Health Information Technology Usage Research Articles

Health Information Technology Use among Chronic Disease Patients: An Analysis of the United States Health Information National Trends Survey.

Chronic disease is the leading cause of mortality in the United States. Health information technology (HIT) tools show promise for improving disease management. This study aims to understand the following: (1) how self-perceptions of health compare between those with and without disease; (2) how HIT usage varies between chronic disease profiles (diabetes, hypertension, cardiovascular disease, pulmonary disease, depression, cancer, and comorbidities); (3) how HIT trends have changed in the past 6 years; and (4) the likelihood that a given chronic disease patient uses specific HIT tools. The Health Information National Trends Survey (HINTS) inclusive of 2014 to 2020 served as the primary data source with statistical analysis completed using Stata. Bivariate analyses and two-tailed t-tests were conducted to compare self-perceived health and HIT usage to chronic disease. Logistic regression models were created to examine the odds of a specific patient using various forms of HIT, controlling for demographics and comorbidities. Logistic regression models controlling for sociodemographic factors and comorbidities showed that pulmonary disease, depression, and cancer patients had an increased likelihood of using HIT tools, for example, depression patients had an 81.1% increased likelihood of looking up health information (p < 0.0001). In contrast, diabetic, high blood pressure, and cardiovascular disease patients appeared to use HIT tools at similar rates to patients without chronic disease. Overall HIT usage has increased during the timeframe examined. This study demonstrates that certain chronic disease cohorts appear to have greater HIT usage than others. Further analysis should be done to understand what factors influence patients to utilize HIT which may provide additional insights into improving design and user experience for other populations with the goal of improving management of disease. Such analyses could also establish a new baseline to account for differences in HIT usage as a direct consequence of the novel coronavirus disease 2019 (COVID-19) pandemic.

Health information technology adoption and acceptance of Turkish physicians-A model proposal and empirical assessment.

Health Information Technology (HIT) systems are receiving increasing attention in recent years. Yet, individual adoption research in health care settings, especially in developing countries are quite limited. Moreover, large body of Information Systems research has focused on user perceptions to form intentions to use a particular technology. However, the antecedents and consequences of perceptions remained largely unanswered in existing research. This study aims to fill this gap by proposing and testing a research model based on a modified Technology Acceptance Model (m - TAM) which incorporates socio psychological and cognitive factors to assess the HIT's adoption level of Turkish physicians. To do so, two different methods were used to collect data from head physicians, assistant head physicians, and physicians: face to face and online survey. Total 212 useful responses were returned. 174 of them were face-to-face surveys which were administrated to all the first level and some second and third level health organizations. The rest of the surveys were administrated to the second and third level healthcare organizations via online participation. Data were analyzed by Structural Equation Modelling via SmartPLS software program. Results present that commitment is a strong predictor of HIT usage, whereas neither motivation nor resistance has a significant impact on HIT usage.

Do EHR and HIE deliver on their promise? Analysis of Pennsylvania acute care hospitals

BackgroundThe HITECH Act of 2009 promoted the use of health information technology (HIT). There is limited research on the effect of health information exchange (HIE) on healthcare outcomes and cost. Analyzing data from the recent past provides us an excellent opportunity to determine EHR and HIE's impact on hospital operations. PurposeTo investigate association between HIT (EHR and HIE) and quality of care, hospital efficiency, and patient flow. MethodologyMultivariable regression models using panel data with year fixed effects and hospital individual effects were used. Outcome variables were readmission index and mortality index (quality of care), cost per inpatient day and cost per inpatient admission (hospital efficiency), and average length of stay (patient flow). We use two variables to measure HIT usage – proportion of functionalities owned/utilized under electronic health records (EHR) and HIE. We use four years of data (2014-17) on 115 acute care hospitals in Pennsylvania from five different data sources. ResultsWe find evidence for efficiency (lower costs) improvement associated with HIE and for EHR associated with reduced mortality. Also, HIE is adversely associated with mortality. Other effects were not significant. ConclusionEHR and HIE usage in the hospitals may not be enough or optimal. The healthcare system may also suffer from integration issues. Diffusion of technology is a slow process and users may take time to understand and learn how to apply effectively. Managers and policy makers must be wary of the short- and long-term effect of technology investments on hospital efficiency and quality of care.

