Adoption Of Health Information Technology Research Articles

Anticipating mismatches of HIT investments: Developing a viability-fit model for e-health services

ObjectivesAlbeit massive investments in the recent years, the impact of health information technology (HIT) has been controversial and strongly disputed by both research and practice. While many studies are concerned with the development of new or the refinement of existing measurement models for assessing the impact of HIT adoption (ex post), this study presents an initial attempt to better understand the factors affecting viability and fit of HIT and thereby underscores the importance of also having instruments for managing expectations (ex ante). MethodsWe extend prior research by undertaking a more granular investigation into the theoretical assumptions of viability and fit constructs. In doing so, we use a mixed-methods approach, conducting qualitative focus group discussions and a quantitative field study to improve and validate a viability-fit measurement instrument. ResultsOur findings suggest two issues for research and practice. First, the results indicate that different stakeholders perceive HIT viability and fit of the same e-health services very unequally. Second, the analysis also demonstrates that there can be a great discrepancy between the organizational viability and individual fit of a particular e-health service. ConclusionThe findings of this study have a number of important implications such as for health policy making, HIT portfolios, and stakeholder communication.

Care Transitions in Long-term Care and Acute Care: Health Information Exchange and Readmission Rates

Care transitions between settings are a well-known cause of medical errors. A key component of transition is information exchange, especially in long-term care (LTC). However, LTC is behind other settings in adoption of health information technologies (HIT). In this article, we provide some brief background information about care transitions in LTC and concerns related to technology. We describe a pilot project using HIT and secure messaging in LTC to facilitate electronic information exchange during care transitions. Five LTC facilities were included, all located within Oklahoma and serviced by the same regional health system. The study duration was 20 months. Both inpatient readmission and return emergency department (ED) visit rates were lower than baseline following implementation. We provide discussion of positive outcomes, lessons learned, and limitations. Finally, we offer implications for practice and research for implementation of HIT and information exchange across care settings that may contribute to reduction in readmission rates in acute care and ED settings.

Accelerated Adoption of Advanced Health Information Technology in Beacon Community Health Centers.

To complement national and state-level HITECH Act programs, 17 Beacon communities were funded to fuel community-wide use of health information technology to improve quality. Health centers in Beacon communities received supplemental funding. This article explores the association between participation in the Beacon program and the adoption of electronic health records. Using the 2010-2012 Uniform Data System, trends in health information technology adoption among health centers located within and outside of Beacon communities were explored using differences in mean t tests and multivariate logistic regression. Electronic health record adoption was widespread and rapidly growing in all health centers, especially quality improvement functionalities: structured data capture, order and results management, and clinical decision support. Adoption lagged for functionalities supporting patient engagement, performance measurement, care coordination, and public health. The use of advanced functionalities such as care coordination grew faster in Beacon health centers, and Beacon health centers had 1.7 times higher odds of adopting health records with basic safety and quality functionalities in 2010-2012. Three factors likely underlie these findings: technical assistance, community-wide activation supporting health information exchange, and the layering of financial incentives. Additional technical assistance and community-wide activation is needed to support the use of functionalities that are currently lagging.

"You Get Reminded You're a Sick Person": Personal Data Tracking and Patients With Multiple Chronic Conditions.

