Effect Of Health Information Technology Research Articles

The impact of interoperability of electronic health records on ambulatory physician practices: a discrete-event simulation study

The effect of health information technology (HIT) on efficiency and workload among clinical and nonclinical staff has been debated, with conflicting evidence about whether electronic health records (EHRs) increase or decrease effort. None of this paper to date, however, examines the effect of interoperability quantitatively using discrete event simulation techniques. To estimate the impact of EHR systems with various levels of interoperability on day-to-day tasks and operations of ambulatory physician offices. Interviews and observations were used to collect workflow data from 12 adult primary and specialty practices. A discrete event simulation model was constructed to represent patient flows and clinical and administrative tasks of physicians and staff members. High levels of EHR interoperability were associated with reduced time spent by providers on four tasks: preparing lab reports, requesting lab orders, prescribing medications, and writing referrals. The implementation of an EHR was associated with less time spent by administrators but more time spent by physicians, compared with time spent at paper-based practices. In addition, the presence of EHRs and of interoperability did not significantly affect the time usage of registered nurses or the total visit time and waiting time of patients. This paper suggests that the impact of using HIT on clinical and nonclinical staff work efficiency varies, however, overall it appears to improve time efficiency more for administrators than for physicians and nurses.

The effects of health information technology on the costs and quality of medical care

Information technology has been linked to productivity growth in a wide variety of sectors, and health information technology (HIT) is a leading example of an innovation with the potential to transform industry-wide productivity. This paper analyzes the impact of health information technology (HIT) on the quality and intensity of medical care. Using Medicare claims data from 1998 to 2005, I estimate the effects of early investment in HIT by exploiting variation in hospitals’ adoption statuses over time, analyzing 2.5 million inpatient admissions across 3900 hospitals. HIT is associated with a 1.3% increase in billed charges (p-value: 5.6%), and there is no evidence of cost savings even five years after adoption. Additionally, HIT adoption appears to have little impact on the quality of care, measured by patient mortality, adverse drug events, and readmission rates.

State funding for health information technology and selected ambulatory healthcare quality measures.

Previous studies on the effects of health information technology (health IT) on ambulatory quality have had mixed results. New York State has invested heavily in health IT throughout the State, creating a unique opportunity to assess effects on health care quality across multiple communities. To determine any association between primary care providers' receipt of funding from New York State's Healthcare Efficiency and Affordability Law for New Yorkers Program (HEAL NY) and ambulatory quality of care. A statewide, longitudinal cohort study of primary care physicians in New York State was conducted. Data regarding which primary care physicians received funding through the HEAL NY program (Phase 5 or Phase 10) in 2008 or 2009 were obtained from the New York State Department of Health. Health care quality in 2010 was measured using claims data that had been aggregated across 7 commercial health plans across the state. Physicians were divided into 2 groups, based on receipt of HEAL funding (yes/no). Any association was measured between study group and each of 7 quality measures, all of which appear in the Stage 1 federal Meaningful Use program. Negative binomial regression was used, adjusting for provider gender and specialty. The study included 3,988 primary care providers, of whom 863 (22%) had received HEAL NY funding. The HEAL-funded physicians provided higher quality of care on 5 of the 7 measures: breast cancer screening, eye exams in patients with diabetes, nephropathy screening in patients with diabetes, influenza vaccination and pneumococcal vaccination (p<0.0001 for all adjusted comparisons). The HEAL-funded group provided higher quality of care by an absolute 2 to 6 percentage points per measure for those 5 measures. Primary care physicians who received state funding for health IT provided higher quality of care than those who did not receive such funding.

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.

Dental care providers' and patients' perceptions of the effect of health information technology in the dental care setting

The use of electronic health records (EHRs) in dental care and their effect on dental care provider-patient interaction have not been studied sufficiently. The authors conducted a study to explore dental care providers' interactions with EHRs during patient visits, how these interactions influence dental care provider-patient communication, and the providers' and patients' perception of EHR use in the dental clinic setting during patient visits. The authors collected survey and interview data from patients and providers at three dental clinics in a health care system. The authors used qualitative and quantitative methods to analyze data obtained from patients and dental care providers. The provider survey results showed significant differences in perceptions of EHR use in patient visits across dental care provider groups (dentists, dental hygienists and dental assistants). Patient survey results indicated that some patients experienced a certain level of frustration and distraction because of providers' use of EHRs during the visit. The provider survey results indicated that there are different perceptions across provider groups about EHRs and the effect of computer use on communication with patients. Dental assistants generally reported more negative effects on communication with patients owing to computer use. Interview results also indicated that dental care providers may not feel comfortable interacting with the EHR without having any verbal or eye contact with patients during the patient's dental visit. A new design for dental operatories and locations of computer screens within the operatories should be undertaken to prevent negative nonverbal communication such as loss of eye contact or forcing the provider and patient to sit back to back, as well as to enhance patient education and information sharing.

