It has never been hard to imagine how information technology (IT) could improve health services. Quick messages to replace faxes. Electronic health information is readily available. Software that can inform physician decisions. Telemedicine to facilitate care. The opportunities seem endless.
But as a new review paper from the MIT economist finds, the overall impact of information technology on health care has evolved, not changed. Technology has reduced costs and improved patient care – but in a modest way it is changing on the healthcare landscape, but only improving productivity slightly. High -tech equipment has also not changed many healthcare workers.
“What we found was that although there is this crisis in the use of IT, there has not been much change in health care,” said Joseph Doyle, a at the MIT Sloan School of Management and author of the new. paper. “We’re seeing other businesses need time to learn how to use [IT] effectively. Health care seems to be walking on that path.”
Accordingly, when it comes to health care jobs, Doyle said, “We don’t see major changes in employment or wages in various health care settings. We’re seeing evidence of declining employment. people who write orders, but for people who work in IT, we see a lot of employees being hired in those skills.But there is nothing dangerous in terms of nursing or work. doctor. ”
Instead, Doyle notes that health care “can be on the cusp of major changes” because organizations make better use of efficient technology.
The paper, “The Impact of Health Information and Communication Technology on Clinical Quality, Productivity, and Workers,” was published online by the Annual Review of Economics as part of their August issue.
The authors are Ari Bronsoler PhD ’22, a recent graduate doctor in economics at MIT; Doyle, the Erwin H. Schell Professor of Management and Economics at the MIT Sloan School of Management; and John Van Reenen, a mathematician at MIT’s Initiative for the Digital Economy and Ronald Coase School Professor at the London School of Economics.
The paper itself is a comprehensive review of 975 educational research papers in technology and health services; Doyle is a well -known health professional whose own experimental studies have estimated, among other things, the difference that has increased costs. for health. This book study was developed as part of MIT’s Work of the Future project, which aims to better understand the impact of innovation on employment. Given that health spending is about 18 percent of U.S. GDP by 2020, understanding the impact of technology tools on the sector is an important part of this effort.
One area of healthcare that has seen significant IT -based changes is the use of electronic health data. In 2009, less than 10 percent of hospitals used the data; by 2014, approximately 97 percent of hospitals were available. On the other hand, these data can facilitate the flow of information within the provider companies and aid in the use of support -management tools – programs that help inform physician decisions.
However, a review of the evidence shows that the health care system did not follow the same standards with respect to other types of applications, such as tools to support selection. One reason for that may be patient-safety concerns.
“There are risks when it comes to people’s health,” Doyle said. “You [physician providers] don’t want to make a mistake. When you go into a new system, you have to make sure you’re doing it well, well, so that you don’t let anything fall into the gap while you’re making that change. So, I can see why it takes so long to use IT in health care, while organizations are making that change.
Numerous studies show that the increase in total productivity is due to IT in health care, but not a dramatic amount – the total impact is likely to be around 1 percent. at 3 percent.
They add to the work, but not the agents, now
Patient outcomes appear to help IT, but with different effects. Examining other clinical studies, the authors noted that a 2011 study found that 60 percent of studies showed increased morbidity associated with increased IT use, no effect in 30 percent of studies, and a negative association in 10 percent of studies. A 2018 review of 37 studies found positive effects from IT in 30 cases, 7 studies had no clear effect, and no negative effect.
The greater impact in recent studies “may reflect the teaching” of the industry, Bronsoler, Doyle, and Van Reenen write in their paper.
Their analysis also suggests that although each time technology data will destroy healthcare jobs – through graphics, robots, etc. – IT tools have not reduced the power of employees. . In 1990, there were 8 million health care workers in the U.S., about 7 percent of employment; today there are 16 million health care workers in the US, accounting for 11 percent of employment. At that time there was a small decline in medical staff, falling from 16 per cent to 13 per cent of health workers, probably because the machine was some routine work. But the continuity of professional work has been strong: The percentage of nurses has grown slightly in health care jobs since 1990, for example, from 15.5 percent to 17.1 percent.
“We didn’t see a big shock in the job market,” Doyle said. “These software tools are mostly support [for employees], rather than replacement. We say economically they are the helpers and not the substitutes, at least for now. ”
Will technology reduce our bills, or not?
As the authors note in the paper, past practices are not a guarantee of future consequences. In some industries, the use of IT tools over the past few years has been limited in the first place and more intensified later. And in the history of technology, many important things, such as electricity, have had their greatest impact in the many years since they were introduced.
It is hoped that the American healthcare industry may undergo some major IT -based changes in the future.
“We can look at the accelerated telemedicine epidemic, for example,” Doyle said. Certainly, he observed, that situation depends in part on what patients want outside of the acute stage of a disease: “People are becoming accustomed to interacting with their doctors [on the video] for routines. Other things, you have to go in and see … But this adoption-spreading curve has a hurricane [an increasing suddenness] during the disease.
However, even the use of telemedicine also depends on its costs, Doyle said.
“Every phone is now a [virtual] visit,” he said. “Thinking about how we’re going to pay for that in a way that encourages adoption, but doesn’t break the bank, is something [insurers] and companies are discussing as we talk.”
With regard to all IT changes to medicine, Doyle added, “Even though we already spend one in five dollars of every dollar we earn on health care, there are a lot of opportunities. in healthcare can increase the amount we spend.Health can also be improved in ways to prevent increasing spending on healthcare.In this case, he added, IT can then “add to our health care bills or inflate our health care bills.”
For their part, Bronsoler, Doyle, and Van Reenen are working on a study to examine changes in U.S. state laws to determine how those policies affect information and the use of electronic health data. . In all areas of health care, he added, ongoing research into the impact of technology is acceptable.
‘There’s a lot of research that needs to be done,’ Doyle said.
Funding for the study was provided, in part, by the MIT Work of the Future Task Force, and the UK’s Economic and Social Research Council, through its Program On Innovation and Diffusion.
