Roundtable Discussion Report

I was lucky enough to be invited to participate in a roundtable discussion today and tomorrow on “How Can Health IT Promote Health Equity and Patient-Centered Care?”  It’s been sponsored by the Agency for Healthcare Research and Quality, the American Medical Informatics Association, and the Kaiser Permanente Institute for Health Policy.*

Usually, I’m not a meeting sort of guy. I avoid most meetings like the plague, and the word “roundtable” is enough to send me running to the hills. But I’m really glad I came.

The point of this discussion is one that resonates with me. Much of my research has to do with the study of information technology in health care. Experience has shown me that there are almost always unintended consequences to implementing information technology. IT is often sold by politicians and experts as the silver bullet for what ails our health care system. It will, they say, increase efficiency, save money, and improve quality. Unfortunately, the experience of many who implement IT into clinical practice does not line up with that sentiment. It’s expensive, it often makes things less efficient, and the quality benefits are often elusive.

The tendency persists, however, to view the implementation of information technology as an unequivocal good. The point of this discussion was to question this belief from the viewpoint of disparities. We all know they exist in health care. What if information technology makes them worse?

My personal bias is to recoil against our rush to embrace the newest gadget. These days it seems to be iPads. I often run into people in health IT who can’t wait to imagine how iPads can be incorporated into care. It doesn’t matter that a very small percentage of Americans actually own an iPad (regardless what you hear on TV). It doesn’t matter that the majority of functioning practices don’t even have decent electionic medical records. Forget that. iPads!

Personally, I’ve come to the conclusion that when it’s working best, technology can sometimes help us to do the things we already know how to do more efficiently or more cheaply.  When it comes to providing good care, though, we don’t always do things well to begin with.  If you don’t have a working telephone, for instance, then an EMR isn’t going to help much.  If your patients can’t get to clinic, then all the cool gizmos won’t help.  Forcing IT on people will only help those who are ready to move forward. It will leave those already struggling even further behind.

It’s good for us to acknowledge that.  I’m sure I’ll post some more on this in the next few days as I think about what people have said. But I see it as a good sign that people are willing to acknowledge that information technology in itself is not progress; how we apply it can be.

*Full disclosure: AHRQ funds some of my research (unrelated to my being invited), and I am a member of AMIA.

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