Adoption Of Health Information Technology Research Articles

Comparing "Meaningful Use" of Health Information Technology in Pennsylvania: Electronic Prescription Rates of Metropolitan and Rural Counties.

The Health Information Technology for Economic and Clinical Health Act incentivized the adoption of electronic health records (EHRs). Health systems looked to leverage technology to assist in serving populations in health professional shortage areas. Qualitative research points to EHR usability as a source of health inequities in rural settings, making the challenges of EHR usage a subject of interest. Pennsylvania offers a model for investigating rural health infrastructure with it having the third largest rural population in the United States. This study analyzed the adoption of Electronic Prescribing in the 67 Pennsylvania (PA) counties. Physician adoption and usage data for PA and the United States were compared using a t-test to establish a basis for comparison. PA counties were categorized using the United States Department of Agriculture (USDA)'s Rural-Urban Commuting Areas (RUCAs) system. Surescript use percentages were plotted against the RUCA scores of each PA county to create a polynomial regression model. PA office-based physicians, on average, utilize e-prescription tools at the same rate as the national average with 59% of practices utilizing Surescripts as of 2013. There was no significant correlation between Surescript usage and the rural/urban classification of counties in Pennsylvania (R-squared value of 0.06). Pennsylvania was able to adopt health information technology (HIT) infrastructure at the same rate as the national average. Rural and metropolitan definitions do not correlate to meaningful use of HIT, thus usability of HIT cannot be tied to health outcomes. Future studies looking at specific forms of HIT and their ability to decrease the burden of administrative work for clinicians.

Evaluating the Relationship Between Information Technology Adoption and Healthcare Outcomes in Sub-Saharan Africa

Purpose: The aim of the study was to investigate evaluating the relationship between information technology adoption and healthcare outcomes in Sub-Saharan Africa
 Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries.
 Findings: The study found that IT adoption in Sub-Saharan Africa's healthcare varied by country and played a positive role in improving healthcare outcomes when effectively implemented. However, challenges like infrastructure limitations and financial constraints hindered adoption. Tailored strategies and policy interventions are needed to overcome these barriers and harness the potential benefits of IT adoption in the region's healthcare systems.
 Unique Contribution to Theory, Practice and Policy: Technology Acceptance Model, Diffusion of Innovations Theory & Health Information Technology Adoption Model may be used to anchor future studies on evaluating the relationship between information technology adoption and healthcare outcomes in Sub-Saharan Africa. Advocate for capacity building initiatives to enhance digital literacy and IT skills among healthcare providers, administrators, and policymakers. Engage with policymakers at the national and regional levels to influence the formulation of healthcare IT adoption policies.

THE MOVING FORWARD NURSING HOME COALITION: A CALL TO ACTION TO SUPPORT NURSING HOME REFORM

Abstract The Moving Forward Nursing Home Quality Coalition advances the goals outlined by the 2022 National Academies of Sciences, Engineering, and Medicine (NASEM) report aimed at improving nursing home (NH) quality. Over two years, Coalition committee members – along with a network of national leaders, nursing home residents, and the general public – will develop, test and promote action plans that will improve the way the United States finances, delivers, and regulates care in Nursing Homes. The Coalition is comprised of a steering committee and working committees that align with and advance the seven NASEM goals including; 1) advancing delivery of person-centered care; 2) ensuring a well-prepared and compensated workforce; 3) increasing financial transparency and accountability; 4) creating a rational and robust financing system; 5) designing more effective and responsive quality assurance; 6) expanding quality measurement and continuous quality improvement; and 7) adopting health information technology. Coalition committees have engaged in three of four phases of their two-year work plan including convening stakeholders to prioritize and develop action plans to test and promote change. Throughout the work, committee collaboration has ensured action plans are refined and expanded in synergistic ways to shape state and national policy. This presentation will provide an overview of the broader Coalition work and give context for the other presentations which provide an example of collaborative work leading to proposed recommendations for critical policy and regulatory change around person-centered care planning.

