Integrated Health Information Technology and the Quality of Patient Care: A Natural Experiment

Abstract

Fragmentation of care delivery remains one of the main challenges of healthcare systems. In this study, we examine health information technology (HIT) that is electronically integrated across care physicians, specialists, hospitals, and pharmacists and its impact on quality of care. Drawing on the structure–process–outcome framework, we hypothesize that integrated HIT will have both a direct and an indirect effect on quality of care. By providing more complete information to physicians and allowing them to detect and manage health problems early in the care cycle, integrated HIT is expected to directly improve quality of care. Integrated HIT is also hypothesized to improve quality of care indirectly by increasing continuity of care and reducing the odds of therapeutic errors. We test these hypotheses through a contemporaneous natural experiment of a matched set of 15,626 outpatients receiving ambulatory care through an integrated HIT system and 15,626 outpatients in a control group. The results show that the patients treated with the integrated system had better quality of care in the follow-up period than patients of the control group. Integrated HIT also had an indirect effect on quality of care through an increase in continuity of care. Our study contributes to research by examining how an integrated HIT system—rather than specific HIT components—influences patient-related outcomes, and how this effect is mediated by two key processes: continuity of care and therapeutic duplication errors. Our work also helps decision makers to better understand the impact of HIT in a complex and highly decentralized and fragmented care delivery system.