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

Hospital process performance and the adoption of medical devices: An organization-based view

Over the past two decades, there has been a growing scholarly interest in the adoption of technology in healthcare. While numerous studies have delved into the effects of specific technologies on the performance of different organizational units and medical specialties, the findings have often been divergent. Unlike the established literature, our approach focuses on the organization's perspective to analyze how technology impacts process performance in hospital settings. More precisely, we compiled a tailored dataset from 56 healthcare organizations in Italy and conducted a comprehensive analysis of panel data from 2016 to 2019, utilizing Ordinary Least Squares (OLS) regression as our main analytical tool. The data shows a clear relationship between an organization's use of medical devices and its overall process performance. Our research highlights the importance of achieving substantial improvements in process performance by strategically integrating new technologies and devices. Policymakers are encouraged to consider introducing incentives to drive hospitals to invest in innovative technologies. Furthermore, monitoring expenditures on new devices could serve as a valuable metric for assessing the extent of technology adoption within clinical practices.

Ensuring useful adoption of generative artificial intelligence in healthcare

OBJECTIVES

This article aims to examine how generative artificial intelligence (AI) can be adopted with the most value in health systems, in response to the Executive Order on AI.

MATERIALS AND METHODS

We reviewed how technology has historically been deployed in healthcare, and evaluated recent examples of deployments of both traditional AI and generative AI (GenAI) with a lens on value.

RESULTS

Traditional AI and GenAI are different technologies in terms of their capability and modes of current deployment, which have implications on value in health systems.

DISCUSSION

Traditional AI when applied with a framework top-down can realize value in healthcare. GenAI in the short term when applied top-down has unclear value, but encouraging more bottom-up adoption has the potential to provide more benefit to health systems and patients.

CONCLUSION

GenAI in healthcare can provide the most value for patients when health systems adapt culturally to grow with this new technology and its adoption patterns.

Exploring maturity of electronic medical record use among allied health professionals

BACKGROUND

Electronic medical records (EMRs) have the potential to improve and streamline the quality and safety of patient care. Harnessing the full benefits of EMR implementation depends on the utilisation of advanced features, defined as "mature usage." At present, little is known about the maturity of EMR usage by allied health professionals (AHPs).

OBJECTIVE

To examine current maturity of EMR use by AHPs and explore perceived barriers to mature EMR utilisation and optimisation.

METHOD

AHPs were recruited from three health services. Participants completed a 27-question electronic questionnaire based on the EMR Adoption Framework, which measures clinician EMR utilisation (0 = paper chart, 5 = theoretical maximum) across 10 EMR feature categories. Interviews were conducted with both clinicians and managers to explore the nature of current EMR utilisation and perceived facilitators and barriers to mature usage.

RESULTS

Questionnaire responses were obtained from 193 participants AHPs. The majority of questions (74%) showed a mean score of <3, indicating a lack of mature EMR use. Pockets of mature usage were identified in the categories of health information, referrals and administration processes. Interviews with 21 clinicians and managers revealed barriers to optimisation across three themes: (1) limited understanding of EMR opportunities; (2) complexity of the EMR change process and (3) end-user and environmental factors.

CONCLUSION

Mature usage across EMR feature categories of the EMR Adoption Framework was low. However, questionnaire and qualitative interview data suggested pockets of mature utilisation.

IMPLICATIONS

Achieving mature allied health EMR use will require strategies implemented at the clinician, EMR support, and service levels.

Scratch Where It Itches: Electronic Sharing of Health Information and Costs

The electronic sharing of health information holds the potential to enhance communication and coordination among hospitals and providers, ultimately leading to improved hospital performance. However, despite the benefits, hospitals often encounter significant challenges when it comes to sharing information with external parties. Our study aimed to identify the circumstances under which sharing information with external parties can result in changes in overall hospital costs, with a particular emphasis on various obstacles that hospitals may encounter, including lack of incentives or capabilities essential to facilitate effective information exchange. To achieve this goal, we obtain data from multiple sources, including the American Hospital Association (AHA) annual and IT surveys, the Center for Medicare and Medicaid Services (CMS) hospital compare dataset, and the Census Bureau's small-area income and poverty estimates. Consistent with previous research, we observed a significant reduction in hospital costs when information was shared internally but not externally. However, our findings also revealed that the sharing of health information can lead to cost savings for hospitals when they encounter challenges such as the absence of incentives and capabilities regardless of whether the information is shared internally or externally. The implication of our study is simple but strong: perseverance and effort yield positive outcomes. Only when hospitals push through challenges related to sharing information can they achieve the anticipated advantages of information sharing. Based on our results, we suggest that policymakers should strategically target hospitals and providers that face challenges in sharing health information rather than focusing on those without obstacles. This targeted approach can significantly increase policy efficiency, and we emphasize the need for policymakers to address the specific areas where hospitals and providers encounter difficulties. By doing so, they can effectively "scratch where it itches" and address the core issues hindering the successful exchange of health information.

