Adoption Of Healthcare Information Technology Research Articles

The efficiency analysis and spatial implications of health information technology: A regional exploratory study in China.

The new adoption of healthcare information technology is costly, and effects on healthcare performance can be questionable. This nationwide study in China investigated the efficient performance of healthcare information technology and examined its spatial correlation. Panel data were extracted from the Annual Investigation Report on Hospital Information in China and the China Health Statistics Yearbook for 2007 through 2015 (279 observations). Stochastic frontier analysis was employed to estimate the technical efficiency of healthcare information technology performance and related factors at the regional level. Healthcare information technology performance was positively associated with electronic medical records, total input, and cost of inpatient stay, while picture archiving and communication systems and net assets were negatively related. Local Indicators of Spatial Association showed that there existed significant spatial autocorrelation. Governmental policies would best make distinctions among different forms of healthcare information technology, especially between electronic medical records and picture archiving and communication systems. Policies should be formulated to improve healthcare information technology adoption and reduce regional differences.

Examining the effects of social influence in pre-adoption phase and initial post-adoption phase in the healthcare context

Despite the widespread adoption of healthcare information technology (HIT) in hospitals, fostering physicians’ acceptance of this system is a challenging task. This study focuses on and compares two critical phases for user acceptance of HIT, namely, pre-adoption phase and initial post-adoption phase. Based on the psychological attachment theory, we propose that social influence factors exert differentiated effects on physician acceptance of HIT in these two phases. Survey results show that reward, sanction, and informational influence affect physicians’ HIT acceptance in the pre-adoption phase, whereas reward and image are significantly associated with HIT acceptance in the initial post-adoption phase.

Health Care Information Technology, Work Organization, and Nursing Home Performance

The authors investigate whether electronic medical record (EMR) systems are associated with higher levels of nursing home performance. Their difference-in-differences analysis is based on a survey of health care information technology (HIT) use in approximately 304 New York State nursing homes, combined with regulatory data from the Center for Medicaid and Medicare Studies (CMS) Nursing Home Compare database and the New York State RHCF-4 financial reports. For nursing home owners, the authors find a positive effect of EMR-system implementation, on the order of 1% higher productivity, 3% greater efficiency, but approximately 2.7% higher cost. They also find that EMR systems amplify the returns to modern workplace organization. Facilities that are one standard deviation higher on a work-organization scale—composed of practices that encourage employee collaboration, decision making, suggestions, and problem solving—have no adverse cost impact of adoption of HIT, and adoption of HIT is associated with a productivity increase of 1.5% or more. They find no evidence of an impact on health care quality.

Factors influencing adoption of clinical information system in private clinics in Chennai, India

Healthcare information technology (HIT) is being adopted to improve the quality of the care provided. However, the rate of adoption of HIT among independent practitioners appears to be significantly low. The scope of the study is to understand the factors that influence technology adoption and to evolve a model to examine the factors that influence adoption of clinical information systems by private medical practitioners in Chennai, India. Existing literature were reviewed. After studying different models, a new model was evolved through discussions with experts and validated. The research methodology will involve a descriptive study using a structured research instrument with 54 randomly chosen target population and validated with statistical tools. The Cronbach alpha score ranged between 0.75 and 0.9. The outcome should motivate the private medical practitioners to use clinical information system to manage their patient's health data and improve the quality of the care provided to patients.

Factors influencing adoption of clinical information system in private clinics in Chennai, India

Healthcare information technology (HIT) is being adopted to improve the quality of the care provided. However, the rate of adoption of HIT among independent practitioners appears to be significantly low. The scope of the study is to understand the factors that influence technology adoption and to evolve a model to examine the factors that influence adoption of clinical information systems by private medical practitioners in Chennai, India. Existing literature were reviewed. After studying different models, a new model was evolved through discussions with experts and validated. The research methodology will involve a descriptive study using a structured research instrument with 54 randomly chosen target population and validated with statistical tools. The Cronbach alpha score ranged between 0.75 and 0.9. The outcome should motivate the private medical practitioners to use clinical information system to manage their patient's health data and improve the quality of the care provided to patients.

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.

Factors affecting the adoption of healthcare information technology.

In order to improve the quality and performance of healthcare services, healthcare information technology is among the most important technology in healthcare supply chain management. This study sets out to apply and test the Unified Theory of Acceptance and Use of Technology (UTAUT), to examine the factors influencing healthcare Information Technology (IT) services. A structured questionnaire was developed and distributed to healthcare representatives in each province surveyed in Thailand. Data collected from 400 employees including physicians, nurses, and hospital staff members were tested the model using structural equation modeling technique. The results found that the factors with a significant effect are performance expectancy, effort expectancy and facilitating conditions. They were also found to have a significant impact on behavioral intention to use the acceptance healthcare technology. In addition, in Thai provincial areas, positive significance was found with two factors: social influence on behavioral intention and facilitating conditions to direct using behavior. Based on research findings, in order for healthcare information technology to be widely adopted and used by healthcare staffs in healthcare supply chain management, the healthcare organizational management should improve healthcare staffs' behavioral intention and facilitating conditions.

