Healthcare Information Technology Implementation Research Articles

Information Technology in Healthcare: HHC-MOTES, a Novel Set of Metrics to Analyse IT Sustainability in Different Areas

Sustainability, as a science, is the guideline of the present work. It aims to analyse, by means of a literature review, various areas of healthcare in which information technology (IT) has been- or could be-used, leading to several sources of sustainability, for example, cost savings, better teamwork, higher quality and efficiency of medical care. After a brief introduction analysing the strategic contexts in which innovation in general, and IT in particular, can be a source of general improvements in efficiency, cost savings and service quality, the research focuses on the healthcare system by discussing the different nature of private and public organizations in terms of adopting innovations and changes and discussing the issue of consumer health costs and consumer choices. The following part focuses on the qualitative benefits of IT in healthcare and discusses the importance of metrics for measuring performance, costs and efficiency in this area. The work then qualitatively introduces a new set of Key Performance Indicators (KPI), partly based on literature from different topics and existing and validated sets of metrics, analysing, under the point of view of sustainability, the implementation of IT in healthcare, namely in management, organization, technology, environment and social fields (HHC-MOTES framework). The model, inspired by and to sustainability, can be used as a decision support at the strategic management level as well as for the analysis and investigation of the effects of IT systems in the healthcare sector from various perspectives.

Built to Learn: How Work Practices Affect Employee Learning During Healthcare Information Technology Implementation

We test the hypothesis that work practices complement IT investment, in part, by accelerating how rapidly employees acquire the skills needed to use new IT systems. We combine support request data from an EMR vendor with survey responses on work practice

A path analysis study of retention of healthcare professionals in urban India using health information technology.

BackgroundHealthcare information technology (HIT) applications are being ubiquitously adopted globally and have been indicated to have effects on certain dimensions of recruitment and retention of healthcare professionals. Retention of healthcare professionals is affected by their job satisfaction (JS), commitment to the organization and intention to stay (ITS) that are interlinked with each other and influenced by many factors related to job, personal, organization, etc. The objectives of the current study were to determine if HIT was one among the factors and, if so, propose a probable retention model that incorporates implementation and use of HIT as a strategy.MethodsThis was a cross-sectional survey study covering 20 hospitals from urban areas of India. The sample (n = 586) consisted of doctors, nurses, paramedics and hospital administrators. Data was collected through a structured questionnaire. Factors affecting job satisfaction were determined. Technology acceptance by the healthcare professionals was also determined. Interactions between the factors were predicted using a path analysis model.ResultsThe overall satisfaction rate of the respondents was 51 %. Based on factor analysis method, 10 factors were identified for JS and 9 factors for ITS. Availability and use of information technology was one factor that affected JS. The need for implementing technology influenced ITS through work environment and career growth. Also, the study indicated that nearly 70 % of the respondents had awareness of HIT, but only 40 % used them. The importance of providing training for HIT applications was stressed by many respondents.ConclusionThe results are in agreement with literature studies exploring job satisfaction and retention among healthcare professionals. Our study documented a relatively medium level of job satisfaction among the healthcare professionals in the urban area. Information technology was found to be one among the factors that can plausibly influence their job satisfaction and intention to stay. Based on the results of the study, a retention strategy has been suggested that utilizes implementation of HIT and provision of training to influence the retention of healthcare workers.

The Impact of Hospital Information Technology Bundles on Performance: an Econometric Study

Increased emphasis on healthcare information technology (HIT) following the HITECH Act has raised questions about conditions under which technology investments can lead to improved hospital cost and quality performance. Existing studies on this topic have yielded mixed results and suffer from generalizability issues due to focus on small number of technologies, small sample sizes, specific hospital settings and use of cross-sectional data. We address these gaps by taking a portfolio view of HIT implementation using a large longitudinal dataset of 3615 US hospitals from 2008-2011. We classify 80 HITs into three bundles based on their functionality and the extent of interaction with the caregivers: Clinical, Caregivers and Support. Data from five secondary data sources is combined for the analysis. Results indicate presence of tradeoffs between Clinical and Caregiver HIT in achieving improvements in cost and quality of care. These tradeoffs however diminish with an increase in the experience of hospitals with these systems. Even with the tradeoffs, hospitals investing in HIT assets not only show better cost and quality performance but also faster improvements when compared to a base year. Overall our results suggest a preferred sequence of adoption for technology bundles.