Electronic consent in clinical care: an international scoping review

OBJECTIVE

Digital technologies create opportunities for improvement of consenting processes in clinical care. Yet little is known about the prevalence, characteristics or outcomes of shifting from paper to electronic consenting, or e-consent, in clinical settings. Thus questions remain around e-consent's impact on efficiency, data integrity, user experience, care access, equity and quality. Our objective was to scope all known findings on this critical topic.

MATERIALS AND METHODS

Through an international, systematic scoping review, we identified and assessed all published findings on clinical e-consent in the scholarly and grey literatures, including consents for telehealth encounters, procedures and health information exchanges. From each relevant publication, we abstracted data on study design, measures, findings and other study features.

MAIN OUTCOME MEASURES

Metrics describing or evaluating clinical e-consent, including preferences for paper versus e-consenting; efficiency (eg, time, workload) and effectiveness (eg, data integrity, care quality). User characteristics were captured where available.

RESULTS

A total of 25 articles published since 2005, most from North America or Europe, report on the deployment of e-consent in surgery, oncology and other clinical settings. Experimental designs and other study characteristics vary, but nearly all focus on procedural e-consents. Synthesis reveals relatively consistent findings around improved efficiency and data integrity with, and user preferences for, e-consent. Care access and quality issues are less frequently explored, with disparate findings.

DISCUSSION AND CONCLUSION

The literature is nascent and largely focused on issues that are immediate and straightforward to measure. As virtual care pathways expand, more research is urgently needed to ensure that care quality and access are advanced, not compromised, by e-consent.

Collaborating neuroscience online: The case of the Human Brain Project forum

This paper analyzes user interactions on the public-access online forum of the Human Brain Project (HBP), a major European Union-funded neuroscience research initiative, to understand the utility of the Forum for collaborative problem solving. We construct novel data using discussion forum posts and detailed user profiles on the HBP Forum. We find that HBP Forum utilization is comparable to that of a leading general-interest coding platform, and that online usage metrics quickly recovered after an initial Covid-19-related dip. Regression results show that user interactions on the Forum are more active for questions on programming and in HBP core areas. Further, Cox proportional hazard analyses show that such problems are solved faster. Forum posts with users from different countries tend to be discussed more actively but solved slower. Higher shares of administrator support tend to solve problems faster. There are no clear patterns regarding gender and seniority. Our results suggest that building novel collaborative forums can support researchers working on complex topics in challenging times.

Value Implications of Sourcing Electronic Health Records: The Role of Physician Practice Integration

Should hospitals source electronic health records (EHR) systems from a single vendor or multiple vendors to deliver high-value care? We study hospitals’ EHR sourcing strategies based on their degree of integration with physician practices and its impact on the value of healthcare delivered. We propose a novel framework to define healthcare value as the extent to which a hospital effectively expends clinical resources to deliver services that improve patient outcomes. Drawing on modular systems and transaction cost economics theories, we propose a moderated-mediation model that explores the pathways through which EHR sourcing strategies can create value in healthcare. We test our research hypotheses on a large, longitudinal sample of U.S. hospitals and observe that hospitals with EHR configurations closer to single sourcing strategies exhibit greater health information sharing compared with hospitals with multisourced EHR systems. Furthermore, we find that hospital-physician practice integration moderates the impact of single sourcing on health information sharing, which in turn, improves value. Specifically, tighter integration between hospitals and physician practices can create greater value if it is aligned with hospitals’ EHR sourcing strategies. As the healthcare industry moves toward value-based payment reform, our findings provide a useful roadmap to practitioners and policy makers to improve the performance of hospitals and healthcare providers.

History: Rajiv Kohli, Senior Editor; Sunil Wattal, Associate Editor.

Funding: I.R. Bardhan thanks the Foster Parker Centennial Professorship and the Dean’s Research Excellence Grant at the McCombs School of Business at UT Austin for generous financial support. C. Bao thanks the Spears Fellowship at Oklahoma State University for financial support.

Supplemental Material: The online appendix is available at https://doi.org/10.1287/isre.2022.1183 .

Analysis of two diverse nursing records applications: Mixed methods approach

Introduction

Poor adoption of electronic health records among healthcare workers can diminish their impact. Healthcare informatics solutions development should diligently acknowledge end-user needs. This study compares a user experience and perceived quality of the nursing process integration in two different applications for electronic documentation of the nursing care plan. Both applications were designed and tested in Slovenia.

Methods

In the first phase, final year undergraduate nursing students were recruited (n=73) and randomly assigned into two groups. Each group used one of the applications for a duration of five hours. A survey among students was conducted. In the second phase, additional students were recruited (n=40) and invited to participate in qualitative analysis of the unfavourably rated application.

