The broad use of information technology (IT) has been touted as key to improving the efficiency of healthcare treatment and delivery, and thus reducing costs. And so IT-enabled diabetes management (ITDM) for patients should improve care processes, cut cost and delay Type-2 diabetes complications.
That's what a report titled "The Value of Information Technology-Enabled Diabetes Management" [ITDM] by the Center for Information Technology Leadership (CITL: Boston) confirms.
Well, sort of.
The answer isn't as clear cut as a simple yes or no.
Before researchers can stand firmly on a solid answer, ITDMs and the market for these devices — which include electronic diabetes registries — has to play "catch up" and provide much lower-cost products, according to the CITL report, just released
"The use of these technologies is in the minority right now," Eric Pan, MD, a senior scientist and director at CITL, told Medical Device Daily. "As more people use them and the devices become more available and the market is able to manufacture more of the devices, more people can benefit. What we can see from technology used five years ago is very promising."
The report is based largely on projections by means of a computer-based model that simulated the outcomes for Type-2 diabetes patients in a diabetes management program over 10 years, along with literature reviews, assessments by experts and other market research.
Of existing technologies, electronic diabetes registries used by providers, followed by clinical decision support systems (CDSS) for providers, were projected as showing the greatest improvement in clinical outcomes.
While CITL found that all forms of ITDM improved the health of patients with diabetes and reduced healthcare expenditures, during a 10-year period, electronic diabetes registries saved the most, about $14.5 billion.
Other technologies had varying degrees of savings, from hundreds of thousands to several billion dollars.
But the report came with a large proviso: Given the current costs of IT systems, national adoption of ITDM would cost more than it saves.
Pan described the current ITDM market to be akin to the laptop environment 10 to 15 years ago.
"Back then one laptop would consume my entire department's budget," he said. "Now I have three on my desk now – they're more affordable."
Thus, he said that it will take a few years to provide actual figures concerning IT costs and the resultant savings with ITDMs.
"Unfortunately we certainly couldn't say [now] that ITDMs would be five or 10 times cheaper," he told MDD.
The report tended to be more certain about the clinical benefits of ITDMs, whatever the costs.
Diabetes management is currently a self-management game and thus results in fairly poor compliance.
CITL's analysis shows that ITDM can improve compliance with standards of care, from the current rate of less than 50% to as high as 80%. As a result, millions of cases of diabetes complications, such as kidney failure, stroke, heart attacks, and blindness, can be avoided, and hundreds of thousands of lives could be saved.
Another conclusion to be drawn from CITL's report is that payers, especially Medicare, stand to benefit the most from ITDM since they bear the most financial risk.
CITL said that "misaligned incentives," such as episodePage-based payment systems for providers, may cause the market to under-utilize provider-based forms of ITDM, though these ironically may be the most cost-beneficial approaches of all.
"Adoption of ITDM is in its early stages, and the evidence of impact in this space is starting to be realized, said Blackford Middleton, MD, chairman of CITL. "At this point, our research suggests that diabetes registries are a clear win for patients, and they give providers the groundwork for expanded use of IT in their practices."
He continued: "Our research also suggests that costs are a major factor in realizing value from ITDM, and that we need to find the means to lower the costs of these IT-enabled interventions. Ultimately, getting the most value from ITDM will require the coordination of provider, payer, and patient-based initiatives … and alignment of financial incentives will be key in this equation."
The report, which took two years to complete, was funded through a Robert Wood Johnson Foundation (Princeton, New Jersey) grant and supported by the Healthcare Information and Management Systems Society (Chicago, Illinois).
DCITL previously has published reports on the value of computerized provider orde entry in ambulatory care and the value of standardized national healthcare information exchange and interoperability.
"We have several related studies that are coming up," Pan said. "It seems like a natural area for us to [research] given our position" on information technology-enabled diabetes management."
CITL was chartered in 2002 by Partners HealthCare Systems (Boston), a non-profit organization, and charged with developing research to assess the value of IT in the healthcare mix.