BackgroundConsumer health information technologies (HIT) that encourage self-tracking, such as diet and fitness tracking apps and disease journals, are attracting widespread interest among technology-oriented consumers (such as “quantified self” advocates), entrepreneurs, and the health care industry. Such electronic technologies could potentially benefit the growing population of patients with multiple chronic conditions (MCC). However, MCC is predominantly a condition of the elderly and disproportionately affects the less affluent, so it also seems possible that the barriers to use of consumer HIT would be particularly severe for this patient population.ObjectiveOur aim was to explore the perspectives of individuals with MCC using a semistructured interview study. Our research questions were (1) How do individuals with MCC track their own health and medical data? and (2) How do patients and providers perceive and use patient-tracked data?MethodsWe used semistructured interviews with patients with multiple chronic diseases and providers with experience caring for such patients, as well as participation in a diabetes education group to triangulate emerging themes. Data were analyzed using grounded theory and thematic analysis. Recruitment and analysis took place iteratively until thematic saturation was reached.ResultsInterviews were conducted with 22 patients and 7 health care providers. The patients had an average of 3.5 chronic conditions, including type 2 diabetes, heart disease, chronic pain, and depression, and had regular relationships with an average of 5 providers. Four major themes arose from the interviews: (1) tracking this data feels like work for many patients, (2) personal medical data for individuals with chronic conditions are not simply objective facts, but instead provoke strong positive and negative emotions, value judgments, and diverse interpretations, (3) patients track for different purposes, ranging from sense-making to self-management to reporting to the doctor, and (4) patients often notice that physicians trust technologically measured data such as lab reports over patients’ self-tracked data.ConclusionsDevelopers of consumer health information technologies for data tracking (such as diet and exercise apps or blood glucose logs) often assume patients have unlimited enthusiasm for tracking their own health data via technology. However, our findings potentially explain relatively low adoption of consumer HIT, as they suggest that patients with multiple chronic illnesses consider it work to track their own data, that the data can be emotionally charged, and that they may perceive that providers do not welcome it. Similar themes have been found in some individual chronic diseases but appeared more complex because patients often encountered “illness work” connected to multiple diseases simultaneously and frequently faced additional challenges from aging or difficult comorbidities such as chronic pain, depression, and anxiety. We suggest that to make a public health impact, consumer HIT developers should engage creatively with these pragmatic and emotional issues to reach an audience that is broader than technologically sophisticated early adopters. Novel technologies are likely to be successful only if they clearly reduce patient inconvenience and burden, helping them to accomplish their “illness work” more efficiently and effectively.

Undirected health IT implementation in ambulatory care favors paper-based workarounds and limits health data exchange

BackgroundThe adoption and use of health information technology (IT) continues to grow around the globe. In Switzerland, the government nor professional associations have to this day provided incentives for health IT adoption. ObjectiveWe aim to assess the proportion of physicians who are routinely working with electronic health data and describe to what extent physicians exchange electronic health data with peers and other health care providers. Additionally, we aim to estimate the effect of physicians’ attitude towards health IT on the adoption of electronic workflows. MethodsBetween May and July 2013, we conducted a cross-sectional survey of 1200 practice based physicians in Switzerland. Respondents were asked to report on their technical means and where applicable their paper-based workarounds to process laboratory data, examination results, referral letters and physician’s letters. Physicians’ view of barriers and facilitators towards health IT use was determined by a composite score. ResultsA response rate of 57.1% (n=685) was reached. The sample was considered to be representative for physicians in Swiss ambulatory care. 35.2% of the respondents documented patients’ health status with the help of a longitudinal semi-structured electronic text record generated by one or more encounters in the practice. Depending on the task within a workflow, around 11–46% of the respondents stated to rely on electronic workflow practices to process laboratory and examination data and dispatch referral notes and physician’s letters. The permanent use of electronic workflow processes was infrequent. Instead, respondents reported paper-based workarounds affecting specific tasks within a workflow. Physicians’ attitude towards health IT was significantly associated with the adoption of electronic workflows (OR 1.04–1.31, p<0.05), but the effect sizes of factors related to the working environment (e.g., regional factors, medical specialty, type of practice) were larger. ConclusionAt present, only a few physicians in Swiss ambulatory care routinely work with electronic health data. Until more of their peers participate in electronic exchange of structured clinical information, most physicians will continue to stay in paper-based systems and workarounds. The survey found that physicians with a positive attitude towards health IT were more likely to adopt electronic workflows, but the impact is minor. It will likely be necessary to introduce financial incentives and develop national standards in order to promote the adoption by a critical mass of practicing clinicians.

Human Factors and Ergonomics in the Design of Health Information Technology: Trends and Progress in 2014.