Results

The modern, visually improved application was favourably rated by students in terms of all aspects of application usability. However, students reported a significant number of inadequacies regarding the nursing process methodology integration. On the contrary, the students using the poorly rated and visually outdated application reported no such concerns. Qualitative analysis of student reflections identified additional positive features of software design that were not detected in survey results analysis.

Conclusion

This study showed that a user-centred approach can be used to compare diverse electronic solutions. Detected discrepancies in findings using qualitative and quantitative analysis show the importance of integrating diverse research approaches for adequate evaluation of software solutions. Furthermore, this study design promotes empowerment of healthcare workers to participate in the development and critical evaluations of software solutions.

Higher Electronic Health Record Functionality Is Associated with Lower Operating Costs in Urban—but Not Rural—Hospitals

Objectives  The aim of the study is to examine the relationship between electronic health record (EHR) use/functionality and hospital operating costs (divided into five subcategories), and to compare the results across rural and urban facilities.

Methods  We match hospital-level data on EHR use/functionality with operating costs and facility characteristics to perform linear regressions with hospital- and time-fixed effects on a panel of 1,596 U.S. hospitals observed annually from 2016 to 2019. Our dependent variables are the logs of the various hospital operating cost categories, and alternative metrics for EHR use/functionality serve as the primary independent variables of interest. Data on EHR use/functionality are retrieved from the American Hospital Association's (AHA) Annual Survey of Hospitals Information Technology (IT) Supplement, and hospital operating cost and characteristic data are retrieved from the American Hospital Directory. We include only hospitals classified as “general medical and surgical,” removing specialty hospitals.

Results  Our results suggest, first, that increasing levels of EHR functionality are associated with hospital operating cost reductions. Second, that these significant cost reductions are exclusively seen in urban hospitals, with the associated coefficient suggesting cost savings of 0.14% for each additional EHR function. Third, that urban EHR-related cost reductions are driven by general/ancillary and outpatient costs. Finally, that a wide variety of EHR functions are associated with cost reductions for urban facilities, while no EHR function is associated with significant cost reductions in rural locations.

Conclusion  Increasing EHR functionality is associated with significant hospital operating cost reductions in urban locations. These results do not hold across geographies, and policies to promote greater EHR functionality in rural hospitals will likely not lead to short-term cost reductions.

A qualitative study of challenges affecting the primary care system performance: Learning from Iran's experience

Background and Aims

Primary care and the use of a referral system are essential components of any health system. The aim of this study was to investigate and identify the challenges affecting the performance of the primary health‐care system in Iran.

Methods

This qualitative study was carried out consisting of 14 interviews with experts and those familiar with the primary care system and its function. Purposive and snowball sampling was used to identify the samples. The recorded files were transcribed and entered into the MAXQDA‐11 software to be analyzed. The conventional content analysis approach was used for data analysis.

Results

The findings of this study included 72 initial codes classified into 7 main themes and 18 subthemes. Seven main themes consist of governance, manpower, resources, financial management, services delivery, trans‐sectional, and social and cultural. The greatest challenges for Iran's primary health care (PHC) system are governance and human resources problems.

Conclusion

Various dimensions of Iran's primary care system especially governance and human resources are facing several challenges that threaten its performance and efficiency. Policymakers and planners must address challenges fundamentally and do not get satisfied with superficial reforms that have short‐term and soothing effects. In this regard, enhancing governance functioning can profoundly solve numerous challenges of Iran's primary care system. We also suggest the strengthening of intersectoral collaboration.

Sustainable Technology in High-Income Economies: The Role of Innovation

The aim of this article is to examine the effects of innovation on the availability of cutting-edge technologies while controlling education, public funds and life expectancy in high-income countries from 2008 to 2018. In this study, Westerlund cointegration, fully modified ordinary least squares and dynamic ordinary least squares tests were applied. The research results indicate that: (i) there is a cointegrating link between the availability of the latest technologies and innovation, education, public funding and life expectancy; (ii) innovation increases the availability of cutting-edge technologies in high-income economies, whereas education, public funds and life expectancy contribute to sustainable technological availability; (iii) innovation, education, public funding and life expectancy result in the availability of cutting-edge technologies. The results are important in showing why policymakers in high-income economies should foster innovation capacity to sustain technological development.

