Health IT Report: Coordinating Patient Care Takes Back Seat to Processing Claims

Over the next five years, health information technology is likely to focus more and more on administrative functions like claims processing than on clinical functions, like viewing patient care and test results.

Thats the conclusion of a group of Harvard Medical School faculty and clinicians established to predict the status of networked health information in the next five years.

The report also concluded that health ITs ability to help patients is hampered because providers have different IT capabilities.

Hospitals are rapidly adopting health IT, but when patients are discharged, electronic records dont move with them.

“The quality benefits of HIT systems will be limited as patients move from highly computerized settings to paper-based outpatient settings,” the report stated. “These handoff points are particularly susceptible to errors.”

The Harvard study compared a so-called model NHIN (national health information network) that could be in place within five years to the likely NHIN that would exist if health IT trends continue at their current rates.

Information technology for handling administrative functions is already much more advanced than IT for clinical functions, but this study shows the gap widening, particularly for home health agencies and skilled nursing facilities.

The reason for the growing gap is simple: The financial benefits for administrative functions are clear, and those that pay for the systems reap the financial benefits.

In addition HIPAA has pushed institutions to submit claims electronically. A related report found that electronic health records could benefit small practices financially but would improve clinical care only slightly.

The benefit came largely through a process called “charge capture”: physicians billed for more of the services that they were already providing.

Understanding exactly who benefits from electronic health records, and how much, is at the heart of a debate between health care providers and health care payers.

Clinicians say they are pressured to purchase expensive systems that primarily benefit payers.

Payers dont want to help physicians purchase systems that will help provide care to competitors clients.

However, in regions where a handful of insurance companies cover a high percentage of patients, some creative collaborations are under way.

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