To summarize significant contributions to the research on human factors and organizational issues in medical informatics. An extensive search using PubMed/Medline and Web of Science® was conducted to identify the scientific contributions, published in 2014, to human factors and organizational issues in medical informatics, with a focus on health information technology (HIT) usability. The selection process comprised three steps: (i) 15 candidate best papers were selected by the two section editors, (ii) external reviewers from a pool of international experts reviewed each candidate best paper, and (iii) the final selection of three best papers was made by the editorial board of the IMIA Yearbook. Noteworthy papers published in 2014 describe an efficient, easy to implement, and useful process for detecting and mitigating human factors and ergonomics (HFE) issues of HIT. They contribute to promote the HFE approach with interventions based on rigorous and well-conducted methods when designing and implementing HIT. The application of HFE in the design and implementation of HIT remains limited, and the impact of incorporating HFE principles on patient safety is understudied. Future works should be conducted to advance this field of research, so that the safety and quality of patient care are not compromised by the increasing adoption of HIT.

Clinical and surgical applications of smart glasses.

With the increased efforts to adopt health information technology in the healthcare field, many innovative devices have emerged to improve patient care, increase efficiency, and decrease healthcare costs. A recent addition is smart glasses: web-connected glasses that can present data onto the lenses and record images or videos through a front-facing camera. In this article, we review the most salient uses of smart glasses in healthcare, while also denoting their limitations including practical capabilities and patient confidentiality. Using keywords including, but not limited to, ``smart glasses'', ``healthcare'', ``evaluation'', ``privacy'', and ``development'', we conducted a search on Ovid-MEDLINE, PubMed, and Google Scholar. A total of 71 studies were included in this review. Smart glasses have been adopted into the healthcare setting with several useful applications including, hands-free photo and video documentation, telemedicine, Electronic Health Record retrieval and input, rapid diagnostic test analysis, education, and live broadcasting. In order for the device to gain acceptance by medical professionals, smart glasses will need to be tailored to fit the needs of medical and surgical sub-specialties. Future studies will need to qualitatively assess the benefits of smart glasses as an adjunct to the current health information technology infrastructure.

Tales from the Frontline: Implementing an E-Prescription Technology

Health Information Technology (HIT) has great potential to enhance patient care and improve efficiency of health care delivery if it is appropriately designed, implemented and used. In 2009 the Office of the National Coordinator (ONC) created Meaningful Use (MU) incentives to promote HIT adoption, which has spurred major investment in HIT, but the program has shown no reduction in use errors. Because the MU program mainly focuses on clinical process measures, with no attention to the processes of system design and implementation, many organizations encounter challenges to attain the MU. Previous studies identified lack of adequate implementation plans, lack of team support, lack of workflow analysis, and lack of dedicated resources as main barriers to MU attainment. We have identified similar concerns, and here present tales from the frontline to show perceptions of end users when our organization rushed through the implementation of e-prescription technology to meet the MU deadlines. Insufficient attention to the design and implementation process has put our organizations at risk. Reactive mitigation solutions were put in place to counteract the identifiable potential risks.

Causes and consequences of e-prescribing errors in community pharmacies.

Major national policy forces are promoting the adoption and use of health information technology (health IT) to improve the quality, safety, and efficiency of health care delivery. One such health IT is electronic prescribing (e-prescribing), which is the direct transmission of prescription information from a provider to a pharmacy. Given research showing that handwritten prescriptions are unsafe and associated errors can lead to tremendous inefficiency for patients and pharmacists, e-prescribing has many potential benefits. However, as with the introduction of any new technology, unintended, adverse consequences may result. The purpose of this review is to explore the causes and consequences of e-prescribing errors in community pharmacies, which are pharmacies not affiliated with a hospital or clinic. Many new types of errors – including provider order entry errors, transcription errors, and dispensing errors – appear to result from e-prescribing. These lead to important consequences for pharmacies, including safety threats to patients, reduced efficiency for pharmacists, processing delays, and increased pharmacy cost. Increased attention to system design and pharmacist training, as well as additional research in this area, will be critical to realize the full benefits of e-prescribing.