Functional IT Complementarity and Hospital Performance in the United States: A Longitudinal Investigation

For healthcare practitioners and policymakers, one of the most challenging problems is understanding how to implement health information technology (HIT) applications in a way that yields the most positive impacts on quality and cost of care. We identify four clinical HIT functions which we label as order entry and management (OEM), decision support (DS), electronic clinical documentation (ECD), and results viewing (RV). We view OEM and DS as primary clinical functions and ECD and RV as support clinical functions. Our results show that no single combination of applications uniformly improves clinical and experiential quality and reduces cost for all hospitals. Thus, managers must assess which HIT interactions improve which performance metric under which conditions. Our results suggest that synergies can be realized when these systems are implemented simultaneously. Additionally, synergies can occur when support HIT is implemented before primary HIT and irrespective of the order in which primary HITs are implemented. Practitioners should also be aware that the synergistic effects of HITs and their impact on cost and quality are different for chronic and acute diseases. Our key message to top managers is to prioritize different combinations of HIT contingent on the performance variables they are targeting for their hospitals but also to realize that technology may not impact all outcomes.

Analysis of the Effects of Electronic Medical Records and a Payment Scheme on the Length of Hospital Stay

Objectives: This study analyzed the effects of computerization of medical information systems and a hospital payment scheme on medical care outcomes. Specifically, we examined the effects of Electronic Medical Records (EMRs) and a diagnosis procedure combination/per-diem payment scheme (DPC/PDPS) on the average length of hospital stay (ALOS).Methods: Post-intervention changes in the monthly ALOS were measured using an interrupted time-series analysis.Results: The level changes observed in the monthly ALOS immediately post-DPC/PDPS were –1.942 (95% confidence interval [CI], –2.856 to –1.028), –1.885 (95% CI, –3.176 to –0.593), –1.581 (95% CI, –3.081 to –0.082) and –2.461 (95% CI, –3.817 to 1.105) days in all ages, <50, 50–64, and ≥65 years, respectively. During the post-DPC/PDPS period, trends of 0.107 (95% CI, 0.069 to 0.144), 0.048 (95% CI, –0.006 to 0.101), 0.183 (95% CI, 0.122 to 0.245) and 0.110 (95% CI, 0.054 to 0.167) days/month, respectively, were observed. During the post-EMR period, trends of –0.053 (95% CI, –0.080 to –0.027), –0.093 (95% CI, –0.135 to –0.052), and –0.049 (95% CI, –0.087 to –0.012) days/month were seen for all ages, 50–64 and ≥65 years, respectively.Conclusions: The increasing post-DPC/PDPS trends offset the decline in ALOS observed immediately post-DPC/PDPS, and the observed ALOS was longer than the counterfactual at the end of the DPC/PDPS study periods. Conversely, due to the downward trend seen after EMR introduction, the actual ALOS at the end of the EMR study period was shorter than the counterfactual, suggesting that EMRs might be more effective than the DPC/PDPS in sustainably reducing the LOS.

Strategic use of health information exchange and market share, payer mix, and operating margins

BACKGROUND

Health information exchange (HIE) capabilities are tied to health care organizations' strategic and business goals. As a technology that connects information from different organizations, HIE may be a source of competitive advantage and a path to improvements in performance.

PURPOSE

The aim of the study was to identify the impact of hospitals' use of HIE capabilities on outcomes that may be sensitive to changes in various contracting arrangements and referral patterns arising from improved connectivity.

METHODOLOGY

Using a panel of community hospitals in nine states, we examined the association between the number of different data types the hospital could exchange via HIE and changes in market share, payer mix, and operating margin (2010-2014). Regression models that controlled for the number of different data types shared intraorganizationally and other time-varying factors and included both hospital and time fixed effects were used for adjusted estimates of the relationships between changes in HIE capabilities and outcomes.

RESULTS

Increasing HIE capability was associated with a 13 percentage point increase in a hospital's discharges that were covered by commercial insurers or Medicare (i.e., payer mix). Conversely, increasing intraorganizational information sharing was associated with a 9.6 percentage point decrease in the percentage of discharges covered by commercial insurers or Medicare. Increasing HIE capability or intraorganizational information sharing was not associated with increased market share nor with operating margin.

CONCLUSIONS

Improving information sharing with external organizations may be an approach to support strategic business goals.

PRACTICE IMPLICATIONS

Organizations may be served by identifying ways to leverage HIE instead of focusing on intraorganizational exchange capabilities.

Analysis of job burnout, satisfaction and work-related depression among neurological and neurosurgical nurses in Poland: A cross-sectional and multicentre study

Aim

This study investigated the status of job burnout, work‐related depression and job satisfaction among neurological and neurosurgical nurses in Poland.

Design

A cross‐sectional and multicentre study.

Methods

The sample consisted of 206 neurological and neurosurgical nurses, all of whom completed a self‐report questionnaire designed by the authors.