Perspectives on the enablers of e-heath adoption: an international interview study of leading practitioners

Studies examining the application of information technology to the delivery of health-care services often highlight the anticipated benefits. In consequence, the benefits of health-care information technology adoption, often referred to as 'e-health', are widely reported yet there is limited empirical evidence as to how such benefits can be realized. Design and implementation guidelines have been considered from a socio-technical perspective and there is support for the successful application of these principles. There are also some global surveys on the topic, but these often report only statistical data and lack richness of content. This study draws on existing literature to examine whether the principles of health-care information technology adoption are currently applied in practice. The paper presents a timely international analysis of the drivers, critical enablers and successful deployment strategies for e-health from the perspective of leading practitioners. The study considers the adoption of e-health in 15 countries. A qualitative research design was used and semistructured interviews were conducted with 38 thought leaders with expertise in health-care information systems and technology. The study presents a comparative analysis of the lessons learned from implementing, integrating and embedding e-health in practice, and presents a four-phase approach from the perspective of practitioners for the accelerated deployment of e-health systems: (i) develop a strategic approach, (ii) engage the workforce, (iii) capitalize on information technology and (iv) partner with the patient/citizen.

Emerging technologies in orthopaedics: Are we ready for the challenge?

Emerging technologies in orthopaedics: Are we ready for the challenge?

State of Content: Healthcare Executive’s Role in Information Technology Adoption

Over the past 30 years, researchers have demonstrated that health care information technology (HIT) can improve patient safety and quality of care. More recently, attention has turned increasingly to the role of information and communication technology as a means to improve clinical decision-making as well as organizational efficiency and effective- ness. Despite these streams of research, there is a lack of investigation that look at why and how health care executives leverage HIT. In this paper, the researchers investigate factors that may have an impact on health care executives’ intentions to further adopt HIT in their workplace. The analysis of collected data suggests that these factors play a significant role in increased HIT adoption in the future.

Technical Report: The Business Case for Healthcare Information Technology in Nursing Homes

We investigate whether the implementation of electronic medical records is associated with higher levels of economic performance in nursing homes in terms of quality, profitability, cost, productivity, and efficiency. Our analysis is based on a survey of Healthcare Information Technology (HIT) usage for approximately 200 New York State Nursing Homes, including 26 that participated in the NY Nursing Home Demonstration project. The survey data are combined with regulatory data from CMS Nursing Home Compare and the NY State RHCF-4 financial reports. The analysis uses a “difference in differences approach” comparing changes in economic performance in a facility before and after HIT implementation to changes over the same time periods in other facilities that are known to not have implemented HIT. Overall, we do not find conclusive evidence that adoption of HIT raises productivity, increases commonly used performance measures, or improves quality scores in the short run. There is some evidence of a positive effect after several years. We do find that there appears to be a slight increase (1-3%) in variable costs, but also slightly greater efficiency when measured by frontier analysis. However, facilities that adopt HIT and either adopt or have in place progressive work practices (which include greater staff autonomy, cooperative labor-management relations, and greater teamwork) consistently show performance gains. Firms that are one standard deviation higher on our progressive work practice score get a 2-3% increase in productivity, a 2-3% reduction in costs and a 1-2% incremental efficiency gain upon adoption of HIT relative to their peers.Our results suggest that adoption of EMR can have significant positive economic benefits when implemented in conjunction with progressive work practices.

The Use of Governance Tools in Promotion of Health Care Information Technology Adoption by Physicians

Electronic health records are important technology for health care with promises of streamlining and improving care. However, physicians have been slow to adopt the technology usually because of financial constraints. Third-party payers, including Medicare and Medicaid, are coming forward with solutions and funding. While payers have the most to gain in terms of cost savings, they have been slow to provide a solution to the financial dilemmas posed by the new technology. This article details some governance tools that are frequently used to alleviate the financial concerns. Grants, loans, and tax expenditures are some of the options available to physicians to purchase electronic health records and other types of health care information technology.