Utilizing Health Information Technology to Support Universal Healthcare Delivery: Experience of a National Healthcare System.

Recent discussions have focused on using health information technology (HIT) to support goals related to universal healthcare delivery. These discussions have generally not reflected on the experience of countries with a large amount of experience using HIT to support universal healthcare on a national level. HIT was compared globally by using data from the Ministry of the Interior, Republic of China (Taiwan). Taiwan has been providing universal healthcare since 1995 and began to strategically implement HIT on a national level at that time. Today the national-level HIT system is more extensive in Taiwan than in many other countries and is used to aid administration, clinical care, and public health. The experience of Taiwan thus can provide an illustration of how HIT can be used to support universal healthcare delivery. In this article we present an overview of some key historical developments and successes in the adoption of HIT in Taiwan over a 17-year period, as well as some more recent developments. We use this experience to offer some strategic perspectives on how it can aid in the adoption of large-scale HIT systems and on how HIT can be used to support universal healthcare delivery.

Health Information Technology Adoption in the Emergency Department

To describe the trend in health information technology (IT) systems adoption in hospital emergency departments (EDs) and its effect on ED efficiency and resource use. 2007-2010 National Hospital Ambulatory Medical Care Survey - ED Component. We assessed changes in the percent of visits to EDs with health IT capability and the estimated effect on waiting time to see a provider, visit length, and resource use. The percent of ED visits that took place in an ED with at least a basic health IT or an advanced IT system increased from 25.2 and 3.1 percent in 2007 to 69.1 and 30.6 percent in 2010, respectively (p<.05). Controlling for ED fixed effects, waiting times were reduced by 6.0minutes in advanced IT-equipped EDs (p<.05), and the number of tests ordered increased by 9 percent (p<.01). In models using a 1-year lag, advanced systems also showed an increase in the number of medications and images ordered per visit. Almost a third of visits now occur in EDs with advanced IT capability. While advanced IT adoption may decrease wait times, resource use during ED visits may also increase depending on how long the system has been in place. We were not able to determine if these changes indicated more appropriate care.

Adoption of health information technologies by physicians for clinical practice: The Andalusian case

ObjectivesWe investigated the level of adoption of Health Information Technologies (HIT) services, and the factors that influence this, amongst specialised and primary care physicians; in Andalusia, Spain. MethodsWe analysed the physicians’ responses to an online survey. First, we performed a statistical descriptive analysis of the data; thereafter, a principal component analysis; and finally an order logit model to explain the effect of the use in the adoption and to analyse which are the existing barriers. ResultsThe principal component analysis revealed three main uses of Health Information Technologies: Electronic Health Records (EHR), ePrescription and patient management and telemedicine services. Results from an ordered logit model showed that the frequency of use of HIT is associated with the physicians’ perceived usefulness. Lack of financing appeared as a common barrier to the adoption of the three types of services.For ePrescription and patient management, the physician's lack of skills is still a barrier. In the case of telemedicine services, lack of security and lack of interest amongst professionals are the existing barriers. ConclusionsEHR functionalities are fully adopted, in terms of perceived usefulness. EPrescription and patient management are almost fully adopted, while telemedicine is in an early stage of adoption.

Health information technology in hospitals: current issues and future trends.

Healthcare is at an important crossroads in that current models of care are increasingly seen by politicians and policymakers as unsustainable. Furthermore, there is a need to move away from the reactive, doctor-centred model of care to one that is more patient-centred and that consistently delivers accessible, high-quality and safe care to all. Greater use of health information technology (HIT) is seen by many key decision makers as crucial to this transformation process and, hence, substantial investments are made in this area. However, healthcare, particularly in UK hospitals, remains a laggard in HIT adoption. To uncover the underlying reasons, we discuss current implementation and adoption challenges and explore potential ways to address these. We outline strategic, organisational, technical and social factors that can 'make or break' technological implementations. Most importantly, we suggest that efforts should be characterised by an underlying awareness of the complexity of the hospital environment and the need to develop tools that support provision of integrated multidisciplinary care. We conclude with a discussion of promising future developments, including increased patient involvement; access and contribution to shared records; the penetration of smart devices; greater health information exchange and interoperability; and innovative real-time secondary uses of data. We argue that there is considerable merit in evaluating the introduction of these interventions to help ensure that they are optimised for effectiveness, support efficient working and minimise the possibility of inadvertently introducing new risks into already complex health systems. Our over-riding message is that HIT should be seen as, where appropriate, a potential enabler and an important source of data to support healthcare redesign and that critical, ongoing evaluation is key to maximising benefits. However, it should not be seen as a silver bullet.

