Further, if government wants to see substantial implementation of IT amongs the nation’s practices, it has to come up with a simple but effective method of levelling the playing field when it comes to IT companies. Current rate of expenditures related to implementation and maintenance of CCHIT-certified EMRs is beyond the reach of the majority of small practices, which provide more than 50 % of all the care in the communites across the country. While physician practices have to limit their revenues in a price-fixed marketplace, they simply cannot afford to continue to pay conventional “freemarket” rates to IT vendors. The goverment has to decide which side of this unequal equation can be eliminated – either allow physicians to collect their fair, freemarket payment rates from their customers/patients or let IT vendors play by the same price-fixed rules of third-party payment system.

Incidentally, I find this idea of outcome-based reimbursements rather unique to the health care field. For instance, do we pay our accountants more if they get a higher refund from the IRS or less if we end up paying more? Or do we stop paying our investment advisor since all our investments tanked last year? Or do we not pay our barber because the haircut did not come out exactly as we had expected? Or do we not pay our lawyer in case we lost our legal case in court? Is there any profession that is reimbursed in such a manner, simply based on outcomes? While the idea sounds great, the perils of pursuing such ideas are far more than meets the eye.

I wrote about this controversy last May, (see – http://www.healthpolcom.com/blog/2008/05/23/more-perspectives-on-health-information-technology-%E2%80%93-can-we-call-it-prevention/), and the reality is that health IT needs to be viewed as prevention: Money is spent up front to achieve improvements (cost savings, better quality, etc.) down the road. In the case of IT, the upfront costs can be significant, and those costs and the later savings may not be equally distributed, i.e. those who pay might not see the most benefits, etc.

Another major challenge for making health IT useful and produce savings and improving quality, is getting clinicians and other health professionals to use it properly. This is particularly true for those working in the outpatient setting, because unlike in a hospital environment they often have much less institutional IT support and capital resources to invest in IT – and in its updating, maintenance and training. This is aspect of health IT needs more attention and funding, since dropping machines into the outpatient world will get IT “out there,” but it could also prevent long-term successful adoption if clinicians initial experiences are frustrating and counter-productive to their own interests.