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Measuring provider productivity
One of the more vexing problems in the health IT transition is determining the actual impact of new technology on the delivery of healthcare services.
In particular, is new health IT making providers more productive? How can we really know?
Writing recently in the New England Journal of Medicine, three physicians grapple with those question head-on, and the answer they settle on might be summed up as, “We shouldn’t be too hasty in concluding one way or the other.”
They spend a fair amount of time comparing healthcare performance measures to those used in other industries. Not surprisingly, the healthcare measures come up lacking.
“The performance measures used to assess the costs and quality of health care,” they note, “are drawn from administrative data that lack key details needed to detect the effects of health IT. In fact, one study showed that less than 2% of ambulatory performance metrics were suitable for measuring the effects of health IT. Furthermore, measures of health care productivity, such as relative value units, are predicated on traditional forms of use. Health care providers who, for example, use telephone calls or e-mail in lieu of some office visits will appear less productive on measures of productivity, even if they are actually delivering more convenient, accessible, and effective care.”
Another problem they point to involves the fact that “the reengineering of health care delivery is only beginning. Health care professionals are tempted to simply digitize paper-based workflows, but swapping out the medical record cabinet and prescription pad for a computer is proving insufficient to realize the benefits of health IT. Instead, newly IT-enabled processes that support teamwork, care coordination, and innovative approaches such as interactive patient portals have the potential to yield greater convenience, access, and quality for patients and physicians at a lower cost — the definition of greater productivity.”
In the end, they conclude “The resolution of the original IT productivity paradox suggests that current conclusions about the value of health IT investments may be premature. Research suggests three lessons for physicians and health care leaders: invest in creating new measures of productivity that can reveal the quality and cost gains that arise from health IT, avoid impatience or overly optimistic expectations about return on investment and focus on the delivery reengineering needed to create a productivity payoff, and pay greater attention to measuring and improving IT usability. In the meantime, avoiding broad claims about overall value that are based on limited evidence may permit a clearer focus on the best ways of optimizing IT's use in health care.”
Of course, while it may be wise to avoid “broad claims about overall value”, both providers and policymakers are bound to continue to crunch whatever data they can in order to reach some sort of conclusion about the investment. Moreover, one thing the writers overlooked was the assumption that, in addition to making providers more productive, new health IT will raise the level of healthcare outcomes.
Given that that assumption involves factoring in the myriad varieties of patient behavior, we suspect determining what success looks like in that category will make determining provider productivity seem simple.
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