Towards a Strategic Process Model of Governance for Agile IT Implementation: A Healthcare Information Technology Study in China

To remain competitive in the present dynamic environment, ‘governance for agility’ has become a key solution. Past literature paid little attention to understanding how governance for agility, particularly in regard to the delivery of Information Technology (IT) implementation. Using agile organisation and IT-governance theory as lenses to analyse data from a hospital case study, a strategic process model of governance for agility is empirically derived. This model suggests that agile healthcare information technology implementation is achievable via phase-based IT-governance strategies and forms which authorise decision makers to maneuver resources strategically in a dynamic environment. Theoretically, this study contributes to the dearth of empirical understanding of IT governance in the Healthcare IT literature and advances knowledge by making a conceptual distinction through introducing the use of phase-based IT-governance strategies and forms to generate agile organisational capabilities to achieve agile Healthcare IT implementation. The findings serve as a foundation for future research within the information systems (IS) discipline. Practitioners could plan an agile Healthcare IT implementation by referring to the model—a systematic roadmap for governing and strategising hospital resources and capabilities.

Users’ Commitment in Information System Implementation: The Role of Top-Management Commitment and Organizational Context

The improvement in quality of care is a primary concern and driving force in the use of Healthcare Information Technology (HIT). Notwithstanding high expectations for the value of IT (Information Technology) in healthcare, many attempts at HIT implementation have failed. Various studies of the implementation of change programs have demonstrated the importance of stakeholders’ commitment as well as organizational context when Information Systems/Information Technology (IS/IT) is implemented. Here, two case studies following the implementation of a HIT in a hospital setting are analysed, focusing on stakeholders’ commitment to the IS/IT. An understanding is sought as to how top-management commitment and organizational context influence stakeholder’s commitment to benefits achievement from HIT implementation. A qualitative, interpretative and case-based research was used employing semi-structured interviews and document analysis. Findings revealed that organizational context and top-management commitment can be particularly important to the commitment of users in achieving the expected IS/IT benefits. DOI: 10.5585/rgss.v2i1.52

Rise of the Cyborgs: Residents With Smartphones, iPads, and Androids

In this issue Lobo et al1 report the results of a pilot study surveying residents' use of iPads. This study of 12 residents found there was high self-reported use of the devices, with an average of 2.1 hours per day. Using their iPads, residents could access electronic health records along with a range of educational resources. Most residents perceived that iPads should be distributed to all residents and fellows, and that this would improve communication and efficiency. To put this pilot study in context, there has been a rapid uptake in the use of smartphones and tablets in medical practice: a recent survey estimates that 85% of residents have smartphones2 and most use smartphones for clinical work. The expected benefits of using smartphones and tablets in medical practice include improved access to knowledge and patient information, and improved communication and documentation. The future of mobile smartphones and tablets promises to be exciting, with advances in medical functionality such as mobile ultrasound. However, it is important to pause and consider the unintended consequences of the adoption of this technology. Unintended consequences are now a well-recognized phenomenon in health care information technology implementation.3 For example, there have been multiple reports of medical errors caused by information technology, such as computerized provider order entry and clinical decision support systems.4 For the unintended consequences of tablet and smartphone adoption, we may consider both noneducational and educational effects. Noneducational impacts include infection control issues with colonization of devices, which would likely be similar to other medical devices such as stethoscopes. Because of the increased connectivity of these devices to work colleagues as well as to residents' personal life, interruptions may increase in both realms. This may result in “distracted doctoring” and increased medical errors.5 If smartphones and tablets are used to communicate patient information through nonsecure messaging, there are additional privacy concerns.6 From an educational perspective, we have found that providing residents with smartphones makes them, in effect, more global and less local.6 This combined with increased interruptions can create professionalism issues. A resident may be providing good care for a patient on a distant ward when he responds quickly to a request from a nurse via smartphone or tablet. However, this act may be viewed as rudeness by the patient right in front of the resident. These devices may also negatively impact resident learning. Because devices make reaching supervisors easier, residents may defer most decision making to supervisors, with resulting loss of autonomy and learning. Tablets and smartphones also increase connections to residents' personal lives. Recently at our institution, an attending on rounds observed his medical student accessing Facebook while the attending was discussing a recently diagnosed cancer with the patient. Finally, with enhanced connectivity and increased interruptions, trainee time for thoughtful reflection may be disappearing. What is the evidence to support adoption of this technology? To date there is limited information that tablets or smartphones improve care or efficiency. However, a lack of evidence will not stop the ongoing rapid adoption of smartphones and tablets in the clinical setting. It is more important to recognize that increasingly we are “screen-staring, button-clicking” cyborgs: humans with electronic enhancements of smartphones, tablets, and apps.7 We need to understand the implications of widespread use of these devices with further research. The next steps for research should continue along the lines of this pilot study to confirm the residents' self-perceived benefits of iPads. Next, studies should look at the unintended consequences of iPads not only on residents but also other users, including nurses, physician supervisors, and patients. Studies need to examine actual observations, not just perceptions of users. In addition, methods to define and teach the rapidly evolving concept of digital professionalism will be important. From an educational point of view, there are many challenges ahead. The ability of residents to have nearly instantaneous access to knowledge and universal connectivity will likely dramatically alter how we educate residents. These changes have already begun.