Sociodemographic disparities in the use of health information technology by a national sample of head and neck cancer patients

BackgroundQuantifying disparities in health information technology (HIT) use among head and neck cancer (HNC) patients may help clinicians reduce care gaps and improve outcomes. MethodsRelationships between HIT usage and sociodemographic characteristics were studied for adults with HNC between 2011 and 2018 through a retrospective analysis of the US National Health Interview Survey. ResultsMultivariate logistic regression indicated HIT usage disparities based on race, age, educational attainment, and insurance status. Black (aOR 0.07, 95% CI 0.01–0.52, P = 0.010), uninsured (aOR 0.21, 95% CI 0.06–0.79, P = 0.022), and senior patients (aOR 2.72, 95% CI 1.55–4.80, P < 0.001) emailed providers less than non-Hispanic White, privately insured, and middle-aged (45–64) patients, respectively. Similar disparities were found among patients searching for health information, scheduling appointments, and filling prescriptions online. ConclusionBlack, older, less educated, and un/underinsured HNC patients use HIT less than their counterparts. Reducing these inequities may help improve their outcomes.

Sexual Orientation Effects in Health Information Technology Usage: Increasing Equity in Access While Physical Distancing

In the face of surging cases of the coronavirus SARS-CoV-2 (COVID-19), healthcare professionals are searching for ways to provide care to the general public that obviates the need for in-person contact. Pervasive heterosexism and social stigma have long presented structural barriers to care for sexual (i.e., lesbian, gay, bisexual) and gender (i.e., trans-identified, nonbinary, gender fluid) minority health service users. Health information technology (HIT) creates an opportunity for enhanced healthcare and communications that can simultaneously reduce harmful barriers to care, while also maintaining physical distancing to reduce COVID-19 exposure. While research has demonstrated the value of HIT usage for purchasing medications, communicating with healthcare providers, seeking health information, and managing personal health records, there remains a dearth of published empirical research concerning the participation in online health-related activities among sexual minorities, particularly emerging adults. In order to address this gap, we examined HIT usage as a function of sexual orientation through the secondary analysis of data collected in the National Health Interview Survey (2016–2018). Using multivariate analysis, we assessed the likelihood of using technology as a resource for health-related care and communication in sexual and gender minority (SGM) and heterosexual participants. After adjusting for demographic and health variables, SGM male and female participants had increased odds of HIT use when compared to their heterosexual counterparts. Results indicate that health information technologies might be an innovative means of increasing access to care for stigmatized populations, while also ameliorating the choice between risking COVID-19 exposure during a clinical visit or postponing needed care.

Level of agreement on health information technology adoption and use in survey data: a mixed-methods analysis of ambulatory clinics in 1 US state.

ObjectiveAdoption of health information technology (HIT) is often assessed in surveys of organizations. The validity of data from such surveys for ambulatory clinics has not been evaluated. We compared level of agreement between 1 ambulatory statewide survey and 2 other data sources: a second survey and interviews with survey respondents.Materials and methodsWe used 2016 data from 2 surveys of ambulatory providers in Minnesota—the Healthcare Information and Management Systems Society (HIMSS) survey and the Minnesota HIT Ambulatory Clinic Survey—and primary data collected through qualitative interviews with survey respondents. We conducted a concurrent triangulation mixed-methods assessment of the Minnesota HIT survey by assessing level of agreement between it and HIMSS, and a thematic analysis of interview data to assess the respondent’s understanding of what was being asked and their approach to responding.ResultsWe find high agreement between the 2 surveys on questions related to common HIT functionalities—such as computerized provider order entry, medication-based decision support, and e-prescribing—which were widely adopted by respondents’ organizations. Qualitative data suggest respondents found wording of items about these functionalities clear but encountered multiple challenges including interpreting items for less commonly adopted functionalities, estimating degree of HIT usage, and indicating relevant barriers. Respondents identified multiple errors in responses and likely reported greater within-group homogeneity than actually existed.ConclusionsSurvey items related to the presence or absence of widely adopted HIT functionalities may be more valid than items about less common functionalities, degree of usage, and barriers.

Adoption of Health Information Technology Among US Nursing Facilities

ObjectivesNursing facilities have lagged behind in the adoption of interoperable health information technology (ie technologies that allow the sharing and use of electronic patient information between different information systems). The objective of this study was to estimate the nationwide prevalence of electronic health record (EHR) adoption among nursing facilities and to identify the factors associated with adoption. DesignCross-sectional survey. Setting & participantsWe surveyed members of the Society for Post-Acute & Long-Term Care Medicine (AMDA) about their organizations’ health information technology usage and characteristics. MeasurementsUsing questions adopted from existing instruments, the survey measured nursing home's EHR adoption, the ability to send, receive, search and integrate electronic information, as well as barriers to usage. Additionally, we linked survey responses to public use secondary data sources to construct measurements for 8 determinants known to be associated with organizational adoption: innovativeness, functional differentiation, role specialization, administrative intensity, professionalism, complexity, technical knowledge resources, and slack resources. A series of regression models estimated the association between potential determinants and technology adoption. Results84% of nursing facilities reported using an EHR. After controlling for all other factors, respondents who characterized their organization as more innovative had more than 6 times the odds (adjusted odds ratio = 6.39, 95% confidence interval = 2.69, 15.21) of adopting an EHR. Organization innovativeness was also associated with an increased odds of being able to send, integrate, and search for electronic information. The most commonly identified barrier to sharing clinical information among nursing facilities with an EHR was a reported absence of interoperability (57%). Conclusions/ImplicationsAn organizational culture that fosters innovation and awareness campaigns by professional societies may facilitate further adoption and effective use of technology. This will be increasingly important as policy makers continue to emphasize the use of EHRs and interoperability to improve the quality of care in nursing facilities.

