The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Medical IT: Is Free Free Enough?

Posted by Alan on March 17, 2009

The health care investments contained in the recent economic stimulus bill could go a long way toward reducing medical costs — the number one priority if we’re to strengthen the U.S. health care system. By moving the provider community toward more widespread adoption of electronic records and other useful technologies, the stimulus package seeks to increase efficiency and reduce errors, both costly problems.

The government’s approach to encouraging adoption includes both carrots and sticks, the strongest carrot being the “free” technology. As others have found before, however, sometimes free isn’t free enough. That was WellPoint’s experience when it offered free PCs and prescription-customized PDAs to its network providers. The cost of changing behavior was too high to lead to widespread adoption.

That’s the concern of folks over at the web site Software Advice. As the name suggests, they’re a group that provides companies and consumers with advice on software, they match up buyers and vendors, and get a commission from the vendors (it’s free to the buyer). They’ve seen a lot of software installed and have concerns that the electronic health records aspect of the stimulus package could be headed for trouble. In a post by Austin Merritt the company warns that while moving to electronic records is a great goal, “the subsidies won’t change healthcare providers’ late adopter mindsets about information technology.”

I bring this up not to denigrate the IT skills of doctors and other providers. It’s to highlight the complexity of health care reform. President Barack Obama was absolutely correct to include push the provider community to adopt useful IT. Doing so will stimulate the economy, reduce costs in the health care system and save lives. But passing legislation is just the first step. The tough part comes in implementing the system. The real world reacts to new laws and regulations in unanticipated ways. The best and the brightest can’t out-think or out-plan the world. Reforms are needed, but they need to be thought through carefully. And in making change, its important not to destroy the existing support structures that make a system work.

Even when change is free, it’s not always free enough. That goes for health care IT, health insurance and most every other aspect of this complicated system. Legislate. But legislate with caution.


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