Results

The results revealed a work‐related burnout incidence of 32%, colleague‐related burnout incidence of 44.2% and patient‐related burnout incidence of 22.8%. Nurses working in neurological departments were statistically over three times more likely to struggle with colleague‐related burnout than nurses working in neurosurgical departments were. Further, work‐related burnout was higher in people aged above 54 years than those in the youngest age category. Nonetheless, 71.8% of the nurses expressed satisfaction with their work. In sum, our results indicated that job burnout is common among registered nurses and that personal (age) and workplace (type of ward, distance to work, experience and shift work) factors contributed to symptoms of burnout.

Performance of Accountable Care Organizations: Health Information Technology and Quality–Efficiency Trade-Offs

Under a traditional fee-for-service payment model, healthcare providers typically compromise the quality of care in order to reduce costs. Drawing on data from a national sample of accountable care organizations (ACOs), we study whether financial incentives offered under the Affordable Care Act led to fundamental changes in care delivery. Our research suggests that effective use of health information technology (IT) by ACO providers is critical in balancing competing goals of quality and efficiency. Unlike hospitals that did not participate in value-based care initiatives, ACOs were able to generate better quality outcomes while also improving overall efficiency. Furthermore, ACO providers that used health IT effectively demonstrated better patient health outcomes due to greater information integration with other providers. In other words, ACOs created value by not only reducing the cost of care but also improving patient outcomes simultaneously. Our research provides a roadmap for practitioners to succeed in a value-based healthcare environment and for policy makers to design better incentives to promote interorganizational information sharing across providers. Our findings suggest that healthcare policy needs to incorporate appropriate incentives to foster effective IT use for care coordination between healthcare providers.

The complementarity of drug monitoring programs and health IT for reducing opioid-related mortality and morbidity

In response to the opioid crisis, each US state has implemented a prescription drug monitoring program (PDMP) to collect data on controlled substances prescribed and dispensed in the state. I study whether health information technology (HIT) complements patient prescription data in PDMPs to reduce opioid-related mortality and morbidity. A novel dataset is constructed that records state policies that integrate PDMP with HIT and facilitate interstate data sharing. Using difference-in-differences models, I find that PDMP-HIT integration policies reduce opioid-related inpatient morbidity. The reductions are substantial in states that established integration without ever mandating the use of a PDMP. A mechanism test suggests that PDMP integration works mainly through the hospital system while a mandate affects legal opioids prescription. The impacts from integration are strongest for the vulnerable groups-middle-aged, low-to middle-income patients, and those with public insurance. There is suggestive evidence that interstate data sharing further complements integration despite not having a significant impact independently. The results are robust to a set of tests using alternative specifications and measures. The total benefits from integration far exceed the associated costs.

Fast-Tracking Health Data Standards Development and Adoption in Real-World Settings: A Pilot Approach

BACKGROUND

Pilot-testing is important in standards development because it facilitates agile navigation of the gap between needs for and use of standards in real-world settings and can reveal the practicalities of implementation. As the implementation and use of health data standards are usually more complicated than anticipated, the Office of the National Coordinator for Health Information Technology (ONC) routinely oversees and organizes relevant pilot projects.

OBJECTIVES

This article provides an in-depth look into a sample of ONC's standards-focused pilot projects to (1) inform readers of the complexities of developing, implementing, and advancing standards and (2) guide those seeking to evaluate new standards through pilot projects.

METHODS

The ONC's approach to conducting pilot projects begins with identifying a clinical care need, research requirement, or policy outcome that is not well supported by existing standards through a landscape review. ONC then selects a testing approach based on the identified need and maturity of relevant standards. Next, ONC identifies use cases and sites to pilot-test the relevant standard. Once complete, ONC publishes a report that informs subsequent projects and standards development.

RESULTS

Pilot projects presented here are organized into three categories related to their demonstrated focus and related approach: (1) improving standards for presenting and sharing clinical genetic data, (2) accelerating the development and implementation of new standards, and (3) facilitating clinical data reuse. Each project illustrates the pilot approach from inception to next steps, capturing the role of collaboration among standards development organizations, stakeholders, and end-users to ensure standards are practical and fit for purpose.

CONCLUSION

The ONC approach identifies implementation difficulties prior to broader adoption and use of standards, and provides insight into the steps needed to scale use of standards. The ONC's organization of pilot projects serves as a natural accelerator for building communities of practice, often providing a well-connected beneficiary of lessons learned.

[After all, how many nationwide Health Information Systems are there in Brazil?]

