Suzanne Lestina's inbox was flooded with e-mails predicting major health reforms -- everything from expanded insurance coverage to IT investment -- but those messages have essentially stopped.
"What was on the front burner six months ago seems to have been pushed to the back," Lestina, a technical manager on the revenue cycle for the Health Care Financial Management Association, said. The horse-race-style coverage of the election seems to have crowded out further discussion of specific health reform initiatives, including IT -- at least for the time being, according to Lestina.
Chris Dixon, manager of state and local industry analysis at the research firm Input and author of a recent report on IT spending projections, agreed. IT spending in the coming year will likely take a "business as usual" course, rather than one of major, unanticipated investment, Dixon predicted.
"Investment will more likely be driven by the life cycle of turnover of various systems," Dixon said, adding, "Whichever hospitals are due for IT will go to market, regardless of the political environment."
'Business as Usual' Means It's Booming
"Business as usual" for health IT -- at least in recent years -- has been significant investment. A recent study by the strategic marketing firm the Gantry Group found that about 50% of surveyed providers each invested more than $10 million in health IT last year, with 53% reporting that they would likely reach the same level in 2008.
However, an anticipated economic downturn -- brought about by a rapid decline in housing prices and other factors -- could affect IT investment.
"Even if hospitals wanted to go wholeheartedly into a health IT-transformed environment, they just wouldn't have the resources to do it," Dixon said.
Hospitals will need to think strategically about where best to direct their health IT dollars.
According to Lestina, this is an especially difficult job, particularly as many hospitals face a strain on staff and financial resources.
Lynn Vogel -- vice president and CIO of the University of Texas M.D. Anderson Cancer Center in Houston, where he has led an effort to create and implement an in-house electronic health record system -- concurred.
"One of the biggest challenges we face today is having a sufficient number of highly qualified [IT] staff, in terms of knowledge to operate," Vogel said, adding that local competition from big businesses such as Exxon makes it difficult to draw skilled IT technicians to the hospital.
To recruit IT staff to M.D. Anderson, hospital executives have put together a comprehensive benefits package, including education and health offerings.
Vogel recommended that hospitals tap into staff -- and even patients -- to determine where to best spend IT dollars. At M.D. Anderson, a governance committee of about 200 faculty, staff and patients join together once monthly to review recent IT investments and make recommendations for future ones.
"There probably isn't anything else in the health care business today that is as ubiquitous as" IT, Vogel said, adding, "Everybody uses IT, and everybody wants a say in how we should use it. The governance process helps us answer the 'what,' as in, 'what should we invest in?'"
Consumer-Driven IT Investment
Meanwhile, hospitals will have to confront the reality that many patients are delaying various procedures and visits as their insurance copayments and deductibles continue to rise.
When considering IT investments, hospitals should keep these increasingly cost-conscious patients in mind, Lestina recommended. To that end, IT that will aid the ability to explain, calculate or predict out-of-pocket patient obligations would be a wise investment, Lestina said. IT that automates verification of benefits or identifies a given patient's ability to pay would be useful for the same reason, according to Lestina.
Consumers are becoming increasingly frustrated with outmoded health IT, Lestina said, adding, "They say, 'I can pay my phone bill at 11 o'clock at night, why can't I pay my health care bill?'"
State and Local Investment
State and local governments will need to be smart, rather than innovative, about where they invest their IT dollars. Dixon recommended that states fold health IT investment into their Medicaid budgets -- crunched or otherwise -- as a way of boosting efficiency and trimming costs.
"Medicaid is the primary tool that governors have at their disposal for driving attention on this issue. ... Now is the time for vendors and providers to come together to make a more effective investment plan, rather than just falling back on the same old cost reduction measures," Dixon said, adding, "Policymakers need to ask themselves how they can use those funding streams to drive more rapid health IT adoption."
Input's research projects that state and local health IT investment will increase to as much as $10.8 billion in 2012, from $6.9 billion in 2007. The increase will largely be driven by investment in Medicaid Management Information Systems, according to Input.