Adoption Of Health Information Technology Research Articles

Health information technology adoption in New Zealand optometric practices

BackgroundHealth information technology (HIT) has the potential to fundamentally change the practice of optometry and the relationship between optometrists and patients and to improve clinical outcomes. This paper aims to provide data on how health information technology is currently being used in New Zealand optometric practices. Also this paper aims to explore the potential benefits and barriers to the future adoption of health information technology in New Zealand.MethodsOne hundred and six New Zealand optometrists were surveyed about their current use of health information technology and about potential benefits and barriers. In addition, 12 semi‐structured interviews were carried out with leaders of health information technology in New Zealand optometry. The areas of interest were the current and intended use of HIT, the potential benefits of and barriers to using HIT in optometric offices and the level of investment in health information technology.ResultsNearly all optometrists (98.7 per cent) in New Zealand use computers in their practices and 93.4 per cent of them use a computer in their consulting room. The most commonly used clinical assessment technology in optometric practices in New Zealand was automated perimeter (97.1 per cent), followed by a digital fundus/retinal camera (82.6 per cent) and automated lensometer (62.9 per cent). The pachymeter is the technology that most respondents intended to purchase in the next one to five years (42.6 per cent), followed by a scanning laser ophthalmoscope (36.8 per cent) and corneal topographer (32.9 per cent). The main benefits of using health information technology in optometric practices were improving patient perceptions of ‘state of the art’ practice and providing patients with information and digital images to explain the results of assessment. Barriers to the adoption of HIT included the need for frequent technology upgrades, cost, lack of time for implementation, and training.ConclusionsNew Zealand optometrists are using HIT broadly in their practices and expect HIT use to increase over time.

A Call for Standardized Metrics to Assess Health IT Impact on Medication Safety

To the Editor: It has been repeatedly affirmed that increased technology use in health care is a cost-effective means of providing higher quality patient care. One main driver for expanded health information technology (IT) is the belief that it increases the safety of the medication use process. Through the use of substantial public and private investment, particularly the Health Information Technology for Economic and Clinical Health (HITECH) Act, as part of the 2009 Recovery Act, which amounted to $25.9 billion, this viewpoint has been validated.1 Furthermore, a 2011 American Society of Health-System Pharmacists (ASHP) national survey of hospital pharmacy practice that focused on technology utilization related to medication dispensing and administration found an increase in the level of adoption of various technologies such as computerized prescriber order entry (CPOE), barcode medication administration (BCMA), and smart infusion pumps.2 Health system administrators are left to devise their own metrics to determine whether their investment in such technologies is money well spent. We recently conducted a review of the literature to analyze whether there was any uniformity among health systems in choosing appropriate metrics to assess the impact of health IT implementation on medication safety-related outcomes. Using predetermined PubMed search criteria, we evaluated 43 articles, and, as expected, we observed broad diversity with 34 different metrics identified. About 59% of these metrics were utilized in just 2 or fewer articles, further emphasizing the variance observed in the literature review. The measurement of voluntarily reported medication errors was most commonly utilized, but this metric is inherently unreliable due to the difficulty in quantifying and qualifying such errors. Many confounding factors exist, and literature suggests that some types of health IT may introduce new errors, all leading to concerns whether this particular metric is the most accurate to use. Overall, our research suggests a lack of concordance as to how best to measure the impact of health IT on medication safety. What can be done to create a safer and more accurate method for assessing medication safety? The Institute of Medicine (IOM) has previously called for a uniform standard of metrics that would more easily determine the effectiveness of health IT on medication safety outcomes. In a November 2011 report titled Health IT and Patient Safety: Building Safer Systems for Better Care, the agency called on the Department of Health and Human Services (HHS) to promote the “development of new measures for reliably assessing the current state of health IT safety and monitoring for improvements.”3 The IOM urged HHS to “fund a new Health IT Safety Council, within an existing voluntary consensus standards organization.”3 The purpose of this council would be to develop criteria to judge the safe use of health IT and to evaluate how it is used to enhance safety.3 To date, this council has not yet been formed. Although there have been increments of advancement in the development of standards in measuring the impact of health IT on medication safety, it is clear there is more to accomplish in developing a framework by which such implementation can be assessed. A consensus of all major health care stakeholders is needed to create a uniform method to assess how health IT is impacting safety. Ultimately, there should be further development of validated metrics that more clearly demonstrate whether the adoption of health IT, which can cost millions of dollars, is cost-effective and is indeed improving the safety of the medication-use process.