Barriers to Physicians’ Adoption of Healthcare Information Technology: An Empirical Study on Multiple Hospitals

Prior research on technology usage had largely overlooked the issue of user resistance or barriers to technology acceptance. Prior research on the Electronic Medical Records had largely focused on technical issues but rarely on managerial issues. Such oversight prevented a better understanding of users' resistance to new technologies and the antecedents of technology rejection. Incorporating the enablers and the inhibitors of technology usage intention, this study explores physicians' reactions towards the electronic medical record. The main focus is on the barriers, perceived threat and perceived inequity. 115 physicians from 6 hospitals participated in the questionnaire survey. Structural Equation Modeling was employed to verify the measurement scale and research hypotheses. According to the results, perceived threat shows a direct and negative effect on perceived usefulness and behavioral intentions, as well as an indirect effect on behavioral intentions via perceived usefulness. Perceived inequity reveals a direct and positive effect on perceived threat, and it also shows a direct and negative effect on perceived usefulness. Besides, perceived inequity reveals an indirect effect on behavioral intentions via perceived usefulness with perceived threat as the inhibitor. The research finding presents a better insight into physicians' rejection and the antecedents of such outcome. For the healthcare industry understanding the factors contributing to physicians' technology acceptance is important as to ensure a smooth implementation of any new technology. The results of this study can also provide change managers reference to a smooth IT introduction into an organization. In addition, our proposed measurement scale can be applied as a diagnostic tool for them to better understand the status quo within their organizations and users' reactions to technology acceptance. By doing so, barriers to physicians' acceptance can be identified earlier and more effectively before leading to technology rejection.

Transforming healthcare with information technology in Japan: A review of policy, people, and progress

Purpose Healthcare reform as part of the economic recovery plan in Japan is placing emphasis on the use of healthcare information technology (HIT). This research mainly focuses on the HIT efforts in Japan with reference to the US for context. The purpose is to: (a) provide detail on governmental policy impacting promotion of HIT adoption to provide services to the people of Japan, (b) describe the outcomes of past and present policy impacting progress based on a case study of HIT use in the Kyoto Yamashina area, and (c) discuss issues for refinement of current policy. Methods The method is case study, and data collection techniques include: (a) interviews of people involved in policy making for HIT in Japan (Japanese healthcare professionals, government officials, and academics involved in HIT research in Japan) and use in the medical community of HIT in the Kyoto Yamashina area, (b) archived document analysis of reports regarding government policy for HIT policy and user assessment for HIT mainly in the case study site, and (c) the literature review about HIT progression and effectiveness assessments to explore and describe issues concerning the transformation with HIT in Japan. Results This study reveals the aspects of governmental policy that have been effective in promoting successful HIT initiatives as well as some that have been detriments in Japan to help solve pressing social issues regarding healthcare delivery. For example, Japan has stipulated some standardized protocols and formats for HIT but does not mandate exactly how to engage in inter-organizational or intra-organizational health information exchange. This provides some desired autonomy for healthcare organizations and or governments in medical communities and allows for more advanced organizations to leverage current resources while providing a basis for lesser equipped organizations to use in planning the initiative. The insights gained from the Kyoto Yamashina area initiative reflect the success of past governmental policy efforts and the current intent to promote HIT adoption. Insights from the case study as well as other social issues facing Japan warrant some refinement of policy. The refinement concerns: (a) the necessity for leadership and IT knowledge in the medical communities, (b) provider incentives, (c) legislation regarding accountability, security, privacy and confidentiality, (d) inclusion of stakeholders in solution development, and (e) creating sustainable business models. Conclusion The research highlights the efforts of Japan for using HIT in healthcare reform. We present outcomes from a case study of the Kyoto Yamashina area medical community as proof of concept for past and present policy in Japan that are insightful for proliferation of successful projects in Japan and adoption of HIT in general.

PS1-25: Unintended Consequences of Implementing Healthcare Information Technology (HIT): A Survey of Users

Background: Health information technologies (HIT) such as electronic medical records (EMR), computerized physician order entry (CPOE), and clinical decision support systems (CDSS) have enhanced the quality, safety, and effectiveness of medical care. There is also optimism that widespread adoption of HIT in the United States would result in significant cost savings to both providers and consumers of healthcare. However, despite the potential benefits from adopting such technologies, the adoption rates of such technologies remain low. Many observers attribute the low adoption rates to the high financial cost of the technologies, but also to unintended consequences (UC) of HIT implementation. Methods: Online survey of HIT implementers in the HMO Research Network and American Health Information Management Association members. Results: Nearly 90% of the 224 respondents were administrators or managers. The UC occurred within EMR (37.4%, N = 83), eMAR (1.4%, N = 3), other HIT system (7.2%, N = 16), or a combination of ≥ 2 systems (54.1%, N = 120). Over 60% of the systems were hospital based and 52.5% were initial implementations while 19.8% were upgrades. The majority of UC involved technical problems (46.4%) or workflow issues (39.2%). Each of the following UC occurred about 30% of the time; increased workload, poorly integrated systems, or process errors. Even after remediation efforts, the UC persisted 79.7% of the time. Conclusions: UC are common in HIT and difficult to resolve. Involve all stakeholders in HIT planning, implementation, and remediation processes.

