Wednesday, February 15, 2017

With All The Excitement Around Digital Health It Is Important To Preserve The Evidentiary Perspective!

These two articles appeared close together and serve to ram home the point that we must all resist the hype.
First:

Why the pressure’s rising for EMRs to make an impact

Published February 06 2017, 2:44pm EST
As the country wonders about the next iteration or obliteration of the Affordable Care Act, the 1996 movie Jerry Maguire starring Tom Cruise and Cuba Gooding, Jr., provides all the information needed to prepare for changes in the healthcare marketplace in 2017. Cruise plays sports agent Jerry Maguire who represents Rod Tidwell, a fictional Arizona Cardinals wide receiver played by Gooding.
In one poignant scene, Rod chastises Jerry in an effort to motivate him to work harder to secure a more valuable contract for Rod’s services to the Cardinals. Through the repetitive mantra “Show me the money, Jerry,” Rod makes it clear to his agent that only the monetary value of the contract matters.
After spending more than $30 billion on incentive payments, many in and outside government wonder what value that investment in electronic medical records (EMR) delivers to patients. Similarly, many hospital boards of directors, provider organization leadership groups and physicians in private practice wonder what type of return on investment they are receiving from implementing these healthcare information technology (HIT) systems.
EMRs are expensive to implement and maintain. In addition, there exists no clear evidence that they increase productivity, enhance quality or reduce medical errors. Although studies do show some benefits obtained from the use of EMRs, this evidence is not definitive, and any benefits are not widely reported across the industry.
To understand our struggle to obtain value from EMRs, it is important to “show you the money.” The HITECH act motivated organizations to purchase EMRs to obtain incentive payments from the Federal government through the Meaningful Use program.
As deploying an EMR is both an expensive and risky task, provider organizations focused on implementing the EMR in its most basic format, forgoing the process and clinical workflow redesign necessary to effectively leverage the power of EMRs to positively impact patient care. Organizations most feared loss of revenue because of suboptimal coding, so they therefore focused on proper documentation by clinicians to preserve current revenue streams.
More here:
The fourth paragraph really says it all.
Second we have:

Claims that mHealth can save costs may miss the mark

Feb 6, 2017 11:22am
mHealth research doesn't always offer a comprehensive account of the economic impact.
Proponents of mHealth apps often say the tools can help hospitals cut patient treatment costs by streamlining care. But a more detailed look shows there's often inadequate evidence to support those assertions.
Although almost all studies address the economic factors of an mHealth intervention, including cost savings tied to improved outcomes, many of those studies fail to consider a range of factors that could influence the economic impact, according to a study published in PLOS One.
Researchers with the University of Washington and Columbia University reviewed 39 studies spanning several mHealth interventions—including behavioral health and text messaging—and found that most do not account for all of the Consolidated Health Economic Evaluations Reporting Standards (CHEERS) developed by the International Society for Pharmacoeconomics and Outcomes Researcher (ISPOR), which include a broad spectrum of economic factors.
On average, the studies evaluated included less than 80% of the CHEERS guidelines. Meanwhile, less than one-third of the studies were considered “high quality” based on adherence to CHEERS.
More here:
So, in summary, the evidence for much of what is being done on the conviction that ‘it obviously works and is useful’ is rather less than rock solid. As various other sceptics are prone to say ‘just saying!’
David.

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