Abstract
BackgroundThe benefits from the combination of 4 clinical information systems (CISs)—electronic health records (EHRs), health information exchange (HIE), personal health records (PHRs), and telehealth—in primary care depend on the configuration of their functional capabilities available to clinicians. However, our empirical knowledge of these configurations and their associated performance implications is very limited because they have mostly been studied in isolation.ObjectiveThis study aims to pursue 3 objectives: (1) characterize general practitioners (GPs) by uncovering the typical profiles of combinations of 4 major CIS capabilities, (2) identify physician and practice characteristics that predict cluster membership, and (3) assess the variation in the levels of performance associated with each configuration.MethodsWe used data from a survey of GPs conducted throughout the European Union (N=5793). First, 4 factors, that is, EHRs, HIE, PHRs, and Telehealth, were created. Second, a cluster analysis helps uncover clusters of GPs based on the 4 factors. Third, we compared the clusters according to five performance outcomes using an analysis of variance (ANOVA) and a Tamhane T2 post hoc test. Fourth, univariate and multivariate multinomial logistic regressions were used to identify predictors of the clusters. Finally, with a multivariate multinomial logistic regression, among the clusters, we compared performance in terms of the number of patients treated (3 levels) over the last 2 years.ResultsWe unveiled 3 clusters of GPs with different levels of CIS capability profiles: strong (1956/5793, 37.36%), medium (2764/5793, 47.71%), and weak (524/5793, 9.04%). The logistic regression analysis indicates that physicians (younger, female, and less experienced) and practice (solo) characteristics are significantly associated with a weak profile. The ANOVAs revealed a strong cluster associated with significantly high practice performance outcomes in terms of the quality of care, efficiency, productivity, and improvement of working processes, and two noncomprehensive medium and weak profiles associated with medium (equifinal) practice performance outcomes. The logistic regression analysis also revealed that physicians in the weak profile are associated with a decrease in the number of patients treated over the last 2 years.ConclusionsDifferent CIS capability profiles may lead to similar equifinal performance outcomes. This underlines the importance of looking beyond the adoption of 1 CIS capability versus a cluster of capabilities when studying CISs. GPs in the strong cluster exhibit a comprehensive CIS capability profile and outperform the other two clusters with noncomprehensive profiles, leading to significantly high performance in terms of the quality of care provided to patients, efficiency of the practice, productivity of the practice, and improvement of working processes. Our findings indicate that medical practices should develop high capabilities in all 4 CISs if they have to maximize their performance outcomes because efforts to develop high capabilities selectively may only be in vain.
Highlights
BackgroundOver the past several years, a consensus has emerged on the recognition of the potential of clinical information systems (CISs) to improve the health care delivered to patients and save lives [1,2].Electronic health records (EHRs) are at the heart of the reform of health systems in many developed countries [3] as well as middle-income countries such as Brazil [4] or India [5]
Different CIS capability profiles may lead to similar equifinal performance outcomes
general practitioners (GPs) in the strong cluster exhibit a comprehensive CIS capability profile and outperform the other two clusters with noncomprehensive profiles, leading to significantly high performance in terms of the quality of care provided to patients, efficiency of the practice, productivity of the practice, and improvement of working processes
Summary
BackgroundOver the past several years, a consensus has emerged on the recognition of the potential of clinical information systems (CISs) to improve the health care delivered to patients and save lives [1,2].Electronic health records (EHRs) are at the heart of the reform of health systems in many developed countries [3] as well as middle-income countries such as Brazil [4] or India [5]. An EHR can be defined as “an electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards, and that can be created, managed, and consulted by authorized clinicians and staff across more than one healthcare organization” [6]. EHRs can assist clinicians to improve the care provided to patients by promoting adherence to guidelines [8], improving medical practice management, saving time, and facilitating condition-specific queries, to name a few [9]. The benefits from the combination of 4 clinical information systems (CISs)—electronic health records (EHRs), health information exchange (HIE), personal health records (PHRs), and telehealth—in primary care depend on the configuration of their functional capabilities available to clinicians. Our empirical knowledge of these configurations and their associated performance implications is very limited because they have mostly been studied in isolation
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