Incongruent Needs: Why Differences in the Iron-Triangle of Priorities Make Health Information Technology Adoption and Use Difficult

Incongruent Needs: Why Differences in the Iron-Triangle of Priorities Make Health Information Technology Adoption and Use Difficult

Edward J. Cherian (George Washington University, USA) and Tom W. Ryan (George Washington University, USA)
DOI: 10.4018/978-1-4666-4321-5.ch012


Health Information Technology (HIT) has the potential to redefine the confines of traditional medicine. Yet, in over a decade, little has been shown in improvements from HIT investments. In order to understand the failures of health IT policy, this chapter examines the diverse priorities of stakeholders in the health system. Using kiviat diagrams as adaptations of the traditional iron-triangle of tradeoffs, the priorities of four stakeholder groups (patients, providers, pharmaceuticals, and payers) are mapped against the priorities of government and public health. The chapter finds that the priorities of these stakeholders within the United States healthcare system are incongruent and in conflict. To better understand the HIT needs of the future, policy makers and public health officials must understand these dichotomous priorities and work to bring them in line.
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The Iron Triangle And Hit’S Promise

Within the public health field, policy analysts refer to an iron triangle of trade-offs that confines medicine’s ability to provide the low cost, high quality treatment to a large number of patients. William Kissick’s Medicine’s Dilemmas: Infinite Needs Versus Finite Resources (1994) introduces this idea, noting that when a health care system is in equilibrium, better performance of the health care system within one of the three dimensions (cost-containment, quality, and accessibility of care) can cause decreased performance in one or both of the other dimensions. Cost-containment, quality, and access are in constant conflict, and an increase in one must be offset by the reduction of the other two. For example, increases in quality would be offset by either a decrease in accessibility or an increase in cost.

Kissick did, however, note in some instances, these tradeoffs between cost-containment, quality, and accessibility of care are not always required, and health information technology may be one such occasion. Donald Berwick, former Administrator of the Centers for Medicare and Medicaid Services, echoes these sentiments that the iron-triangle may be expanded, recently noting that at least twenty percent of United States healthcare spending is “waste” in that it provides no value to the patient or system (Birnbaum, 2012, p. 719). He lists five reasons for waste, three of which HIT can meet head on: “overtreatment of patients, the failure to coordinate care, [and] the administrative complexity of the health care system” (Pear, 2011). Berwick argues that this wasteful spending prevents investment in those areas that improve patients’ health, decreasing the quality of healthcare all while keeping costs high (Birnbaum, 2012, pp. 719-720). Taken together, HIT has the potential to answer Berwick’s call for improvements in patient care through reduction of waste, breaking from the confines of Kissick’s iron-triangle by saving the United States billions in health care costs all while improving patient health and access to care.

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