Facilitators of and barriers to the use of a computer-based self-monitoring system by type 2 diabetic and/or hypertensive patients

BackgroundConsumer health information technologies (IT) are being increasingly applied to improve access to self-care resources for individuals with chronic illnesses. Thus, it is important to identify the factors influencing the patients’ adoption or rejection of these technologies. ObjectiveThis study contributes to the literature on consumer health IT adoption by identifying the facilitators and barriers to the use of a computer-based chronic disease self-monitoring system by patients with type 2 diabetes mellitus and/or hypertension. MethodsSemi-structured interviews nested within a 3-month randomized controlled trial were conducted with 38 patients. Guided by the home care health IT implementation framework described in Or et al. (2009), their data were contented analyzed. ResultsThe facilitators and barriers identified were organized around the six variable categories of the Health IT implementation framework, including patient attributes, technological characteristics, patient–technology interaction, home environment, organizational factors (e.g., influences, resources, and support), and patient outcomes. ConclusionsOur study provides a holistic insight into the conceptualization of consumer health IT adoption by patients. When creating and implementing consumer health IT, taking into account the identified facilitators and barriers might boost the likelihood of technology adoption.

A Survey of Technology Abandonment in US Nursing Homes

ObjectiveAdoption of health information technology (HIT) in nursing homes (NHs) improves quality of care. Although there is a robust body of research on HIT adoption, the closely related process of technology abandonment is not well understood. As NHs grow more reliant on HIT, problems of technology abandonment, defined as failure to scale up, spread, and sustain HIT need to be studied. Our objective is to describe HIT abandonment and its associations with organizational characteristics among a national sample of US NHs. DesignLongitudinal, retrospective analysis of data from 2 sources: HIT Maturity Survey and Staging model and public data from the Care Compare database. Setting and ParticipantsRandom sample of NHs (n = 299) representing each US state that completed the HIT maturity survey in 2 consecutive years: year 1 (Y1) was June 2019–August 2020 and year 2 (Y2) was June 2020–August 2021. MethodsThe primary dependent variable was technology abandonment, operationalized by using total HIT maturity score, HIT maturity stage, and subscale scores within each dimension/domain. Independent variables were NH organizational characteristics including bed size, type of ownership, urbanicity, Centers for Medicare & Medicaid Services Five-Star Overall Rating and Staffing Rating. ResultsOver the 2-year period, HIT abandonment occurred in 28% (n = 85) of NHs compared with 44% (n = 133) that experienced growth in HIT systems. HIT capabilities in resident care were abandoned most frequently. Using multivariable multinomial logistic regression, we found that large NHs (bed size greater than 120) were more likely to experience technology abandonment in administrative activities. Conclusions and ImplicationsTechnology abandonment can increase strain on scarce resources and may impact administrators’ ability to oversee clinical operations, especially in large NHs. This study contributes to the limited understanding of technology abandonment and can serve as a building block for others working to ensure limited resources are used effectively to improve care for NH residents.

UTILISATION OF HEALTH INFORMATION TECHNOLOGY AMONG DIETITIANS IN THE WORKPLACE: A QUALITATIVE STUDY

Dietitians play an important role in advocating lifestyle changes, such as dietary modifications and physical activity, to effectively prevent chronic diseases and avoid complications. The use of information technologies (IT) helps dietitians to engage with their patients. This paper explores the use health information technology among dietitians in the workplace. Four focus group sessions involving fifteen dietitians from hospitals and universities were conducted using an online platform. Participants were recruited using purposive and snowball sampling. A semi-structured questionnaire was used to facilitate the interview to understand better dietitians' health IT practices. Interviews were videotaped, verbatim transcribed, and emerging themes and subthemes were thematically analysed. Inductive and deductive content analysis were used. Four themes emerged from the data: 1. utility of health IT tools, 2. factors that influence the use of health IT, 3. frequency of use, and 4. perceived barriers to adoption of health IT. Participants used health IT through health-related mobile applications, web-based platforms, and social media applications. Participants cited self-motivation, advertisement, training, peers, patients, content, ease of use, developers, quality, and functionality as factors in their use of health IT. Some barriers to utilising health IT included not disease-specific tools, inappropriate for all age groups, inaccurate information, inconvenient, required a paid version, and being overloaded with information. This study demonstrates how dietitians make use of health information technology in their practice. Support is required to overcome information technology barriers to be applied successfully in practice. It is important for dietitians to stay current with technological advancements. Dietitians will be able to stay relevant and continue to support evidence-based practice if they do so now and in the future.