Health Information Technology in Developing Countries: A Structured Literature Review with Reference to the Case of Libya

This paper reports a structured literature review of the application of Health Information Technology in developing countries, defined as the World Bank categories Low-income countries, Lower-middle-income, and Upper-middle-income countries. The aim was to identify and classify the various applications of health information technology to assess its current state in developing countries and explore potential areas of research. We offer specific analysis and application of HIT in Libya as one of the developing countries. A structured literature review was conducted using the following online databases: IEEE, Science Direct, PubMed, and Google Scholar. Publication dates were set for 2000-2013. For the PubMed search, publications in English, French, and Arabic were specified. Using a content analysis approach, 159 papers were analyzed and a total number of 26 factors were identified that affect the adoption of health information technology. Of the 2681 retrieved articles, 159 met the inclusion criteria which were carefully analyzed and classified. The implementation of health information technology across developing countries is varied. Whilst it was initially expected financial constraints would have severely limited health information technology implementation, some developing countries like India have nevertheless dominated the literature and taken the lead in conducting scientific research. Comparing the number of studies to the number of countries in each category, we found that Low-income countries and Lower-middle-income had more studies carried out than Upper-middle-income countries. However, whilst IT has been used in various sectors of the economy, the healthcare sector in developing countries is still failing to benefit fully from the potential advantages that IT can offer.

Effects of health information technology on malpractice insurance premiums.

ObjectivesThe widespread adoption of health information technology (IT) will help contain health care costs by decreasing inefficiencies in healthcare delivery. Theoretically, health IT could lower hospitals' malpractice insurance premiums (MIPs) and improve the quality of care by reducing the number and size of malpractice. This study examines the relationship between health IT investment and MIP using California hospital data from 2006 to 2007.MethodsTo examine the effect of hospital IT on malpractice insurance expense, a generalized estimating equation (GEE) was employed.ResultsIt was found that health IT investment was not negatively associated with MIP. Health IT was reported to reduce medical error and improve efficiency. Thus, it may reduce malpractice claims from patients, which will reduce malpractice insurance expenses for hospitals. However, health IT adoption could lead to increases in MIPs. For example, we expect increases in MIPs of about 1.2% and 1.5%, respectively, when health IT and labor increase by 10%.ConclusionsThis study examined the effect of health IT investment on MIPs controlling other hospital and market, and volume characteristics. Against our expectation, we found that health IT investment was not negatively associated with MIP. There may be some possible reasons that the real effect of health IT on MIPs was not observed; barriers including communication problems among health ITs, shorter sample period, lower IT investment, and lack of a quality of care measure as a moderating variable.

Health information technology adoption: effects on patient safety and quality of care

The adoption of healthcare information technology (HIT) has been advocated by various groups as critical for addressing the growing crisis in the US healthcare industry. This study aims to understand differences in patient outcomes between healthcare providers that do and that do not adopt HIT. This is accomplished by examining the relationships between the adoption of HIT in US acute care hospitals and two risk-adjusted patient outcomes: patient safety and quality. The new contribution of the study lies in the fact that it uses nationally representative data and it incorporates a large number of technologies.

