In 2005, RAND Corporation researchers issued a report projecting that the United States could save more than $81 billion annually thanks to health IT. That prediction has not come to pass. A new study from RAND set out to explore what's to blame for disappointing progress — and what providers, patients and vendors need to do to ensure health IT does reach its full potential.

"What It Will Take To Achieve The As-Yet-Unfulfilled Promises Of Health Information Technology," published in this January's issue of Health Affairs, highlights three main causes for health IT's slow showing: lack of interoperability between IT systems, the challenge of learning new systems and lack of patient access and engagement.

In terms of interoperability, the analysis notes that health IT systems even within the same hospital or from the same vendor may not be able to communicate with each other. A patient also can't use the information in his or her record when visiting an out-of-network provider. The paper says that while EHRs should work as convenient "ATM cards" that can be used anywhere, they instead act as "frequent flier cards" that enforce "brand loyalty" to a health care system.
"For vendors, there needs to be more willingness to embrace the concept of interoperability and compete on that, rather than trying to lock in their clients with technology," said Spencer Jones, an information scientist at RAND and a co-author of the paper.

Other studies have suggested that usability can be a challenge for providers and IT staff when starting a new program. The paper suggests that because health care systems have been made to rush implementation in order to receive government incentives, there has not been as much motivation for vendors to develop more user-friendly systems. The report suggests that health IT follow the example of car companies and offer versions with consistent enough controls that users can switch easily without instruction.

Finally, the report emphasizes that patient engagement is key to the success of health IT. Just like the way people manage their finances online, the paper explains that patients should also be able to access their health records and easily send them along to physicians they are planning to see. The report notes that the government has taken steps to encourage that the availability of health records to patients, as view, download and transmit functionality will be part of Meaningful Use stage 2 incentives that go into effect in 2014.

Government incentives have also helped urge along implementation, the paper says, but numbers are still below the 90 percent threshold on which the previous RAND report was based. Around 40 percent of U.S. physicians and 27 percent of hospitals are using at least a "basic" electronic health record, according to the report. It also notes the gap in use between urban and teaching hospitals and smaller rural hospitals.

"Overall, the paper says we shouldn't rush to judgment on health IT because it's still in an early stage," said Jones. "There's a lot that needs to happen before we can make a real solid conclusion about whether it's gong to fill all of its potential."

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