Sometimes ideas for academic research can come from the unlikeliest of places. Like out of your earbuds.
Hilal Atasoy, assistant professor in the Department of Accounting at the Fox School, was hardly expecting to discover a subject that would lead to years of study while listening to a podcast, but that is exactly what happened.
“I was listening to a story about a cancer patient,” says Atasoy. In addition to being physically and emotionally difficult, having cancer can be costly. The patient explained that during her treatment she had moved and had to change hospitals and doctors several times because of her relocation and other reasons.
“She was saying how difficult it was to keep transferring her tests, results, procedures, and other records. She had to go through this ordeal again and again,” recalls Atasoy. Finally, the patient landed at a hospital with a good electronic health records (EHR) system, and she didn’t need to go to any extra trouble or expense anymore.
That got Atasoy thinking. Since the HITECH Act of 2009 made the migration of patient information from paper files to electronic health records mandatory, many studies have investigated whether this shift actually benefits hospitals, as electronic health records systems are costly to implement.
The results of previous research, particularly around healthcare costs, have been inconclusive. Studies point to the likelihood that costs actually go up—not down—as electronic health records systems are put into practice, at least for the individual hospital in question. But Atasoy’s research looks beyond the adopting hospital to the region surrounding it. “The question we’re asking in the study is whether the impacts of the electronic health records go beyond the adopting hospital.”
It’s common for someone to have a dermatologist at one hospital, get a mammogram at a different hospital, and see a primary care doctor affiliated with a yet a third institution, especially if that person lives in a city. When you factor in the costs at not only the individual hospital that adopted EHRs but also the costs at surrounding hospitals where there are shared patients, Atasoy has found that there is a marked cost-saving benefit after all. Estimates suggest that if one hospital in each area adopts an EHR system, it would add up to a net reduction of $18 billion in healthcare costs nationwide.
To conduct her research, Atasoy relied on several data sets. “We tracked information about the adoption of electronic health records systems at almost all the hospitals in the U.S. from 1998 to 2012,” she says. She also used Medicare data, census data, and HIMSS data (a dataset that comprises information about EHR use across the country). Atasoy and her team used statistical analysis software to interpret the numbers and come to their conclusions about the costs and benefits of EHR beyond the walls of any one hospital. Her research was published last year in the journal Management Science.
Atasoy notes that implications for her research extend beyond the healthcare sector. “It shows the importance of connections across different organizations. Businesses might be connected, for example, through shared customers,” she says. “Obviously, the firms are focused on their customers and their purchases and all the information they have on their customers right within their business, but there are many organizations that share customers or share suppliers. They have these connections.”
Her work on hospital-level data led into her current research, which focuses on patient-level data and seeks to identify the cost and quality of care benefits that could come with the widespread sharing of EHR between health institutions. “We’ve learned that only 20 percent of doctors use electronic health records, and what we’ve seen suggests that there are significant benefits to patients when doctors do use them,” says Atasoy. This seems to be especially true for patients living with chronic conditions such as cancer, diabetes, or heart disease.
Atasoy hopes her research will help spark a discussion about the value of hassle-free information reciprocity at hospitals, something that, on a policy level, she believes needs to be incentivized. Just as she began to look at the bigger picture, viewing hospitals regionally as a group and not individually, viewing a patient’s multi-year health journey and not just a single procedure, she hopes hospital administrators will zoom out, too.
“One big problem with healthcare in the United States is that it’s very fragmented,” says Atasoy. Her work reveals that a hospital isn’t an island and that the free flow of information will ultimately benefit everyone’s bottom line.
This story was originally published in On the Verge, the Fox School’s flagship research magazine. For more stories, visit www.fox.temple.edu/ontheverge.