Health Information Technology in Nigeria: Stakeholders’ Perspectives of Nationwide Implementations and Meaningful Use of the Emerging Technology in the Most Populous Black Nation

Background: Nigeria is witnessing continuing advocacy and increase in number of individuals yearning for computerization of health information and healthcare processes. On the other hand, the Government of this most populous black nation is evolving plans and strategies for the adoption and implementation of health information technology (HIT). However, little is known about opinions of the diverse healthcare providers who would act the script of government in ensuring meaningful use of HIT in the country. Objective: This nationwide, cross-sectional study attempted to determine stakeholders’ perspectives of the emerging HIT in Nigeria. Result: HIT stakeholders who gave consent (n=233) at the two conferences participated in the study, 76% of whom were male professionals, mostly (117, 50.2%) from tertiary healthcare institutions. It worthy of note that three of the participants came from United States of America to attend the 1st National Conference on Health Information Technology in Nigeria. Of all participants, the majority (226, 99.1%) opined that HIT will improve communication among healthcare providers. A similar portion (223, 98.2%) were of the opinion that HIT will facilitate prompt retrieval of patient’s health records on point-of-care (POC). Nearly two-third (139, 62.6%) were optimistic of possible realization of nationwide implementations of HIT in the country by the year 2020. The results also indicate that gender, professional inclination, and place of work were important predictors of positive opinion of HIT. The three factors were associated with stakeholders’ opinion that the evolving HIT is capable of improving medical care quality (p=0.059; 0.000; 0.014) of the Nigerian populace. Most stakeholders (61%) recommended that the paper-based health records should be archived post implementation of HIT. Conclusion: The Nigerian healthcare system is manned by providers and stakeholders who are quite abreast of the benefits of health information technology and are willing to embrace the technology in their workflow. This is quite reassuring and tends to prompt the healthcare decision makers to proactively formulate policies and introduce interventions to encourage nationwide acceptance of the emerging technology. Nonetheless, there is more to be done on appropriate clinical documentation in order to set a friendly pedestal for effective takeoff, successful implementations and meaningful use. Appropriate funding and financial incentives for quality improvement is recommended. In addition, the National Conference on HIT should be convened annually and a technical committee be set up to appraise future implementations.

Using Publicly Available Data to Characterize Consumers Use of Email to Communicate with Healthcare Providers.

The use of patient focused technology has been proclaimed as a means to improve patient satisfaction and improve care outcomes. The Center for Medicaid/Medicare Services, through its EHR Incentive Program, has required eligible hospitals and professionals to send and receive secure messages from patients in order to receive financial incentives and avoid reimbursement penalties. Secure messaging between providers and patients has the potential to improve communication and care outcomes. The purpose of this study was to use National Health Interview Series (NHIS) data to identify the patient characteristics associated with communicating with healthcare providers via email. Individual patient characteristics were analyzed to determine the likelihood of emailing healthcare providers. The use of email for this purpose is associated with educational attainment, having a usual place of receiving healthcare, income, and geography. Publicly available data such as the NHIS may be used to better understand trends in adoption and use of consumer health information technologies.

Exploring physicians' behavioural intention toward the adoption of electronic health records: an empirical study from Jordan

The response of health professionals to the use of health information technology (HIT) can partly explain the success or failure of any HIT adoption and/or its application. The present study applies a modified version of the revised technology acceptance model (TAM) to examine EHR acceptance and utilisation by physicians in Jordan. The paper presents the theoretical basis behind the development of a research model which was employed to empirically validate the model using substantial quantitative data. The theoretical significance of this work is evidenced by utilising a rigorously constructed research model to extend technology acceptance research into the health sector.

IT-enabled Community Health Interventions: Challenges, Opportunities, and Future Directions.

Rising health information technology (HIT) adoption and the increasing interoperability of health data have propelled the role of IT in community-wide health transformations. Disseminating the challenges and opportunities that the early adopters of community-wide HIT interventions have experienced is critical for empowering the growing demand for community-based health systems. This special issue of eGEMs addresses that need. This issue includes a variety of community-based HIT projects covering topics such as governance, informatics, and learning health systems. These projects represent a diverse set of stakeholders, a wide selection of data sources, and multiple information platforms to collate or exchange data. We hope that this special issue of eGEMs will be the first of several future issues dedicated to community-wide HIT transformations.