Unintended consequences of health information technology: Evidence from Veterans Affairs Colorectal Cancer Oncology Watch Intervention.

Abstract

6044 Background: Although health information technology (HIT) has been hypothesized to help achieve greater adherence to recommended clinical guidelines and increase use of preventive care, well-conducted empirical studies evaluating this hypothesis are lacking. This study evaluated the ongoing Colorectal Cancer (CRC) Oncology Watch intervention, a clinical reminder system, implemented in 8 Veterans Affairs (VA) hospitals in 2008 for improving CRC (1) screening adherence among average- or higher-risk veterans, and (2) surveillance. Methods: VA administrative data were used to construct 4 cross-sectional groups of average-risk age 50-64 veterans, one for each of 2006, 2007, 2009, and 2010. We applied a linear probability model with hospital fixed-effects for estimation, using a natural experiment in which the 8 hospitals served as the intervention and other 121 hospitals as a control and with 2006-2007 designated as the pre-intervention period and 2009-2010 as the post-intervention period. Results: The sample included 4,352,082 veteran-years in 4 years. The proportions adherent to screening were 37.6%, 31.6%, 34.4%, and 33.2% in the intervention in 2006, 2007, 2009, and 2010, respectively, and the corresponding proportions in the control were 31.0%, 30.3%, 32.3%, and 30.9%. Regression analysis showed that among those eligible for screening, the intervention was associated with a 2.2-percentage-point decrease in likelihood of adherence (P-value<0.0001). Additional analyses showed that the intervention was associated with a 5.6-percentage-point decrease in likelihood of screening by colonoscopy among the adherent, but with increased total colonoscopies (any indication) of 3.6 per 100 veterans age 50-64. Conclusions: The intervention may have slightly reduced CRC screening rates for the studied population. This consequence may have been caused by an unintentional shift of limited VA colonoscopy capacity from average-risk screening to higher-risk screening and to CRC surveillance, or by physicians’ fatigue due to the large number of clinical reminders implemented in the VA.