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.

How and when eHealth is a good investment for patients managing chronic disease

In this article, we elaborate on the cost-effectiveness of eHealth solutions and the need to evaluate the return on investment as is done routinely with all other major expenditures. To this end, we discuss the theory that exists today to explain some of the usage principles affiliated with information technology implementation in healthcare; namely, we reflect on the Technology Adoption Criteria in Health (TEACH) model and Wagner's Chronic Disease Management model. The basic premise of the TEACH model is that adoption requires work; this work must be recognized at the outset, and the progress to overcome the workload increase must be measured for the adoption to continue. Furthermore, both of these models have emphasized that the trade-off between cost and work and the benefits realized (as seen through measurement) must first be applied to patients that use the system frequently and on an ongoing basis (ie, the chronically ill). We refer to these ongoing users as consumers of healthcare resources-Consumers with Chronic Conditions (the 3C patients). In this article, we show that the benefits outweigh the costs only when we do, in fact, apply the analysis to 3C patients. Once an effective eHealth system has been developed for the 3C patients, then it can be straightforwardly extended to include all patients and other stakeholders.

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.

Factors influencing nurses’ attitudes towards healthcare information technology

This literature review examines the current trend in nurses' attitudes toward healthcare information technology (HIT). HIT implementation and expansion are at the core of global efforts to improve healthcare quality and patient safety. As a large portion of the healthcare workforce, nurses' attitudes towards HIT are likely to have a major impact on the electronic health record (EHR) implementation process. A search of PubMed, CINAHL and Medline databases produced 1930 combined hits. Returned articles were scanned for relevancy and applicability. Thirteen articles met all criteria and were subsequently reviewed in their entirety. In accordance with two change theories, if HIT implementation projects are to be successful, nurses must recognize that incorporating EHRs into their daily practice is beneficial to patient outcomes. Overall, the attitudes of nurses toward HIT are positive. Increased computer experience is the main demographic indicator for positive attitudes. The most common detractors are poor system design, system slowdown and system downtime. Nurses are also fearful that the use of technology will dehumanize patient care. Involving nurses in system design is likely to improve post-implementation satisfaction. Creating a positive, supportive atmosphere appears to be instrumental to sustainability.