The use and role of open source software applications in public and not-for-profit hospitals in the United States

The potential cost savings and customizability of open source software (OSS) may be particularly attractive for hospitals. However, numerous health-care-specific OSS applications exist, the adoption of OSS health information technology (HIT) applications is not widespread in the United States. This disconnect between the availability of promising software and low adoption raises the basic question: If OSS HIT is so advantageous, why are more health care organizations not using it? We interviewed the chief information officer, or equivalent position, at 17 not-for-profit and public hospitals across the United States. Through targeted recruitment, our sample included nine hospitals using OSS HIT and eight hospitals not using OSS HIT. The open-ended interview questions were guided by domains included in the fit-viability theory, an organizational-level innovation adoption framework, and those suggested by a review of the literature. Transcripts were analyzed using an inductive and comparative approach, which involved an open coding for relevant themes. Interviews described the state of OSS use in hospitals. Specifically, general OSS applications were widely used by IT professionals. In addition, hospitals using OSS HIT still relied heavily on vendor support. In terms of why decisions arose to use OSS HIT, several hospitals using OSS HIT noted the cost advantages. In contrast, hospitals avoiding OSS HIT were clear, OSS as a class did not fit with clinical work and posed too much risk. Perceptions of OSS HIT ranged from enthusiastic embracement to resigned adoption, to refusal, to abandonment. Some organizations were achieving success with their OSS HIT choices, but they still relied on vendors for significant support. The decision to adopt OSS HIT was not uniform but contingent upon views of the risk posed by the technology, economic factors, and the hospital's existing capabilities.

Diagnostic Reasoning and Decision Making in the Context of Health Information Technology

Diagnostic reasoning and medical decision making have been focal areas of research in the fields of medical education, cognition, and artificial intelligence in medicine. Drawing on several decades worth of research, we propose an integrated summary of prior research on diagnostic reasoning and decision making—in terms of both historical development and theoretical shifts. We also characterize the changes in research and theory resulting from the incorporation and adoption of health information technology in the clinical work place. In this paper, we differentiate between the various forms of diagnostic reasoning and trace the evolution of the various models of reasoning, including knowledge-based, exemplar-based, and visual strategies. We also discuss the effect of clinical expertise on reasoning processes. Within the medical decision-making research, we delineate the various approaches highlighting decision-making errors that arise due to the nature of heuristics and biases and other factors. Although there has been significant progress in our understanding, there is still a need for greater theoretical integration of disparate empirical phenomena. Specifically, there is a need to reconcile the various characterizations of reasoning and to evaluate the similarity and differences in the context of current health care practice. Finally, we discuss the role of human factors research in the study of clinical environments and also in relation to devising approaches and methodologies for understanding, evaluating, and supporting the diagnostic reasoning and decision processes.

“Willing but Unwilling”: Attitudinal barriers to adoption of home-based health information technology among older adults

While much research focuses on adoption of electronic health-care records and other information technology among health-care providers, less research explores patient attitudes. This qualitative study examines barriers to adoption of home-based health information technology, particularly personal electronic health records, among older adults. We conducted in-depth interviews (30-90 min duration) with 35 American adults, aged 46-72 years, to determine their perceptions of and attitudes toward home-based health information technology. Analysis of interview data revealed that most barriers to adoption fell under four themes: technological discomfort, privacy or security concerns, lack of relative advantage, and perceived distance from the user representation. Based on our findings, systems to promote home-based health information technology should incorporate familiar computer applications, alleviate privacy and security concerns, and align with older adults' active and engaged self-image.