Health Information Technology in Screening and Treatment of Child Obesity: A Systematic Review

Childhood obesity is a major problem in the United States, yet screening and treatment are often inaccessible or ineffective. Health information technology (IT) may improve the quality, efficiency, and reach of chronic disease management. The objective of this study was to review the effect of health IT (electronic health records [EHRs], telemedicine, text message or telephone support) on patient outcomes and care processes in pediatric obesity management. Medline, Embase, and the Cochrane Registry of Controlled Trials were searched from January 2006 to April 2012. Controlled trials, before-and-after studies, and cross-sectional studies were included if they used IT to deliver obesity screening or treatment to children aged 2 to 18 and reported impact on patient outcomes (BMI, dietary or physical activity behavior change) or care processes (BMI screening, comorbidity testing, diet, or physical activity counseling). Two independent reviewers extracted data and assessed trial quality. Thirteen studies met inclusion criteria. EHR use was associated with increased BMI screening rates in 5 of 8 studies. Telemedicine counseling was associated with changes in BMI percentile similar to that of in-person counseling and improved treatment access in 2 studies. Text message or telephone support was associated with weight loss maintenance in 1 of 3 studies. To date, health IT interventions have improved access to obesity treatment and rates of screening. However, the impact on weight loss and other health outcomes remains understudied and inconsistent. More interactive and time-intensive interventions may enhance health IT's clinical effectiveness in chronic disease management.

Effect of health information technology expenditure on patient level cost.

ObjectivesThis study investigate the effect of health information technology (IT) expenditure on individual patient-level cost using California Office of Statewide Health Planning and Development (OSHPD) data obtained from 2000 to 2007.MethodsWe used a traditional cost function and applied hospital fixed effect and clustered error within hospitals.ResultsWe found that a quadratic function of IT expenditure best fit the data. The quadratic function in IT expenditure predicts a decrease in cost of up to US$1,550 of IT labor per bed, US$27,909 of IT capital per bed, and US$28,695 of all IT expenditure per bed. Moreover, we found that IT expenditure reduced costs more quickly in medical conditions than surgical diseases.ConclusionsInterest in health IT is increasing more than ever before. Many studies examined the effect of health IT on hospital level cost. However, there have been few studies to examine the relationship between health IT expenditure and individual patient-level cost. We found that IT expenditure was associated with patient cost. In particular, we found a quadratic relationship between IT expenditure and patient-level cost. In other word, patient-level cost is non-linearly (or a polynomial of second-order degree) related to IT expenditure.

The Triangle Model for evaluating the effect of health information technology on healthcare quality and safety

With the proliferation of relatively mature health information technology (IT) systems with large numbers of users, it becomes increasingly important to evaluate the effect of these systems on the quality and safety of healthcare. Previous research on the effectiveness of health IT has had mixed results, which may be in part attributable to the evaluation frameworks used. The authors propose a model for evaluation, the Triangle Model, developed for designing studies of quality and safety outcomes of health IT. This model identifies structure-level predictors, including characteristics of: (1) the technology itself; (2) the provider using the technology; (3) the organizational setting; and (4) the patient population. In addition, the model outlines process predictors, including (1) usage of the technology, (2) organizational support for and customization of the technology, and (3) organizational policies and procedures about quality and safety. The Triangle Model specifies the variables to be measured, but is flexible enough to accommodate both qualitative and quantitative approaches to capturing them. The authors illustrate this model, which integrates perspectives from both health services research and biomedical informatics, with examples from evaluations of electronic prescribing, but it is also applicable to a variety of types of health IT systems.

Measurement Error in Performance Studies of Health Information Technology: Lessons from the Management Literature

Just as researchers and clinicians struggle to pin down the benefits attendant to health information technology (IT), management scholars have long labored to identify the performance effects arising from new technologies and from other organizational innovations, namely the reorganization of work and the devolution of decision-making authority. This paper applies lessons from that literature to theorize the likely sources of measurement error that yield the weak statistical relationship between measures of health IT and various performance outcomes. In so doing, it complements the evaluation literature's more conceptual examination of health IT's limited performance impact. The paper focuses on seven issues, in particular, that likely bias downward the estimated performance effects of health IT. They are 1.) negative self-selection, 2.) omitted or unobserved variables, 3.) mis-measured contextual variables, 4.) mismeasured health IT variables, 5.) lack of attention to the specific stage of the adoption-to-use continuum being examined, 6.) too short of a time horizon, and 7.) inappropriate units-of-analysis. The authors offer ways to counter these challenges. Looking forward more broadly, they suggest that researchers take an organizationally-grounded approach that privileges internal validity over generalizability. This focus on statistical and empirical issues in health IT-performance studies should be complemented by a focus on theoretical issues, in particular, the ways that health IT creates value and apportions it to various stakeholders.