Comparison of Health Information Technology Use Between American Adults With and Without Chronic Health Conditions: Findings From The National Health Interview Survey 2012.

BackgroundHealth information technology (HIT) is utilized by people with different chronic conditions such as diabetes and hypertension. However, there has been no comparison of HIT use between persons without a chronic condition, with one chronic condition, and multiple (≥2) chronic conditions (MCCs).ObjectiveThe aim of the study was to assess the difference in HIT use between persons without a chronic condition, with one chronic condition, and with MCCs, to describe the characteristics of HIT use among those with chronic conditions and to identify the predictors of HIT use of the persons with one chronic condition and MCCs.MethodsA secondary data analysis was conducted in spring 2017 using the National Health Interview Survey (NHIS) 2012 Family Core and Sample Adult Core datasets that yielded 34,525 respondents aged 18 years and older. Measures included overall HIT use (ie, any use of the following five HIT on the Internet: seeking health information, ordering prescription, making appointment, emailing health provider, and using health chat groups), as well as sociodemographic and health-related characteristics. Sociodemographic and health characteristics were compared between HIT users and nonusers among those who reported having at least one chronic condition using chi-square tests. Independent predictors of HIT use were identified using multiple logistic regression analyses for those with one chronic condition, with MCCs, and without a chronic condition. Analyses were weighted and performed at significance level of .005.ResultsIn 2012, adults with one health chronic condition (raw count 4147/8551, weighted percentage 48.54%) was significantly higher than among those with MCCs (3816/9637, 39.55%) and those with none of chronic condition (7254/16,337, 44.40%, P<.001). Seeking health information was the most prevalent HIT use. Chi-square tests revealed that among adults with chronic conditions, those who used HIT were significantly different from their counterpart peers who did not use HIT in terms of sociodemographic and health characteristics (P<.001). Overall, the significant factors related to HIT use were similar among the adults with one chronic condition, with MCCs, or without a chronic condition: younger age, female sex, non-Hispanic white, higher education level, and higher income level were shown to be positively related to the HIT use.ConclusionsThis study provides a snapshot of HIT use among those with chronic conditions and potential factors related to such use. Clinical care and public health communication efforts attempting to leverage more HIT use should acknowledge differential HIT usage as identified in this study to better address communication inequalities and persistent disparities in socioeconomic status.

An Ethnographic Study of Health Information Technology Use in Three Intensive Care Units.

To identify the impact of a full suite of health information technology (HIT) on the relationships that support safety and quality among intensive care unit (ICU) clinicians. A year-long comparative ethnographic study of three academic ICUs was carried out. A total of 446hours of observational data was collected in the form of field notes. A subset of these observations-134hours-was devoted to job-shadowing individual clinicians and conducting a time study of their HIT usage. Significant variation in HIT implementation rates and usage was noted. Average HIT use on the two "high-use" ICUs was 49 percent. On the "low-use" ICU, it was 10 percent. Clinicians on the high-use ICUs experienced "silo" effects with potential safety and quality implications. HIT work was associated with spatial, data, and social silos that separated ICU clinicians from one another and their patients. Situational awareness, communication, and patient satisfaction were negatively affected by this siloing. HIT has the potential to accentuate social and professional divisions as clinical communications shift from being in-person to electronically mediated. Socio-technically informed usability testing is recommended for those hospitals that have yet to implement HIT. For those hospitals already implementing HIT, we suggest rapid, locally driven qualitative assessments focused on developing solutions to identified gaps between HIT usage patterns and organizational quality goals.

Health Literacy and Health Information Technology Adoption: The Potential for a New Digital Divide.