Back to School: TIGER and the VLE. Why Faculty Need to Access This Site

world of health care is becoming more dependent on health information technology (HIT) tools. Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009 was designed to promote and expand the adoption of health information technologies. One component focused on ensuring that all health care entities adopt interoperable electronic health care records (EHRs), and criteria were established to ensure that all health care providers would become meaningful users of EHRs and other HIT tools. These meaningful use criteria are tied to national patient safety and quality initiatives and progress across three stages. At each stage, the hospital, clinic, or private physician office must demonstrate how criteria were met by generating and sending reports, exchanging data electronically, or by attestation. With each stage, additional criteria are required to maximize the use of EHRs for the provision of efficient, effective, safe, and quality care. criteria also focus on the engagement of patients and consumers in their health care. As meaningful use progresses through each stage, the goal is for more patients to have the ability to access and read their EHRs while also adding data they generate, such as daily glucose readings. In tandem with federal initiatives, the competencies expected for nursing students at all levels now include information management and informatics outcomes. QSEN initiative (Cronenwett, Sherwood, & Gelmon, 2009), the American Association of Colleges of Nursing Essentials (2008), and the National League for Nursing's outcomes and competencies framework (2010) emphasize the importance of the integration of informatics competencies. But do we have a cadre of nurse faculty who are knowledgeable about informatics who can begin to integrate content into the nursing curriculum to meet these outcome competencies? My sense, from talking with faculty across the United States, is that many schools of nursing are struggling. Many do not have resources to help faculty integrate informatics into the curriculum. In my view, informatics must be woven into the curriculum. Having a separate course will not foster the concept of informatics as an integral and essential component of the health care system and the entire health care experience. What options do schools of nursing have? One new option is now available from the TIGER (Technology Informatics Guiding Educational Reform) initiative. As many of you know, TIGER was a grassroots movement started in 2004 when the secretary of health and human services established the Office of the National Coordinator for Health Information Technology. first phase of TIGER culminated in an invitational summit in which leaders from specialty organizations came together to chart a short- and long-term vision of how we would prepare nurses to work in a consumer-centric information-technology-intensive health care environment. second phase focused on creating action plans. third phase of TIGER saw the creation of the TIGER Virtual Learning Environment (VLE), a web-based learning platform designed by an interprofessional health care team to provide access to knowledge about informatics and allow for interactions with the informatics community. As noted on the VLE webpage, The internet-based format provides convenience, flexibility, dynamic content and real-time accessibility to relevant information through webinars by industry experts, in-depth education sessions, demonstrations, smart rooms, simulations, white papers, and other communications. target audience is clinicians working in health care, faculty and students, administrators, and any health care professional who wants to learn and develop knowledge, skills, and awareness of technology and informatics. By increasing one's knowledge of HIT and informatics, a clinician can contribute to creating a safer, more effective, efficient, timely, patient-centered, and equitable health care system. …

Health Information Technology and Hospital Patient Safety: A Conceptual Model to Guide Research

The literature indicates that health information technology (IT) use may lead to some gains in the quality and safety of care in some situations but provides little insight into this variability in the results that has been found. The inconsistent findings point to the need for a conceptual model that will guide research in sorting out the complex relationships between health IT and the quality and safety of care. A conceptual model was developed that describes how specific health IT functions could affect different types of inpatient safety errors and that include contextual factors that influence successful health IT implementation. The model was applied to a readily available patient safety measure and nationwide data (2009 AHA Annual Survey Information Technology Supplement and 2009 Healthcare Cost and Utilization Project State Inpatient Databases). The model was difficult to operationalize because (1) available health IT adoption data did not characterize health IT features and extent of usage, and (2) patient safety measures did not elucidate the process failures leading to safety-related outcomes. The sample patient safety measure--Postoperative Physiologic and Metabolic Derangement Rate--was not significantly related to self-reported health IT capabilities when adjusted for hospital structural characteristics. These findings illustrate the critical need for collecting data that are germane to health IT and the possible mechanisms by which health IT may affect inpatient safety. Well-defined and sufficiently granular measures of provider's correct use of health IT functions, the contextual factors surrounding health IT use, and patient safety errors leading to health care-associated conditions are needed to illuminate the impact of health IT on patient safety.