Strategic Complements or Substitutes? The Case of Adopting Health Information Technology by U.S. Hospitals

Abstract This paper explores the adoption choice of electronic medical records by U.S. hospitals, which could exhibit strategic complements or substitutes. I find complementarities in adoption through a reduced-form analysis with instruments for unobserved market characteristics. I further develop a dynamic oligopoly model to allow for strategic timing incentives that are missing in the static model. Adopting a dominant local vendor could increase per period profits from adoption by 9.2% over choosing a marginal vendor. A counterfactual analysis suggests that an incentive program rewarding coordination, not just adoption, is more effective in achieving interoperability, especially before the widespread adoption of the technology.

The digital divide: Racial disparities in adoption and utilization of health information technology among patients with lymphoid cancers.

Health information technology (HIT) has the potential to improve healthcare delivery and engagement. Studying racial-ethnic disparities in HIT engagement will help understand and overcome challenges to healthcare utilization. We undertook a patient-reported survey among patients with lymphoid malignancies at two campuses of Mayo Clinic, Florida to explore HIT-related disparities. Variables between Whites and non-Whites, and non-Whites from the two campuses were compared. The survey was completed by 1004 respondents, with 71% whites, 27% non-Whites (race-ethnicity not reported by 2%). Non-Whites included 30% responders at the main campus and 64% at an inner-city campus. Whites were significantly older and had higher education, while non-Whites had lesser access to a computer. Only 51% of non-Whites were registered to use electronic medical records (EMR) as compared to 72% Whites (p < 0.001) and significantly lesser number of non-Whites even knew that EMR existed (81% vs. 92%, p < 0.001). Encouragingly, a higher number of non-Whites wanted to engage in EMR. Non-Whites from the main campus were older, more educated and had more access to a computer as compared to those from the inner-city campus. Similar disparate factors were noted among minorities from the two campuses, suggesting impact of socioeconomic backgrounds on EMR usage among non-Whites. Linguistic barriers were more striking among inner-city campus non-Whites. Non-Whites continue to struggle with suboptimal utilization of the healthcare system and barriers related to integration in HIT, including disparities representing socioeconomic differences. Efforts need to be made at several levels to help racial-ethnic minorities overcome awareness, access, and linguistic barriers to HIT utilization.

Health Systems Need to Transform Data Collection to Advance Health Equity.

Health Systems Need to Transform Data Collection to Advance Health Equity.

Probing into Federal Policies and National Academies’ Recommendations to Adopt Health Information Technology in All U.S. Nursing Homes

Probing into Federal Policies and National Academies’ Recommendations to Adopt Health Information Technology in All U.S. Nursing Homes

What is the level of information technology maturity in Ontario’s long-term care homes? A cross-sectional survey study protocol

IntroductionThe number of Canadians 75 years and older is expected to double over the next 20 years, putting continuing care systems such as long-term care (LTC) homes under increasing pressure....

Probing into Federal Policies and National Academies' Recommendations to Adopt Health Information Technology in All U.S. Nursing Homes.

Probing into Federal Policies and National Academies' Recommendations to Adopt Health Information Technology in All U.S. Nursing Homes.

Opportunities and Challenges to Advance Health Equity Using Digital Health Tools in Underserved Communities in Southeast US: A Mixed Methods Study.