BackgroundApproximately one-half of American adults exhibit low health literacy and thus struggle to find and use health information. Low health literacy is associated with negative outcomes including overall poorer health. Health information technology (HIT) makes health information available directly to patients through electronic tools including patient portals, wearable technology, and mobile apps. The direct availability of this information to patients, however, may be complicated by misunderstanding of HIT privacy and information sharing.ObjectiveThe purpose of this study was to determine whether health literacy is associated with patients’ use of four types of HIT tools: fitness and nutrition apps, activity trackers, and patient portals. Additionally, we sought to explore whether health literacy is associated with patients’ perceived ease of use and usefulness of these HIT tools, as well as patients’ perceptions of privacy offered by HIT tools and trust in government, media, technology companies, and health care. This study is the first wide-scale investigation of these interrelated concepts.MethodsParticipants were 4974 American adults (n=2102, 42.26% male, n=3146, 63.25% white, average age 43.5, SD 16.7 years). Participants completed the Newest Vital Sign measure of health literacy and indicated their actual use of HIT tools, as well as the perceived ease of use and usefulness of these applications. Participants also answered questions regarding information privacy and institutional trust, as well as demographic items.ResultsCross-tabulation analysis indicated that adequate versus less than adequate health literacy was significantly associated with use of fitness apps (P=.02), nutrition apps (P<.001), activity trackers (P<.001), and patient portals (P<.001). Additionally, greater health literacy was significantly associated with greater perceived ease of use and perceived usefulness across all HIT tools after controlling for demographics. Regarding privacy perceptions of HIT and institutional trust, patients with greater health literacy often demonstrated decreased privacy perceptions for HIT tools including fitness apps (P<.001) and nutrition apps (P<.001). Health literacy was negatively associated with trust in government (P<.001), media (P<.001), and technology companies (P<.001). Interestingly, health literacy score was positively associated with trust in health care (P=.03).ConclusionsPatients with low health literacy were less likely to use HIT tools or perceive them as easy or useful, but they perceived information on HIT as private. Given the fast-paced evolution of technology, there is a pressing need to further the understanding of how health literacy is related to HIT app adoption and usage. This will ensure that all users receive the full health benefits from these technological advances, in a manner that protects health information privacy, and that users engage with organizations and providers they trust.

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.

Acceptance of health information technology in health professionals: An application of the revised technology acceptance model

The response of health professionals to the use of health information technology (HIT) is an important research topic that can partly explain the success or failure of any HIT application. The present study applied a modified version of the revised technology acceptance model (TAM) to assess the relevant beliefs and acceptance of HIT systems in a sample of health professionals (n = 133). Structured anonymous questionnaires were used and a cross-sectional design was employed. The main outcome measure was the intention to use HIT systems. ANOVA was employed to examine differences in TAM-related variables between nurses and medical doctors, and no significant differences were found. Multiple linear regression analysis was used to assess the predictors of HIT usage intentions. The findings showed that perceived ease of use, but not usefulness, relevance and subjective norms directly predicted HIT usage intentions. The present findings suggest that a modification of the original TAM approach is needed to better understand health professionals' support and endorsement of HIT. Perceived ease of use, relevance of HIT to the medical and nursing professions, as well as social influences, should be tapped by information campaigns aiming to enhance support for HIT in healthcare settings.

Information technology and hospice palliative care: social, cultural, ethical and technical implications in a rural setting

ObjectiveThere is a need to better understand the specific settings in which health information technology (HIT) is used and implemented. Factors that will determine the successful implementation of HIT are context-specific and often reside not at the technical level but rather at the process and people level. This paper provides the results of a needs assessment for HIT to support hospice palliative care (HPC) delivery in rural settings.MethodsRoundtable discussions using the nominal group technique were done to identify priority issues regarding HIT usage to support rural HPC delivery. Qualitative content analysis was then used to identify sociotechnical themes from the roundtable data.ResultsTwenty priority issues were identified at the roundtable session. Content analysis grouped the priority issues into one central theme and five supporting themes to form a sociotechnical framework for patient-centered care in rural settings.ConclusionThere are several sociotechnical themes and associated issues that need to be considered prior to implementing HIT in rural HPC settings. Proactive evaluation of these issues can enhance HIT implementation and also help to make ethical aspects of HIT design more explicit.

A theoretical model of health information technology usage behaviour with implications for patient safety

Primary objective: Much research and practice related to the design and implementation of information technology in health care has been atheoretical. It is argued that using extant theory to develop testable models of health information technology (HIT) benefits both research and practice. Methods and procedures: several theories of motivation, decision making, and technology acceptance are reviewed and associated theory-based principles of HIT usage behaviour are produced. Main outcomes and results: the case of medical error reporting technology is used to support the validity of the proposed HIT usage behaviour principles. Further, combining these principles produces a testable, theoretical multilevel model of HIT usage behaviour. The model provides an alternative to atheoretical research and practice related to HIT. Conclusions: developing, testing, and revising models of HIT like the one presented here is suggested to be beneficial to researchers and practitioners alike.