The Association between Health Information Technology Adoption and Family Physicians’ Practice Patterns in Canada: Evidence from 2007 and 2010 National Physician Surveys

To describe the association between health information technology (HIT) adoption and family physicians' patient visit length in Canada after controlling for physician and practice characteristics. HIT adoption is defined in terms of four types of HIT usage: no HIT use (NO), basic HIT use without electronic medical record system (HIT), basic HIT use with electronic medical record (EMR) and advanced HIT use (EMR + HIT). The outcome variable is the average time spent on a patient visit (visit length). The data for this study came from the 2007 and 2010 National Physician Surveys. A log-linear model was used to analyze our visit length outcome. The average time worked per week was found to be in the neighbourhood of 36 hours in both 2007 and 2010, but users of EMR and EMR + HIT were undertaking fewer patient visits per week relative to NO users. Multivariable analysis showed that EMR and EMR + HIT were associated with longer average time spent per patient visit by about 7.7% (p<0.05) and 6.7% (p<0.01), respectively, compared to NO users in 2007. In 2010, EMR was not statistically significant and EMR + HIT was associated with a 4% (p<0.1) increased visit length. A variety of practice-related variables such as the mode of remuneration, work setting and interprofessional practice influenced visit length in the expected direction. Use of HIT is found to be associated with fewer patient visits and longer visit length among family physicians in Canada relative to NO users, but this association weakened in the multivariable analysis of 2010.

Health Information Technology: Are We Aware and Engaged?

Health Information Technology: Are We Aware and Engaged?

AAFP INTERVIEW WITH FARZAD MOSTASHARI, MD, MS, NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY

AAFP News Now recently sat down with Farzad Mostashari, MD, MS, head of the Office of the National Coordinator (ONC) for Health Information Technology (IT). This office is responsible for rolling out the various health IT incentives and penalties contained in the Health Information Technology for Economic and Clinical Health (HITECH) Act, which was enacted as part of the 2009 American Recovery and Reinvestment Act. Many physicians who have adopted health IT in the form of electronic health records (EHRs) have expressed disappointment with the technology as it currently exists, so we asked Mostashari some of the questions family physicians have been asking the AAFP.

Health information technology vendor selection strategies and total factor productivity

The aim of this study was to compare health information technology (HIT) adoption strategies' relative performance on hospital-level productivity measures. The American Hospital Association's Annual Survey and Healthcare Information and Management Systems Society Analytics for fiscal years 2002 through 2007 were used for this study. A two-stage approach is employed. First, a Malmquist model is specified to calculate hospital-level productivity measures. A logistic regression model is then estimated to compare the three HIT adoption strategies' relative performance on the newly constructed productivity measures. The HIT vendor selection strategy impacts the amount of technological change required of an organization but does not appear to have either a positive or adverse impact on technical efficiency or total factor productivity. The higher levels in technological change experienced by hospitals using the best of breed and best of suite HIT vendor selection strategies may have a more direct impact on the organization early on in the process. However, these gains did not appear to translate into either increased technical efficiency or total factor productivity during the period studied. Over a longer period, one HIT vendor selection strategy may yet prove to be more effective at improving efficiency and productivity.

Ten key considerations for the successful implementation and adoption of large-scale health information technology.

The implementation of health information technology interventions is at the forefront of most policy agendas internationally. However, such undertakings are often far from straightforward as they require complex strategic planning accompanying the systemic organizational changes associated with such programs. Building on our experiences of designing and evaluating the implementation of large-scale health information technology interventions in the USA and the UK, we highlight key lessons learned in the hope of informing the on-going international efforts of policymakers, health directorates, healthcare management, and senior clinicians.