The study aimed to identify and analyze the nationwide Health Information Systems (SIS) operating in Brazil from 2010 to 2018 and to understand the management and support structure for Information Technology (IT) in these systems in the Ministry of Health. This was a descriptive study based on document analysis, seeking to consolidate the data on nationwide SIS based on selection criteria referenced on the concept of SIS. The documents yielded incomplete and mutually disparate data, evidencing different interpretations of the concepts of systems and health information systems in the Ministry of Health. The survey found 54 nationwide Health Information Systems functioning from 2010 to 2018 and collected information on seven decentralized IT centers in Ministry of Health departments, which work autonomously from the Brazilian Health Informatics Department (DATASUS). The analysis of the logics of their functioning identified four groups of SIS pertaining to the following: monitoring relevant events for public health, greater control and monitoring of health programs in the Ministry of Health, registration of physical and legal persons, and a "new generation" of SIS that are developed and maintained by the Federal Government but differ from its verticalized programmatic logic, focused on administrative rationalization and improving the quality of services provided by the SUS at the local and regional levels.

The Impact of Health Information Sharing on Hospital Costs

Despite substantial progress in the adoption of health information technology (IT), researchers remain uncertain as to whether IT investments benefit hospitals. This study evaluates the effect of health information sharing on the cost of care, and whether the effect varies with context. Our results suggest that information sharing using health IT, specifically the extent (breadth) and level of detail (depth) of information sharing, helps to reduce the cost of care at the hospital level. The results also show that the effects of depth of information sharing on cost savings are salient in poor and less-concentrated regions, but not in wealthier, more-concentrated areas, whereas the the effects of breadth of information sharing on cost savings are equivalent across wealth and concentration. To realize the benefits of using health IT more effectively, policy makers’ strategies for encouraging active use of health IT should be informed by market characteristics.

Improved efficiency of coding systems with health information technology

This study aimed to investigate the impact of health information technology (IT) on the Case Mix Index (CMI). This study was a retrospective cohort study using hospital financial data from the Office of Statewide Health Planning and Development (OSHPD) in California. A total of 309 unique hospitals were included in the study for 7 years, from 2009 to 2015, resulting in 2,135 hospital observations. The effects of health information technology (IT) on the Case Mix Index (CMI) was evaluated using dynamic panel data analysis to control endogeneity issues. This study found that more health IT adoption could lead to a lower CMI by improving coding systems. Policy makers, researchers, and healthcare providers must be cautious when interpreting the effect of health IT on the CMI. To encourage the adoption of health IT, the cost savings and reimbursement reductions resulting from health IT adoption should be compared. If any profit loss occurs (i.e., the cost savings is less than reimbursement reduction), more incentives should be provided to healthcare providers.

Electronic medical records and primary care quality: Evidence from Manitoba

Improvements in quality of care through supporting decision-making processes and increased efficiency have prompted widespread implementation of electronic medical records (EMRs) in Canada. Using a set of indicators of preventive care, chronic disease management, and hospitalizations due to ambulatory care sensitive conditions (ACSC), this study measures the effect of EMR adoption on quality of primary care measures. Population-based data for the Canadian province of Manitoba are used in a difference-in-differences approach with patient- and time-fixed effects. Evidence of changes in the selected quality-of-care indicators is weak, with preventive care, management of asthma, and hospitalizations showing no significant change due to EMR adoption. A statistically significant increase in the quality of diabetes care was found for EMR users, changes being larger for late EMR adopters which is possibly explained by a network effect. This research demonstrates that measuring whether EMRs prompt changes in the quality of care confronts serious challenges. The rapid evolution and gradual adoption of EMR technology, the inevitable learning/acceptance process by individual health practitioners, and its potential reflection on different patient populations create unmeasurable variables that confound EMRs' impact. This study also underscores the importance of data development to support the economic value of EMRs.

The interaction between high-level electronic medical record adoption and hospitalist staffing levels: A focus on value-based purchasing

OBJECTIVE

This study sought to understand the relationship of hospital performance with high-level electronic medical record (EMR) adoption, hospitalists staffing levels, and their potential interaction.

MATERIALS AND METHODS

We evaluated 2,699 non-federal, general acute hospitals using 2016 data merged from four data sources. We performed ordinal logistic regression of hospitals' total performance score (TPS) on their EMR capability and hospitalists staffing level while controlling for other market- and individual-level characteristics.

RESULTS

Hospitalists staffing level is shown to be positively correlated with TPS. High-level EMR adoption is associated with both short-term and long-term improvement on TPS. Large, urban, non-federal government hospitals, and academic medical centers tend to have lower TPS compared to their respective counterparts. Hospitals belonging to medium- or large-sized healthcare systems have lower TPS. Higher registered nurse (RN) staffing level is associated with higher TPS, while higher percentage of Medicare or Medicaid share of inpatient days is associated with lower TPS.

DISCUSSION

Although the main effects of hospitalists staffing level and EMR capability are significant, their interaction is not, suggesting that hospitalists and EMR act through separate mechanisms to help hospitals achieve better performance. When hospitals are not able to invest on both simultaneously, given financial constraints, they can still reap the full benefits from each.

CONCLUSION

Hospitalists staffing level and EMR capability are both positively correlated with hospitals' TPS, and they act independently to bolster hospital performance.

