Health IT

Gray papers and health care IT cost savings

Dr. Westby Fisher says there’s a flood of “investigations” into conflicts of interest between researchers, academic institutions and other groups. But he says a more insidious connections is between “independent non-profit organizations” that push, among other things, cost savings in electronic medical records.

Dr. Westby G. Fisher is a board certified internist, cardiologist, and cardiac electrophysiologist at NorthShore University HealthSystem in Evanston, Ill., who writes regularly at Dr. Wes.

More from Dr. Wes

If we want to see where the money in health care is going, look to the stock market. Cerner, one of the big players in health information technology, has seen its stock soar 50 percent so far this year, much of it from the federal stimulus package. This is part of the grand plan to save costs in health care, after all: why ask questions? If we just pour a few more billion dollars to health care information technology, we’re sure to see lower costs, right?

So this got me wondering, where did this “cost-saving” mantra come from?

Much of it comes from the backing of a single 2005 Rand Corporation research “study” that concluded “if most hospitals and doctors’ offices adopted [health-care IT], the potential savings for both inpatient and outpatient care could average over $77 billion per year.”

So I had to look this study up. Who is the RAND Corporation? How was the study done? What measures did they use? Is this conclusion of $77 billion on cost savings realistic?

The RAND Corporation mission is “to help improve policy and decisionmaking through research and analysis.” In other words, it is a political organization. Importantly, it’s so-called “research” is funded from federal, state, and local government agencies provide the largest share of the funding; however, RAND also conducts projects for foundations, foreign governments, and private-sector firms. Contributions from individuals, charitable foundations, and private firms, as well as earnings from RAND’s endowment, offer a steadily growing pool of funds that allow RAND to address problems not yet on the policy agenda. As they say, they’re a “think tank.” They THINK they are doing research, I guess.

Here’s the “highlights.” Big “studies”, you see, need highlights. (Other more politically-minded individuals would call them “talking points,” but I digress.) If one reads these highlights, we note that there is no “Limitations” section, a standard section of any reasonable research study that mentions reasons why a study’s conclusions might not be valid. Nope. These conclusions are absolutes.

And I’m still looking for the funding “disclosures.” Can anybody tell me who funded this particular “study?”

But a little digging and we find these “methods:”

The RAND team drew upon data from a number of sources, including surveys, publications, interviews, and an expert-panel review. The team also analyzed the costs and benefits of information technology in other industries, paying special attention to the factors that enable such technology to succeed. The team then prepared mathematical models to estimate the costs and benefits of HIT implementation in healthcare.

Wow. Talk about a mish mash of data! I really have no worries now! Forget bias. Forget objectivity. Just throw everything in to a pot and, voilà, $77 billions of savings!

But it doesn’t stop there. It seems much of the basis of this data came from “gray literature” (their words, not mine) defined as “the body of reports and studies produced by local government agencies, private organizations, and educational facilities that have not been reviewed and published in journals or other standard research publications.” Most of us would call these “white papers” produced by industry, but when their blended with one’s own politically- or industry-supported research and cost savings are extrapolated to make a political point, the papers become “gray.”

Recently, there has been a flood of “investigations” in to conflicts of interest between researchers, their academic institutions, and the medical device and pharmaceutical industries by Congress. But I find these supposedly “independent non-profit organizations,” funded by industry members of the insurance, information technology and pharmaceutical industry including Unitedhealth, Wellcare, Aetna, Blue Cross of California, Genentech, Amgen, and Intel (to name just a few) more insidious and covert. They promulgate messages that are not peer-reviewed, but peer-pressed into the media, government, and create policy decisions that we assume (naively) are unbiased and truthful.


Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005. He writes regularly at Dr. Wes. DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.

This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.