Over the last 30 years, the adoption of health information technology and digital health tools (DHTs) into the US health system has been instrumental to improving access to care, especially for people living in rural, underserved, and underrepresented communities. Despite widespread adoption of DHTs by primary care clinicians, documented challenges have contributed to inequitable use and benefit. The COVID-19 pandemic necessitated rapid adoption of DHTs, accelerated by state and federal policy changes, in order to meet patient needs and ensure access to care. The Digital Health Tools Study employed a mixed methods approach to assess adoption and use of DHTs by primary care clinicians in southeastern states and identify individual- and practice-level barriers and facilitators to DHT implementation. A survey was conducted using a multi-modal recruitment strategy: newsletters, meeting/conference presentations, social media, and emails/calls. Focus groups were conducted to assess priorities, barriers, and facilitators and were recorded/transcribed verbatim. Descriptive statistics were calculated for survey results, produced for the whole sample, and stratified by state. Thematic analysis was conducted of focus group transcripts. There were 1215 survey respondents. About 55 participants who had missing demographic information were excluded from the analysis. About 99% of clinicians used DHTs in the last 5 years, modalities included: telehealth (66%), electronic health records (EHRs; 66%), patient portals (49%), health information exchange (HIE; 41%), prescription drug monitoring programs (39%), remote/home monitoring (27%), and wearable devices (22%). Time (53%) and cost (51%) were identified as barriers. About 61% and 75% of clinicians reported being "satisfied" to "very satisfied" with telemedicine and EHRs, respectively. Seven focus groups with 25 clinicians were conducted and indicated COVID-19 and the use of supplemental tools/apps to connect patients to resources as major motivators for adopting DHTs. Challenges included incomplete and difficult-to-utilize HIE interfaces for providers and internet/broadband access and poor connectivity for patients. This study describes the impact adopting DHTs by primary care clinicians has on expanded access to healthcare and reducing health disparities in regions with longstanding health and social inequities. The findings identify opportunities to leverage DHTs to advance health equity and highlight opportunities for policy improvement.

Health Information Technology Adoption at U.S. Home Health Care Agencies: Results from a Multi-Methods Study.

Health information technology (HIT) holds potential to transform Home Health Care (HHC), yet, little is known about its adoption in this setting. In the context of infection prevention and control, we aimed to: (1) describe challenges associated with the adoption of HIT, for example, electronic health records (EHR) and telehealth and (2) examine HHC agency characteristics associated with HIT adoption. We conducted in-depth interviews with 41 staff from 13 U.S. HHC agencies (May-October 2018), then surveyed a stratified random sample of 1506 agencies (November 2018-December 2019), of which 35.6% participated (N = 536 HHC agencies). We applied analytic weights, generating nationally-representative estimates, and computed descriptive statistics, bivariate and multivariable analyses. Four themes were identified: (1) Reflections on providing HHC without EHR; (2) Benefits of EHR; (3) Benefits of other HIT; (4) Challenges with HIT and EHR. Overall, 10% of the agencies did not have an EHR; an additional 2% were in the process of acquiring one. Sixteen percent offered telehealth, and another 4% were in the process of acquiring telehealth services. In multivariable analysis, EHR use varied significantly by geographic location and ownership, and telehealth use varied by geographic location, ownership, and size. Although HIT use has increased, our results indicate that many HHC agencies still lack the HIT needed to implement technological solutions to improve workflow and quality of care. Future research should examine the impact of HIT on patient outcomes and the impact of the COVID-19 pandemic on HIT use in HHC.

