The impact of information technology (IT) on health care so far has been evolutionary but not revolutionary, according to a paper by an economist at the Massachusetts Institute of Technology (MIT). The study finds that IT has reduced costs and improved patient care, but only modestly, and contrary to many fears, has not resulted in the elimination of healthcare jobs. The article, ” The Impact of Health Information and Communication Technology on Clinical Quality, Productivity, and Workers,”will be published online by the Annual Review of Economics in its upcoming August issue.

Information Technology (IT) is playing an increasingly important role in the health sector. Healthcare facilities and providers can use a variety of IT solutions, for example, to manage computerized patient records, laboratory results and medical imaging. There is also a growing use of telemedicine, which makes care more flexible, and software can help doctors make a diagnosis…

Ari Bronsoler PhD ’22, a recent graduate of MIT’s PhD in economics, Joseph Doyle, the Erwin H. Schell Professor of Management and Applied Economics at the MIT Sloan School of Management, and John Van Reenen, a member of MIT’s Digital Economy Initiative and Ronald Coase School Professor at the London School of Economics, conducted a study of the impacts these technologies have had so far.

Patient safety comes first

Joseph Doyle studies public economics in the areas of health and child welfare. His research on health care examines sources of value and waste to inform policies to improve the quality and cost-effectiveness of the U.S. health care system.

The study involves an extensive review of 975 academic research articles on technology and health care services and was developed as part of MIT’s Work of the Future project, which aims to better understand the effects of innovation on jobs. With healthcare spending accounting for 18% of U.S. GDP in 2020, understanding the impact of high-tech tools on the sector is an important consideration.

The major change in healthcare is the use of electronic health records. While in 2009, less than 10 percent of hospitals used such records, 97 percent of hospitals did so in 2014. These records facilitate the flow of information within providers and the use of clinical decision support tools that help inform physician decisions.

However, these decision support tools, like other applications, have not been as successful, likely due to patient safety concerns.

Joseph Doyle explains:

“There is risk aversion when it comes to people’s health. You [medical providers] don’t want to get it wrong. When you move to a new system, you have to make sure you do it very, very well, so that nothing falls through the cracks while you’re making that transition. So I understand why IT adoption will take longer in healthcare as organizations make that transition.”

Several studies show a very minimal increase in overall productivity as a result of IT applications in healthcare, on the order of 1 to 3 percent.

Additions to work, not substitutes, so far

The use of informatics would improve patient outcomes, but unevenly. In reviewing other literature reviews of specific studies, the authors noted that a 2011 survey found 60% of outcomes were better for patients associated with greater computer use, no effect in 30%, and a negative association in the remaining 10%. A 2018 article containing 37 case studies found positive effects of IT in 30 of them, 7 studies with no clear effect, and thus none with negative effects.

The more positive effects in more recent studies ” may reflect a learning curve by the industry,” according to the article’s authors.

On the other hand, their analysis suggests that, despite recurring claims that technology will eliminate healthcare jobs (imaging, robots…), the IT tools themselves have not reduced the medical workforce. For example, whereas in 1990 there were 8 million healthcare workers in the United States, accounting for 7% of jobs, their number has now grown to 16 million, or 11% of jobs.

During this same time, there has indeed been a slight reduction in office-based medical staff from 16% to 13% of the healthcare workforce, likely due to the automation of some routine tasks. However, hands-on jobs have not been impacted: the percentage of nurses has even increased slightly since 1990, for example, from 15.5% to 17.1% of healthcare employment.

Joseph Doyle states:

“We don’t see a major shock to labor markets yet. These digital tools are mostly supportive [for workers], as opposed to replacements. We say in economics that they are complements, not substitutes, at least so far.”

Will technology drive down health care bills?

As the authors note in the article, past trends do not guarantee future results. Whether the U.S. health care industry will move toward greater IT-based changes in the future is a possibility.

Joseph Doyle states:

“We may see the pandemic accelerate telemedicine, for example. Certainly, this trend depends in part on what patients want outside the acute phases of a pandemic. People have started to get used to interacting with their doctors [on video] for routine things. For other things, you have to go in and be seen… But that adoption-diffusion curve had a discontinuity [a sudden increase] during the pandemic.”

Yet telemedicine adoption also hinges on its costs, Doyle notes:

“Every phone call now becomes a virtual visit.
Figuring out how to pay for that in a way that still encourages adoption, but doesn’t break the bank, is something payers [insurers] and providers are negotiating right now.”

On the subject of IT changes in medicine, Doyle adds:

“Even though we already spend one out of every five dollars we have on health care, better access to health care could increase the amount we spend. It could also improve health in a way that subsequently prevents major health care spending from escalating.”

He adds:

“In that sense, IT could increase our health care bills or moderate our health care bills.”

On the other hand, Bronsoler, Doyle and Van Reenen are working on a study of variations in U.S. privacy laws to determine how these policies affect information sharing and the use of electronic health records.

Joseph Doyle concludes:

“In all areas of health care, continued study of the impact of technology is welcome. There is still much research to be done.”

Funding for the research was provided, in part, by MIT’s Work of the Future Task Force and the U.K. Economic and Social Research Council through its Innovation and Dissemination Program.

Article sources:

“The Impact of Health Information and Communication Technology on Clinical Quality, Productivity, and Workers.”

Ari Bronsoler, Joseph Doyle, John Van Reenen

Vol. 14:- (Volume publication date August 2022)
Review in Advance first posted online on April 4, 2022.
https://doi.org/10.1146/annurev-economics-080921-101909

Translated from L’impact de l’informatique dans le domaine des soins de santé reste modeste, selon une étude du MIT