Technological Change at Work: The Impact of Employee Involvement on the Effectiveness of Health Information Technology

The link between employee involvement (EI) and organizational performance is not clear-cut, and the diffusion of information technology (IT) in the workplace complicates this relationship. The author argues that new technologies offer an important avenue by which EI can improve firm performance. He also contends that those studies that do consider EI in the context of technological change may be focusing exclusively on workplace-level features of the employment relationship, ignoring variation in functional- and strategic-level aspects of employment relations. To test this hypothesis, he uses Kaiser Permanente Northwest Region's patient scheduling module as an exemplar to investigate the extent to which this particular technology interacts with EI to affect clinic-level improvements in patient satisfaction. He studies the impact of the technology over the period October 2004 to August 2007 across 16 clinics to identify variation across sites. Measuring outcomes from a dataset that includes employee and patient surveys, interviews, archival data, and clinic observations, he finds that the use of IT is associated with performance increases and that these effects are greater in those clinics achieving higher mean levels of EI. This study presents the first empirical evidence of the potential of EI to enhance the effectiveness of health IT.

The Effect Of Health Information Technology On Quality In U.S. Hospitals

Health information technology (IT), such as computerized physician order entry and electronic health records, has potential to improve the quality of health care. But the returns from widespread adoption of such technologies remain uncertain. We measured changes in the quality of care following adoption of electronic health records among a national sample of U.S. hospitals from 2004 to 2007. The use of computerized physician order entry and electronic health records resulted in significant improvements in two quality measures, with larger effects in academic than nonacademic hospitals. We conclude that achieving substantive benefits from national implementation of health IT may be a lengthy process. Policies to improve health IT's efficacy in nonacademic hospitals might be more beneficial than adoption subsidies.

Measuring the Effects of Health Information Technology on Quality of Care: A Novel Set of Proposed Metrics for Electronic Quality Reporting

Electronic health records (EHRs), in combination with health information exchange, are being promoted in the United States as a strategy for improving quality of care. No single metric set exists for measuring the effectiveness of these interventions. A set of quality metrics was sought that could be retrieved electronically and would be sensitive to the changes in quality that EHRs with health information exchange may contribute to ambulatory care. A literature search identified quality metric sets for ambulatory care. Two rounds of quantitative rating of individual metrics were conducted. Metrics were developed de novo to capture additional expected effects of EHRs with health information exchange. A 36-member national expert panel validated the rating process and final metric set. Seventeen metric sets containing 1,064 individual metrics were identified; 510 metrics met inclusion criteria. Two rounds of rating narrowed these to 59 metrics and then to 18. The final 18 consisted of metrics for asthma, cardiovascular disease, congestive heart failure, diabetes, medication and allergy documentation, mental health, osteoporosis, and prevention. Fourteen metrics were developed de novo to address test ordering, medication management, referrals, follow-up after discharge, and revisits. The novel set of 32 metrics is proposed as suitable for electronic reporting to capture the potential quality effects of EHRs with health information exchange. This metric set may have broad utility as health information technology becomes increasingly common with funding from the federal stimulus package and other sources. This work may also stimulate discussion on improving how data are entered and extracted from clinically rich, electronic sources, with the goal of more accurately measuring and improving care.

The Effects of Health Information Technology on Inpatient Care

The Effects of Health Information Technology on Inpatient Care

Health information technology and health information exchange in New York State: New initiatives in implementation and evaluation

More research is needed to understand the effects of health information technology (HIT) and health information exchange (HIE) on quality, safety, efficiency, finances, consumers and providers in community-based settings. New York State is investing heavily in HIT and HIE adoption through the HEAL NY program. It has already provided $53 million in seed money and requires that grantee organizations match the funds. HITEC (The Health Information Technology Evaluation Collaborative) was established to measure systematically the effects of HIT and HIE on consumers, providers, health care quality, patient safety, public health, and financial return on investment in New York State, as no individual grantee is able to conduct cross-cutting evaluations. The results of these evaluations should inform decisions made by leaders in HIT and HIE in New York State and across the nation.

Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care

Experts consider health information technology key to improving efficiency and quality of health care. To systematically review evidence on the effect of health information technology on quality, efficiency, and costs of health care. The authors systematically searched the English-language literature indexed in MEDLINE (1995 to January 2004), the Cochrane Central Register of Controlled Trials, the Cochrane Database of Abstracts of Reviews of Effects, and the Periodical Abstracts Database. We also added studies identified by experts up to April 2005. Descriptive and comparative studies and systematic reviews of health information technology. Two reviewers independently extracted information on system capabilities, design, effects on quality, system acquisition, implementation context, and costs. 257 studies met the inclusion criteria. Most studies addressed decision support systems or electronic health records. Approximately 25% of the studies were from 4 academic institutions that implemented internally developed systems; only 9 studies evaluated multifunctional, commercially developed systems. Three major benefits on quality were demonstrated: increased adherence to guideline-based care, enhanced surveillance and monitoring, and decreased medication errors. The primary domain of improvement was preventive health. The major efficiency benefit shown was decreased utilization of care. Data on another efficiency measure, time utilization, were mixed. Empirical cost data were limited. Available quantitative research was limited and was done by a small number of institutions. Systems were heterogeneous and sometimes incompletely described. Available financial and contextual data were limited. Four benchmark institutions have demonstrated the efficacy of health information technologies in improving quality and efficiency. Whether and how other institutions can achieve similar benefits, and at what costs, are unclear.