IMPACT OF EHR IMPLEMENTATION IN NURSING HOMES ON FINANCIAL PERFORMANCE

Abstract Nursing homes (NHs) are a critical part of the US healthcare system providing care to the sick and fragile elderly, and research suggests that they can benefit from the implementation of health information technology (HIT). However, for multiple reasons—exclusion from HITECH incentives; limited financial wherewithal; hazy return on investments (ROI), they have lagged in HIT implementation compared to other significant components of the US healthcare system. Utilizing the resource-based view (RBV) of the firm, the purpose of this study was to examine the longitudinal impact of HIT on NH financial performance potentially building a sustainable economic argument for its implementation. To examine this relationship, we merged data from five different sources between the years 2009-2013-: Health Information and Management Systems Society, LTCFocus, Online Survey Certification and Reporting/Certification and Survey Provider Enhanced Reporting, Area Health Resource Files, and Medicare Cost Reports. The outcome variable was financial performance which was measured in four ways: operating cost and revenue, operating margin, and total margin. The independent variable of interest was HIT implementation and was measured using a novel HIT Adoption Score (HAS) reflecting NH implementation of five different HIT applications. Four separate multivariate linear regression models were estimated, and we included a series of organizational and market characteristics in the analyses. We report a positive association between NH implementation and improved profitability (operating margin) (p≤0.01), and lower operating cost (p≤0.05). Our results, suggesting a potential business case for EHR implementation within NHs, have important policy and managerial implications that are discussed.

Transition to a new nursing information system embedded with clinical decision support: a mixed-method study using the HOT-fit framework

BackgroundNursing information systems embedded with standardized nursing language and clinical decision support have been increasingly introduced in health care settings. User experience is key to the adoption of health information technologies. Despite extensive research into the user experience with nursing information systems, few studies have focused on the interaction between user, technology and organizational attributes during its implementation. Guided by the human, organization and technology-fit framework, this study aimed to investigate nurses’ perceptions and experiences with transition to a new nursing information system (Care Direct) 2 years after its first introduction.MethodsThis is a mixed-method study using an embedded design. An online survey was launched to collect nurses’ self-reported use of the new system, perceived system effectiveness and experience of participation in system optimization. Twenty-two semi structured interviews were conducted with twenty nurses with clinical or administrative roles. The quantitative and qualitative data were merged using the Pillar Integration Process.ResultsThe average score of system use behavior was 3.76 ± 0.79. Regarding perceived system effectiveness, the score of each dimension ranged 3.07–3.34 out of 5. Despite large variations in approaches to participating in system optimization, nurses had generally positive experiences with management and technical support. Eight main categories emerged from the integrated findings, which were further condensed into three themes: perceptions on system content, structure, and functionality; perceptions on interdisciplinary and cross-level cooperation; and embracing and accepting the change.ConclusionsEffective collaboration between clinicians, administrators and technical staff is required during system promotion to enhance system usability and user experience. Clear communication of organizational missions to staff and support from top management is needed to smooth the system implementation process and achieve broader system adoption.

Effects of Hospital Digitization on Clinical Outcomes and Patient Satisfaction: Nationwide Multiple Regression Analysis Across German Hospitals.

The adoption of health information technology (HIT) by health care providers is commonly believed to improve the quality of care. Policy makers in the United States and Germany follow this logic and deploy nationwide HIT adoption programs to fund hospital investments in digital technologies. However, scientific evidence for the beneficial effects of HIT on care quality at a national level remains mostly US based, is focused on electronic health records (EHRs), and rarely accounts for the quality of digitization from a hospital user perspective. This study aimed to examine the effects of digitization on clinical outcomes and patient experience in German hospitals. Hence, this study adds to the small stream of literature in this field outside the United States. It goes beyond assessing the effects of mere HIT adoption and also considers user-perceived HIT value. In addition, the impact of a variety of technologies beyond EHRs was examined. Multiple linear regression models were estimated using emergency care outcomes, elective care outcomes, and patient satisfaction as dependent variables. The adoption and user-perceived value of HIT represented key independent variables, and case volume, hospital size, ownership status, and teaching status were included as controls. Care outcomes were captured via risk-adjusted, observed-to-expected outcome ratios for patients who had stroke, myocardial infarction, or hip replacement. The German Patient Experience Questionnaire of Weisse Liste provided information on patient satisfaction. Information on the adoption and user-perceived value of 10 subdomains of HIT and EHRs was derived from the German 2020 Healthcare IT Report. Statistical analysis was based on an overall sample of 383 German hospitals. The analyzed data set suggested no significant effect of HIT or EHR adoption on clinical outcomes or patient satisfaction. However, a higher user-perceived value or quality of the installed tools did improve outcomes. Emergency care outcomes benefited from user-friendly overall digitization (β=-.032; P=.04), which was especially driven by the user-friendliness of admission HIT (β=-.023; P=.07). Elective care outcomes were positively impacted by user-friendly EHR installations (β=-.138; P=.008). Similarly, the results suggested user-friendly, overall digitization to have a moderate positive effect on patient satisfaction (β=-.009; P=.01). The results of this study suggest that hospital digitization is not an end in itself. Policy makers and hospitals are well advised to not only focus on the mere adoption of digital technologies but also continuously work toward digitization that is perceived as valuable by physicians and nurses who rely on it every day. Furthermore, hospital digitization strategies should consider that the assumed benefits of single technologies are not realized across all care domains.