Health information technology and hospital performance the role of health information quality in teaching hospitals

The research purposed in this paper is to investigate the impact of the health information technology on hospital performance through the health information quality as mediating variable, as new evidence from the teaching hospitals in the north of Jordan. Research design and methodology approach based on a survey that is conducted to collect the requested data to develop a model connect between the health information technologies, health information quality and hospital performance by using the Structural Equation Modeling approach. The research findings show that there is an intertwined and reciprocal relation between Health Information Technologies (HITs), hospital performance, and health information quality. HITs have direct positive impacts on both hospital performance and health information quality. Health information quality has also a direct impact on hospital performance. Besides, health information quality functioned as a partial mediator between HITs and hospital performance. The study did not examine the factors that influence the relationship between HITs, hospital performance and health information quality. This paper is evidence for the investor in the healthcare sector to invest more in HITs and health information quality, where the expected results are productivity improvement, performance leveraging and error reduction. The research originality is to introduce new evidence support literature form the Middle East countries is the main contribution of this paper.

Longitudinal Trends in Costs for Hospitalizations at Children's Hospitals

OBJECTIVES

Children's hospitals are increasingly focused on value-based improvement efforts to improve outcomes and lower costs. Such efforts are generally focused on improving outcomes in specific conditions. Examination of cost drivers across all admissions may facilitate strategic prioritization of efforts.

METHODS

Pediatric Health Information System data set discharges from 2010 to 2017 were aggregated into services lines and billing categories. The mean annual growth per discharge as a percentage of 2010 total costs was calculated for aggregated medical and surgical service lines and 6 individual service lines with highest rates of growth. The mean annual growth per discharge for each billing category and changes in length of stay was further assessed.

RESULTS

The mean annual growth in total costs was similar for aggregated medical (2.6%) and surgical (2.7%) service lines. Individual medical service lines with highest mean annual growth were oncology (3.5%), reproductive services (2.9%), and nonsurgical orthopedics (2.8%); surgical service lines with highest rate of growth were solid organ transplant (3.7%), ophthalmology (3.3%), and otolaryngology (2.9%).

CONCLUSIONS

Room costs contributed most consistently to cost increases without concomitant increases in length of stay. Value-based health care initiatives must focus on room cost increases and their impacts on patient outcomes.

Multilevel analysis exploring the relative importance of workplace resources in explaining nurses' workload perceptions: Are we setting the right focus?

BACKGROUND

Nurses' workload has become increasingly recognized as an important determinant of nurse turnover and shortage and has been also associated with poorer quality of care. Despite strong evidence that heavy workloads have negative consequences, we still lack a comprehensive understanding of the workplace characteristics that contribute most to improving nurses' workload, the relative importance of each in doing so, or indeed the workplace characteristics and other factors that drive nurses' perceptions of their workload.

PURPOSE

The aim of this study was to examine workplace resources as antecedents of nurses' perceptions of their workload and to investigate their relative importance in explaining workload perceptions. We considered workplace resources related to staffing, professional relationships, and technology.

METHODOLOGY

The study sample comprised nurse-reported and administrative data from U.S. Veterans Health Administration hospitals between 2014 and 2017. Our multilevel analyses are based on data from 20,330 nurses working in 273 work groups at 123 hospitals. We developed and empirically tested a theoretical model using multilevel mixed-effects linear regression. The relative importance of workplace resources was assessed by dominance analysis.

RESULTS

Staffing levels, relational climate, and information technology were significantly associated with nurses' workload perceptions. Dominance analysis indicated that relational resources are the most important measure in explaining nurses' workload perceptions.

PRACTICE IMPLICATIONS

This is the first study to examine the relative importance of workplace resources in explaining nurses' perceptions of their workload. Our results suggest that much might be gained by investing in interventions to boost relational resources. In turn, these findings could lead to more targeted, effective, and resource efficient interventions to improve nurses' workload.

Association of the Meaningful Use Electronic Health Record Incentive Program With Health Information Technology Venture Capital Funding

Importance

Although the Health Information Technology for Economic and Clinical Health (HITECH) Act has accelerated electronic health record (EHR) adoption since its passage, clinician satisfaction with EHRs remains low, and the association of HITECH with health care information technology (IT) entrepreneurship has remained largely unstudied.

Objective

To determine whether the passage of the HITECH Act was associated with an increase in key measures of health care IT entrepreneurship.

Design, Setting, and Participants

This economic evaluation of venture capital (VC) activity in the US from 2000 to 2019 examined funding trends in health care IT, EHR-related companies, and all VC investments before and after the passage of HITECH. A difference-in-differences analysis compared investments in health care IT companies with those of companies in 3 categories: general health care (non-IT), IT (non-health care), and all US VC transactions. Data were analyzed from September 2018 to August 2019.

