APPENDIX 2
Ben ef i ts Mo d el Limitations of the RAND Study • The RAND study has certain limitations that were considered and addressed: 1. The study was not intended to be an estimate of savings measured against the total rates of adoption, but rather against the level of adoption relative to a 2004 baseline. 2. It measures the potential impact of widespread adoption of health IT assuming the occurrence of “appropriate changes in health care” rather than the likely impact. This limitation deliberately does not consider present-day payment incentives that would constrain the effective utilization of health IT, even if the technology was widely adopted. 3. In several specific parts of the RAND analysis, the savings that would accrue from the widespread adoption of health IT appear to be overstated8. • Each of RAND’s9 model framework/methodology was modified and enhanced. • The clinical information system benefits estimation study developed by McKinsey and Company was leveraged to pressure test the reasonability of the patient outcomes benefits generated by our adapted, enhanced and refreshed Model 1.
8.
9.
The U.S. Congressional Budget Office indicated that the RAND analysis was based on empirical studies from the literature that found positive effects for the implementation of health IT systems; it excluded the studies, even those published in peer reviewed journals, that failed to find favorable results. This biases the estimate of the actual impact of health IT on spending. The majority of evidence was collected from the peer-reviewed literature. The primary search of the peer-reviewed literature was limited to articles published in the years 1995 through 2004. In total, 1,418 articles were screened using the short form, and 202 articles were coded according to taxonomies, yielding 581 preliminary findings, of which 42 were ultimately included in the models.