Identifying the Trends of Global Publications in Health Information Technology Using Text-mining Techniques

Background: Due to the increased publication of articles in various scientific fields, analyzing the published topics in specialized journals is important and necessary. Objectives: This research has identified the published topics in global publications in the health information technology (HIT) field. Methods: This study analyzed articles in the field of HIT using text-mining techniques. For this purpose, 162,994 documents were extracted from PubMed and Scopus databases from 2000 to 2019 using the appropriate search strategy. Text mining techniques and the Latent Dirichlet Allocation (LDA) topic modeling algorithm were used to identify the published topics. Python programming language has also been used to run text-mining algorithms. Results: This study categorized the subject of HIT-related published articles into 16 topics, the most important of which were Telemedicine and telehealth, Adoption of HIT, Radiotherapy planning techniques, Medical image analysis, and Evidence-based medicine. Conclusions: The results of the trends of subjects of HIT-related published articles represented the thematic extent and the interdisciplinary nature of this field. The publication of various topics in this scientific field has shown a growing trend in recent years.

Learning health system, positive deviance analysis, and electronic health records: Synergy for a learning health system.

Over the past decade, numerous efforts have encouraged the realization of the learning health system (LHS) in the United States. Despite these efforts, and promising aims of the LHS, the full potential and value of research conducted within LHSs have yet to be realized. New technology coupled with a catalyzing global pandemic have spurred momentum. In addition, the LHS has lacked a consistent framework within which "best evidence" can be identified. Positive deviance analysis, itself reinvigorated by recent advances in health information technology (IT) and ubiquitous adoption of electronic health records (EHRs), may finally provide a framework through which LHSs can be operationalized and optimized. We describe the synergy between positive deviance and the LHS and how they may be integrated to achieve a continuous cycle of health system improvement. As we describe below, the positive deviance approach focuses on learning from high-performing teams and organizations. Such learning can be enabled by EHRs and health IT, providing a lens into how digital clinical interventions are successfully developed and deployed.

Pay-for-performance schemes and hospital HIT adoption

Pay-for-performance (P4P) schemes are implemented to incentivize or penalize hospitals for their safe caregiving. Given that health information technology (HIT) results in better healthcare outcomes, P4P schemes are expected to promote hospital HIT adoption. However, P4P schemes could also discourage hospitals from adopting HIT because they may take away resources initially allocated for HIT adoption. This paper is one of the first to empirically investigate the double-edged role of P4P schemes in HIT adoption. We leverage a natural experiment in the US healthcare system, which introduced P4P schemes in 2013. Our empirical analysis reveals an unintended side effect of P4P schemes that could potentially impede HIT adoption. We also find that P4P schemes have a negative spillover effect on nonparticipating hospitals in the same multihospital system (MHS) as participating hospitals, particularly for small nonparticipating hospitals. Our findings provide important implications for health policy design and MHS management.