More than just a question of technology: Factors related to hospitals’ adoption and implementation of health information exchange

Introduction The provisions of the American Recovery & Reinvestment Act increased the likelihood of more widespread health information exchange (HIE), the electronic transfer of patient-level information between organizations, by essentially mandating the use of electronic health record systems. While important, the sparse body of research on HIE efforts and anecdotal reports indicate the barriers to HIE adoption and implementation include factors beyond simply the presence or absence of a specific technology. Methods This paper examines those technological, organizational, and environmental factors that are associated with both HIE adoption and implementation in a sample of 4830 U.S. hospitals. Factors associated with adoption and implementation were modeled using random-intercept logistic regression. Results Consistent with a perspective that adoption and implementation are different phenomena, many factors associated with an increased odds of adoption, were unassociated with implementation and vice versa. Non-profit status, public hospitals, more live and operation applications, more emergency room visits, network membership, and the presence of physician portals all increased hospitals’ odds of HIE adoption. However, only network membership increased the odds of HIE implementation, whereas competition decreased those odds significantly. Conclusions This study agreed with earlier case-studies and anecdotal reports that factors beyond technology were important to both adoption and implementation. While current U.S. policy on healthcare information technology adoption focuses on technological barriers, many other non-technological factors may ultimately hinder effective HIE.

The Differential Performance Effects of Healthcare Information Technology Adoption1

This article examines the relationship between the adoption of healthcare information technology (HIT) and a hospital's operational performance. Combining primary survey data from Florida hospitals and secondary data from two government agencies responsible for hospital certification and licensing, the authors find differential performance effects for different clusters of HIT: administrative, clinical, and strategic. Only clinical HIT investments were found to have a statistically significant positive effect on operational performance.

HIT or Miss: the application of health care information technology to managing uncertainty in clinical decision making

To discuss the usefulness of health care information technology (HIT) in assisting care providers minimize uncertainty while simultaneously increasing efficiency of the care provided. An ongoing study of HIT, performance measurement (clinical and production efficiency) and their implications to the payment for care represents the design of this study. Since 2006, all Maryland hospitals have embarked on a multi-faceted study of performance measures and HIT adoption surveys, which will shape the health care payment model in Maryland, the last of the all-payor states, in 2011. This paper focuses on the HIT component of the Maryland care payment initiative. While the payment model is still under review and discussion, 'appropriateness' of care has been discussed as an important dimension of measurement. Within this dimension, the 'uncertainty' concept has been identified as associated with variation in care practices. Hence, the methods of this paper define how HIT can assist care providers in addressing the concept of uncertainty, and then provides findings from the first HIT survey in Maryland to infer the readiness of Maryland hospital in addressing uncertainty of care in part through the use of HIT. Maryland hospitals show noteworthy variation in their adoption and use of HIT. While computerized, electronic patient records are not commonly used among and across Maryland hospitals, many of the uses of HIT internally in each hospital could significantly assist in better communication about better practices to minimize uncertainty of care and enhance the efficiency of its production.

Health Care Information Technology in Rural America: Electronic Medical Record Adoption Status in Meeting the National Agenda

Continuing is a national political drive for investments in health care information technology (HIT) that will allow the transformation of health care for quality improvement and cost reduction. Despite several initiatives by the federal government to spur this development, HIT implementation has been limited, particularly in the rural market. The status of technology use in the transformation effort is reviewed by examining electronic medical records (EMRs), analyzing the existing rural environment, identifying barriers and factors affecting their development and implementation, and recommending needed steps to make this transformation occur, particularly in rural communities. A review of the literature for HIT in rural settings indicates that very little progress has been made in the adoption and use of HIT in rural America. Financial barriers and a large number of HIT vendors offering different solutions present significant risks to rural health care providers wanting to invest in HIT. Although evidence in the literature has demonstrated benefits of adopting HIT such as EMRs, important technical, policy, organizational, and financial barriers still exist that prevent the implementation of these systems in rural settings. To expedite the spread of HIT in rural America, federal and state governments along with private payers, who are important beneficiaries of HIT, must make difficult decisions as to who pays for the investment in this technology, along with driving standards, simplifying approaches for reductions in risk, and creating a workable operational plan.

Hospital Financial Performance

This study examined whether information technology (IT) governance, a term describing the decision authority and reporting structures of the chief information officer (CIO), is related to the financial performance of hospitals. The study was conducted using a combination of primary survey data regarding health care IT adoption and reporting structures of Florida acute care hospitals, with secondary data on hospital financial performance. Multiple regression models were used to evaluate the relationship of the 3 most commonly identified reporting structures. Outcome variables included measures of operating revenue and operating expense. All models controlled for overall IT adoption, ownership, membership in a hospital system, case mix, and hospital bed size. The results suggest that IT governance matters when it comes to hospital financial performance. Reporting to the chief financial officer brings positive outcomes; reporting to the chief executive officer has a mixed financial result; and reporting to the chief operating officer was not associated with discernible financial impact.