Quality problems within the U.S. health care system are pervasive, with only half of
Americans actually receiving care that meets clinical quality standards. Today,
thousands of U.S. patients die annually as a result of unnecessary medical errors,
and providers often report not having the patient information they need to make
proper treatment decisions. Aetna believes that to improve health care quality, we
must accelerate smart investments in health information technology (HIT) to
ensure providers and their patients receive better and more timely access to key
health care data.
44,000-98,000 Americans die annually due to medical errors — medical errors lead
to roughly $2 billion in annual hospitalization costs.i
The Aetna perspective
Beyond the current efforts to finance and foster the expanded use of electronic health record platforms, Aetna believes it is important to focus our health information technology (HIT) investment on:
1. Developing, implementing and using advanced clinical decision support tools (e.g., ActiveHealth’s CareEngine®) within the private sector to generate better results for patients and overall savings;
2. Developing health information exchanges with initial public seed capital, and later, user-fee revenues to ensure connected providers can access the data they need; and
3. Using federal stimulus and other public resources on HIT adoption to encourage providers to acquire and use electronic health records that are fully integrated into a broader health information exchange.
Maximizing our investment in HIT
To date, only 13 percent of doctors and 7.6 percent of hospitals have adopted extensive electronic records systems, and the adoption rate is even lower for comprehensive systems that typically include clinical decision support (i.e., four percent for doctors and 1.5 percent for hospitals).vii Beyond this failure to electronically manage health care information within a clinical setting, clinicians report missing comprehensive information about their patients at the point of care, which can adversely affect both health care outcomes and physician productivity.
To make the most of our HIT investment, it is important to focus on enhancing data exchange through a secure, interoperable health information network and improving patient care through the use of clinical decision support tools.
Secure, multi-source data exchange is important for providers and their electronic health record (EHR) systems because it gives them a more complete view of patient needs. To achieve this connectivity and link all health care providers, we need sustained regional investment in a health information exchange (HIE) network infrastructure. Today, however, only 41 percent of HIEs receive enough revenue to cover their operating costs.viii
Advanced clinical decision support applications enable rapid analysis of a patient’s full data profile and comparison of that data to appropriate standards of care. When gaps are identified between patient records and the current evidence-based medical information, both provider and patient receive automatic “clinical alerts,” currently delivered in real time. In 2008, ActiveHealth Management,ix a health care data analytics company, delivered over 7 million clinical alerts to physicians and patients through its CareEngine application. A randomized controlled study published in 2005 found that patients monitored by CareEngine experienced 19 percent fewer hospital admissions, and a 2008 follow-up study further showed that CareEngine reduced provider charges by 6 percent.x Connecting HIE networks to clinical decision support tools provides actionable information to physicians and patients, creating greater value for the entire health care system.
i Institute of Medicine, “To Err is Human,” 2000.
ii Girosi, Federico, et al., “Extrapolating Evidence of Health Information Technology Savings and Costs,” RAND Corporation 2005.
iii Institute of Medicine, “The Chasm in Quality: Select Indicators from Recent Reports,” accessed at http://www.iom.edu/CMS/8089/14980.aspx.
iv DesRoches, Catherine M., et al., “Electronic Records in Ambulatory Care — A National Survey of Physicians,” The New England Journal of Medicine, vol. 359:1 (p. 54) July 3, 2008.
v DesRoches, Catherine M., et al. (pp. 54-56) July 3, 2008.
vi DesRoches, Catherine M., et al. (p.56) July 3, 2008.
vii DesRoches, Catherine M., et al., (p.54) July 3, 2008; Jha, Ashish K., et al., “Use of Electronic Health Records in U.S.Hospitals,” The New England Journal of Medicine, vol. 360 (p. 1628) April 16, 2009.
viii Adler- Milstein, Julia, et al., “U.S. Regional Health Information Organizations: Progress And Challenges,” Health Affairs, vol. 28:2 (pp.483-492) 2009.
ix ActiveHealth Management is a subsidiary of Aetna Inc.
x Javitt, Jonathan C., et al., “Using a Claims Data-Based Sentinel System to Improve Compliance With Clinical Guidelines: Results of a Randomized Prospective Study,” The American Journal of Managed Care, vol. 11:2 (pp. 93, 97) 2005; Javitt, Jonathan C., et al., “Information Technology and Medical Missteps: Evidence from a Randomized Trial,” Journal of Health Economics, vol. 27 (pp. 585, 601) 2008.