The Impact of Electronic Integration on Quality of Care: Evaluation of an Integrated Prescription and Drug Management System

Abstract

Fragmentation of service delivery across the continuum of care among primary care physicians, specialists, and hospitals remains one of the main challenges in delivering quality care to patients in North America. This fragmentation leads to a lack of continuity in the care, and results in lower quality of care. Information technology (IT) is often seen as a solution to this challenge of fragmentation in care delivery. In this paper, we study the impact of electronically integrating primary care physicians, specialists, hospitals, and pharmacists, on the quality of care delivered to patients. Conceptualizing electronic integration (EI) as a mechanism that facilitates coordination among health care specialists, we hypothesize that an electronically integrated prescription, drug, and disease management system will have both a direct and an indirect effect on quality of care. First, drawing on theories of information processing, we suggest that electronic integration will improve quality of care directly, because by increasing interdependence, it provides more information for physicians who are then able to detect and manage health problems early on in the care cycle, thereby reducing the effects of care fragmentation. Second, using concepts of coordination, we suggest that electronic integration will impact quality of care indirectly, by improving relational and management continuity of care, through the coordination of care management plans and through improved physician access to patient health history, patient visit patterns, and patient drug interaction information. Based on data from before and after electronic integration, from a matched set of 15,626 patients with electronic integration and 15, 626 patients in a control group, who visited over 95 physicians in a large North American health network, we test these hypotheses for the direct and indirect effects of electronic integration on patient quality of care. The results support our hypotheses and indicate that patients treated through the electronically integrated system had better quality of care in the follow-up period and a higher continuity of care, compared to the control group.