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      The Value From Investments In Health Information Technology At The U.S. Department Of Veterans Affairs

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          Abstract

          We compare health information technology (IT) in the Department of Veterans Affairs (VA) to norms in the private sector, and we estimate the costs and benefits of selected VA health IT systems. The VA spent proportionately more on IT than the private health care sector spent, but it achieved higher levels of IT adoption and quality of care. The potential value of the VA's health IT investments is estimated at $3.09 billion in cumulative benefits net of investment costs. This study serves as a framework to inform efforts to measure and calculate the benefits of federal health IT stimulus programs.

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          Use of electronic health records in U.S. hospitals.

          Ashish Jha, Catherine M DesRoches, Eric G Campbell … (2009)
          Despite a consensus that the use of health information technology should lead to more efficient, safer, and higher-quality care, there are no reliable estimates of the prevalence of adoption of electronic health records in U.S. hospitals. We surveyed all acute care hospitals that are members of the American Hospital Association for the presence of specific electronic-record functionalities. Using a definition of electronic health records based on expert consensus, we determined the proportion of hospitals that had such systems in their clinical areas. We also examined the relationship of adoption of electronic health records to specific hospital characteristics and factors that were reported to be barriers to or facilitators of adoption. On the basis of responses from 63.1% of hospitals surveyed, only 1.5% of U.S. hospitals have a comprehensive electronic-records system (i.e., present in all clinical units), and an additional 7.6% have a basic system (i.e., present in at least one clinical unit). Computerized provider-order entry for medications has been implemented in only 17% of hospitals. Larger hospitals, those located in urban areas, and teaching hospitals were more likely to have electronic-records systems. Respondents cited capital requirements and high maintenance costs as the primary barriers to implementation, although hospitals with electronic-records systems were less likely to cite these barriers than hospitals without such systems. The very low levels of adoption of electronic health records in U.S. hospitals suggest that policymakers face substantial obstacles to the achievement of health care performance goals that depend on health information technology. A policy strategy focused on financial support, interoperability, and training of technical support staff may be necessary to spur adoption of electronic-records systems in U.S. hospitals. 2009 Massachusetts Medical Society
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            Electronic health records in ambulatory care--a national survey of physicians.

            Catherine M DesRoches, Eric G Campbell, Sowmya Rao … (2008)
            Electronic health records have the potential to improve the delivery of health care services. However, in the United States, physicians have been slow to adopt such systems. This study assessed physicians' adoption of outpatient electronic health records, their satisfaction with such systems, the perceived effect of the systems on the quality of care, and the perceived barriers to adoption. In late 2007 and early 2008, we conducted a national survey of 2758 physicians, which represented a response rate of 62%. Using a definition for electronic health records that was based on expert consensus, we determined the proportion of physicians who were using such records in an office setting and the relationship between adoption and the characteristics of individual physicians and their practices. Four percent of physicians reported having an extensive, fully functional electronic-records system, and 13% reported having a basic system. In multivariate analyses, primary care physicians and those practicing in large groups, in hospitals or medical centers, and in the western region of the United States were more likely to use electronic health records. Physicians reported positive effects of these systems on several dimensions of quality of care and high levels of satisfaction. Financial barriers were viewed as having the greatest effect on decisions about the adoption of electronic health records. Physicians who use electronic health records believe such systems improve the quality of care and are generally satisfied with the systems. However, as of early 2008, electronic systems had been adopted by only a small minority of U.S. physicians, who may differ from later adopters of these systems. 2008 Massachusetts Medical Society
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              Effect of the transformation of the Veterans Affairs Health Care System on the quality of care.

              K Kizer, M. Jha, J Perlin … (2003)
              In the mid-1990s, the Department of Veterans Affairs (VA) health care system initiated a systemwide reengineering to, among other things, improve its quality of care. We sought to determine the subsequent change in the quality of health care and to compare the quality with that of the Medicare fee-for-service program. Using data from an ongoing performance-evaluation program in the VA, we evaluated the quality of preventive, acute, and chronic care. We assessed the change in quality-of-care indicators from 1994 (before reengineering) through 2000 and compared the quality of care with that afforded by the Medicare fee-for-service system, using the same indicators of quality. In fiscal year 2000, throughout the VA system, the percentage of patients receiving appropriate care was 90 percent or greater for 9 of 17 quality-of-care indicators and exceeded 70 percent for 13 of 17 indicators. There were statistically significant improvements in quality from 1994-1995 through 2000 for all nine indicators that were collected in all years. As compared with the Medicare fee-for-service program, the VA performed significantly better on all 11 similar quality indicators for the period from 1997 through 1999. In 2000, the VA outperformed Medicare on 12 of 13 indicators. The quality of care in the VA health care system substantially improved after the implementation of a systemwide reengineering and, during the period from 1997 through 2000, was significantly better than that in the Medicare fee-for-service program. These data suggest that the quality-improvement initiatives adopted by the VA in the mid-1990s were effective. Copyright 2003 Massachusetts Medical Society
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                Author and article information

                Journal
                Title: Health Affairs
                Abbreviated Title: Health Affairs
                Publisher: Health Affairs (Project Hope)
                ISSN (Print): 0278-2715
                ISSN (Electronic): 1544-5208
                Publication date Created: April 2010
                Publication date (Print): April 2010
                Volume: 29
                Issue: 4
                Pages: 629-638
                Affiliations
                [1 ] Colene M. Byrne ( ) is a senior analyst at the Center for IT Leadership, Partners Healthcare, in Charlestown, Massachusetts.
                [2 ] Lauren M. Mercincavage is a research analyst at the Center for IT Leadership.
                [3 ] Eric C. Pan is a senior scientist at the Center for IT Leadership.
                [4 ] Adam G. Vincent is an associate senior analyst at the Center for IT Leadership.
                [5 ] Douglas S. Johnston is executive director of the Center for IT Leadership.
                [6 ] Blackford Middleton is chairman of the executive committee, Center for IT Leadership.
                Article
                DOI: 10.1377/hlthaff.2010.0119
                PubMed ID: 20368592
                SO-VID: 1c0cae04-6e4b-4731-90e4-01bfc3e87c72
                Copyright © © 2010
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