The Hayes principles: learning from the national pilot of information technology and core generalisable theory in informatics

There has been much criticism of the NHS national programme for information technology (IT); it has been an expensive programme and some elements appear to have achieved little. The Hayes report was written as an independent review of health and social care IT in England. To identify key principles for health IT implementation which may have relevance beyond the critique of NHS IT. We elicit ten principles from the Hayes report, which if followed may result in more effective IT implementation in health care. They divide into patient-centred, subsidiarity and strategic principles. The patient-centred principles are: 1) the patient must be at the centre of all information systems; 2) the provision of patient-level operational data should form the foundation - avoid the dataset mentality; 3) store health data as close to the patient as possible; 4) enable the patient to take a more active role with their health data within a trusted doctor-patient relationship. The subsidiarity principles set out to balance the local and health-system-wide needs: 5) standardise centrally - patients must be able to benefit from interoperability; 6) provide a standard procurement package and an approved process that ensures safety standards and provision of interoperable systems; 7) authorise a range of local suppliers so that health providers can select the system best meeting local needs; 8) allow local migration from legacy systems, as and when improved functionality for patients is available. And finally the strategic principles: 9) evaluate health IT systems in terms of measureable benefits to patients; 10) strategic planning of systems should reflect strategic goals for the health of patients/the population. Had the Hayes principles been embedded within our approach to health IT, and in particular to medical record implementation, we might have avoided many of the costly mistakes with the UK national programme. However, these principles need application within the modern IT environment. Closeness to the patient must not be interpreted as physical but instead as a virtual patient-centred space; data will be secure within the cloud and we should dump the vault and infrastructure mentality. Health IT should be developed as an adaptive ecosystem.

Paperless healthcare: Progress and challenges of an IT-enabled healthcare system

For most Americans, a trip to the doctor's office or a hospital stay necessitates that medical personnel search through paper charts and records as care is administered. This remains the status quo, despite the increasingly large role that electronic communication plays in other aspects of our business and personal lives. The elevated use of information technology (IT) in healthcare settings—primarily via utilization of electronic health records (EHRs), which allow information to be readily communicated and shared among healthcare providers—has been advocated as a means of improving quality of care and helping to control healthcare costs over the long term. Yet, hastened implementation of healthcare IT will require considerable cost incursion in the near term, and will present various other challenges that must be addressed. Herein, we examine the merits and benefits of healthcare IT, as well as the costs and other challenges that may serve as obstacles to its wider implementation and use. We conclude with a set of recommendations designed to increase the likelihood that extensive expansion in the use of healthcare IT will yield the desired benefits.

Macroergonomic Challenges in Implementation of Healthcare Information Technology

The proposed Macroergonomics and Patient Safety panel will address the particular challenges of healthcare information technology (HIT) and Patient Safety. The development of information technology in health care remains a driving force in American health care facilities, yet little human factors and systems engineering information is available to improve the implementation of HIT. Given the complexity of clinical informatics technology and the intricacy of modern medical care, human factors (HF) and macroergonomic analysis (MA) are especially important in the design, implementation, and use of various HIT. HF and MA should be used to better understand the challenge of developing multi-perspective evaluations for this technology. The panel of experts' presentations and the discussion to follow will address current research on patient safety and integration of HIT.

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.

Pros and Cons of Healthcare Information Technology Implementation

Countless studies and investigations have been performed siding either for or against the implementation of technology in the healthcare setting. This article presents both sides of this debate, with an obvious conclusion that the pros of this debate win. The practice of information technology in the medical domain lags behind its knowledge and discovery by at least 7 years. The key to closing this gap is to show, through various studies, how information technology systems provide decision support to users at the point in time when decisions are needed. What the reader will obtain from this article is that the pros for information technology implementation in healthcare settings weigh much more and have a greater effect than the cons.

The Potential Contribution of Social Science to Information Technology Implementation in Healthcare

Information technology systems in hospitals and other healthcare settings have sometimes proved difficult to implement successfully. Some of the problems encountered in the implementation of information technology systems in healthcare can be explained by the use of techniques and theoretical approaches derived from the social sciences, notably sociology and anthropology. Research from a variety of countries and healthcare systems confirms the explicative value of these techniques and approaches. These techniques can also be used to inform better the process of design and implementation of computer systems. Although they have been successfully applied in several industries and spread across several countries, these techniques have not yet been widely used in healthcare. This article suggests how these approaches can be fruitfully applied to the design and implementation of IT systems in healthcare and how this might be achieved.