LTC Information-Technology Challenges Remain, But Experts Say to Get on Board

LTC Information-Technology Challenges Remain, But Experts Say to Get on Board

A qualitative study of health information technology in the Canadian public health system

BackgroundAlthough the adoption of health information technology (HIT) has advanced in Canada over the past decade, considerable challenges remain in supporting the development, broad adoption, and effective use of HIT in the public health system. Policy makers and practitioners have long recognized that improvements in HIT infrastructure are necessary to support effective and efficient public health practice. The objective of this study was to identify aspects of health information technology (HIT) policy related to public health in Canada that have succeeded, to identify remaining challenges, and to suggest future directions to improve the adoption and use of HIT in the public health system.MethodsA qualitative case study was performed with 24 key stakeholders representing national and provincial organizations responsible for establishing policy and strategic direction for health information technology.ResultsIdentified benefits of HIT in public health included improved communication among jurisdictions, increased awareness of the need for interoperable systems, and improvement in data standardization. Identified barriers included a lack of national vision and leadership, insufficient investment, and poor conceptualization of the priority areas for implementing HIT in public health.ConclusionsThe application of HIT in public health should focus on automating core processes and identifying innovative applications of HIT to advance public health outcomes. The Public Health Agency of Canada should develop the expertise to lead public health HIT policy and should establish a mechanism for coordinating public health stakeholder input on HIT policy.

Advancing the adoption, integration and testing of technological advancements within existing care systems

ObjectiveThis manuscript reviews the work on uptake and dissemination of health information technologies in mental health populations and settings, with the goal of informing the future research agenda. MethodsWe reviewed both the formal and “grey” literature describing the rates and correlates of uptake for electronic health records (EHRs) and personal health records (PHRs) for general and specialty mental health settings. ResultsRates of uptake and use of EHRs and PHRs are low in general medical settings, and the limited evidence suggests even lower rates for specialty mental health settings. Many of the patient, provider and system-level characteristics associated with lower rates of use in general populations would be expected to be exacerbated in mental health settings. ConclusionsThe findings suggest a need to better understand both the causes and strategies for overcoming barriers to uptake of health information technology (HIT) in mental health settings. Observational studies could help to better elucidate the barriers to adoption of HIT that are unique or disproportionate in mental health populations. Implementation science studies are needed to better identify strategies for addressing these barriers and optimizing uptake of mental health HIT interventions.

Gaining acceptance for anesthesia information management systems among anesthesiologists

To the Editor, I read with interest the recent review article by Stabile and Cooper that identifies the lack of clinician involvement in the implementation, planning, design, and installation of anesthesia information management systems (AIMS) as a barrier to the adoption of health information technology. Many challenges are associated with the implementation of new AIMS in the perioperative setting, including the perception that workload will increase or autonomy will decrease. Even if AIMS use were mandated and early acceptance occur, the negative consequences of resistance may surface over the long term if the information system were viewed as prone to error or slow. Medical directors and anesthesiology department chiefs must actively manage the change process and gain physician acceptance for the new information system. Failure to gain acceptance of the AIMS may result in the unsuccessful launch of the system and huge financial losses. The Technology Acceptance Model, the most widely accepted method of adopting information technology, focuses on interventions taken by managers to change employees’ attitudes toward information technology. The model identifies two main factors that influence an individual’s intention to use information technology, namely, the extent to which the user believes that the information technology will enhance their job performance (perceived usefulness) and require little effort (perceived ease of use). Perceived usefulness is determined by social influence and system characteristics, and perceived ease of use is determined by facilitating factors, individual differences, and system characteristics. Social influence variables include the opinions about use of information technology from people who are important to the user (subjective norm) and the extent to which the user’s standing among their peers will be maintained or raised (image). System characteristics are defined by the degree to which the user thinks the information technology is important to their work (job relevance), effective (output quality), able to deliver results that are easy to observe and share (result demonstrability), enjoyable (perceived enjoyment), and matches their desired level of effort (objective usability). Facilitating factors refer to the user’s belief that the organization supports the information technology and has committed resources to maintain its operation (perception of external control). Individual differences are defined by the degree to which the user believes in their computer skills (computer self-efficacy), is apprehensive about using a computer (computer anxiety), and is motivated to use new technology (computer playfulness). Managers should take well-defined steps to target the determinants of perceived usefulness and perceived ease of use in order to improve the adoption of AIMS and influence acceptance of information systems among anesthesiologists.

Understanding Electronic Medical Record Adoption in the United States: Communication and Sociocultural Perspectives

BackgroundThis paper adopts a communication and sociocultural perspective to analyze the factors behind the lag in electronic medical record (EMR) adoption in the United States. Much of the extant research on this topic has emphasized economic factors, particularly, lack of economic incentives, as the primary cause of the delay in EMR adoption. This prompted the Health Information Technology on Economic and Clinical Health Act that allow financial incentives through the Centers of Medicare and Medicaid Services for many health care organizations planning to adopt EMR. However, financial incentives alone have not solved the problem; many new innovations do not diffuse even when offered for free. Thus, this paper underlines the need to consider communication and sociocultural factors to develop a better understanding of the impediments of EMR adoption.ObjectiveThe objective of this paper was to develop a holistic understanding of EMR adoption by identifying and analyzing the impact of communication and sociocultural factors that operate at 3 levels: macro (environmental), meso (organizational), and micro (individual).MethodsWe use the systems approach to focus on the 3 levels (macro, meso, and micro) and developed propositions at each level drawing on the communication and sociocultural perspectives.ResultsOur analysis resulted in 10 propositions that connect communication and sociocultural aspects with EMR adoption.ConclusionsThis paper brings perspectives from the social sciences that have largely been missing in the extant literature of health information technology (HIT) adoption. In doing so, it implies how communication and sociocultural factors may complement (and in some instances, reinforce) the impact of economic factors on HIT adoption.

Diabetes Prevention, Health Information Technology, and Meaningful Use

The U.S. health system has historically been poorly equipped to confront the growing impact of diabetes on the nation's health. The Affordable Care Act legislates a number of new strategies--such as innovative payment and delivery models and increased public health funding--intended to improve diabetes prevention and care quality. Health information technology (IT) is often cited as a critical part of these strategies. Through the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, the federal government has been supporting the rapid adoption of health IT, and more specifically of electronic health records (EHRs) through the Centers for Medicare and Medicaid Services (CMS) EHR Incentive Program. Health IT has the potential to contribute to diabetes prevention and improved quality of care, but the evidence supporting its benefits is mixed. This article provides a brief overview of the CMS EHR Incentive Program and meaningful-use criteria. Then it examines health IT strategies for diabetes prevention in the context of current evidence and identifies areas of needed research and innovation.

Transforming care delivery through health information technology.

The slow but progressive adoption of health information technology (IT) nationwide promises to usher in a new era in health care. Electronic health record systems provide a complete patient record at the point of care and can help to alleviate some of the challenges of a fragmented delivery system, such as drug-drug interactions. Moreover, health IT promotes evidence-based practice by identifying gaps in recommended treatment and providing clinical decision-support tools. In addition, the data collected through digital records can be used to monitor patient outcomes and identify potential improvements in care protocols. Kaiser Permanente continues to advance its capability in each of these areas.

When does adoption of health information technology by physician practices lead to use by physicians within the practice?

We sought to determine the extent to which adoption of health information technology (HIT) by physician practices may differ from the extent of use by individual physicians, and to examine factors associated with adoption and use. Using cross-sectional survey data from the National Study of Small and Medium-Sized Physician Practices (July 2007-March 2009), we examined the extent to which organizational capabilities and external incentives were associated with the adoption of five key HIT functionalities by physician practices and with use of those functionalities by individual physicians. The rate of physician practices adopting any of the five HIT functionalities was 34.1%. When practices adopted HIT functionalities, on average, about one in seven physicians did not use those functionalities. One physician in five did not use prompts and reminders following adoption by their practice. After controlling for other factors, both adoption of HIT by practices and use of HIT by individual physicians were higher in primary care practices and larger practices. Practices reporting an emphasis on patient-centered management were not more likely than others to adopt, but their physicians were more likely to use HIT. Larger practices were most likely to have adopted HIT, but other factors, including specialty mix and self-reported patient-centered management, had a stronger influence on the use of HIT once adopted. Adoption of HIT by practices does not mean that physicians will use the HIT.