Exposures

Venture capital funding received by US companies before and after the HITECH Act.

Main Outcomes and Measures

Venture capital investment in health care IT companies and the proportion of those investments going to seed-stage companies, a proxy for very early-stage entrepreneurship and innovation.

Results

The data included 70 982 investments, of which 9425 (13.3%) were seed stage, 10 706 (15.1%) were early stage, and 50 851 (71.6%) were growth stage. After passage of the HITECH Act, investment in both health care IT companies and EHR-related companies increased at a rate much faster (13.0% and 11.4%, respectively) than VC as a whole (6.9%). In addition, the proportion of investments going to seed-stage health care IT companies increased compared with both overall VC investments and non-IT health care investments. Health care IT companies saw increased probabilities of transactions being seed-stage of 5.1% (SE, 2.2%; 95% CI, 0.8% to 9.3%; P = .02) compared with the entire sample of VC transactions and 13.6% (SE, 1.9%; 95% CI, 9.9% to 17.2%; P < .001) compared with non-IT health care VC transactions. Health care IT had essentially 0 increased probability of a transaction being seed stage compared with IT companies outside health care (-0.8% probability; SE, 2.4%; 95% CI, -5.4% to 3.9%; P = .75).

Conclusions and Relevance

Although widespread clinician dissatisfaction with EHR systems remains a challenge, the HITECH Act's incentive program may have catalyzed early-stage entrepreneurship in health care IT, suggesting an important role for incentives in promoting innovation.

Outcomes of health information technology utilization in nursing homes: Do implementation processes matter?

We examined several outcomes of health information technology utilization in nursing homes and how the processes used to implement health information technology affected these outcomes. We hypothesized that one type of health information technology, electronic medical records, will improve efficiency and quality-related outcomes, and that the use of effective implementation processes and change leadership strategies will improve these outcomes. We tested these hypotheses by creating an original survey based on the case study literature, which we sent to the top executives of nursing homes in seven US states. The administrators reported that electronic medical record adoption led to moderately positive efficiency and quality outcomes, but its adoption was unrelated to objective quality indicators obtained from regulatory agencies. Improved electronic medical record implementation processes, however, were positively related to administrator-reported efficiency and quality outcomes and to decreased deficiency citations at the next regulatory visit to the nursing home. Change leadership processes did not matter as much as technological implementation processes.

How Does Electronic Health Information Exchange Affect Hospital Performance Efficiency? The Effects of Breadth and Depth of Information Sharing

EXECUTIVE SUMMARY

This research was motivated by the large investment in health information technology (IT) by hospitals and the inconsistent findings related to the effects of health IT adoption on hospital performance. Building on resource orchestration theory and the information systems literature, the authors developed a research model to investigate how the configuration strategies for sharing information under health IT systems affect hospital efficiency. The hypotheses were tested using data from the 2010 annual and IT surveys of the American Hospital Association, Centers for Medicare & Medicaid Services case mix index, and U.S. Census Bureau's small-area income and poverty estimates. The study revealed that in health IT systems, the breadth (extent) and depth (level of detail) of digital information sharing among stakeholders each has a curvilinear relationship with hospital efficiency. In addition, breadth and depth reinforce each other's positive effects and attenuate each other's negative effects, and their balance has a positive effect on hospital efficiency. The results of this research have the potential to enrich the literature on the value of adopting health IT systems as well as in providing practitioner guidelines for meaningful use.

Electronic medical records and medical procedure choice: Evidence from cesarean sections

This paper examines how hospital adoption of electronic medical records (EMRs) impacts medical procedure choice in the context of cesarean section deliveries. It provides a unique contribution by tying the literature on EMR diffusion to the literature on the utilization of expensive medical technology and provider practice style. Exploiting within-hospital variation in three types of EMR adoption, we find that computerized physician order entry, an advanced EMR system that typically incorporates decision support, reduces C-section rates for low-risk mothers by 2.5%. Obstetric-specific EMR systems and physician documentation have no statistically significant effect on C-section rates. In addition, we find that the computerized practitioner order entry effect occurs predominantly in hospitals that were already performing fewer C-sections and does not change the behavior of already high-intensity providers.

The Relationship between Health Information Technology Laboratory Tracking Systems and Hospital Financial Performance and Quality

The objective of this study is to explore the relationship between hospitals Health Information Technology (HIT), and financial and quality performance. The study merged the 2017 Centers for Medicare & Medicaid Services (CMS) Healthcare Cost Report Information System, American Hospital Association Annual Survey, and two CMS Hospital Compare datasets. A total of 3002 hospitals were analyzed using multivariate analysis. We found that hospitals with laboratory tracking systems reported better financial performance on five financial performance measures. Policymakers should consider developing policies that facilitate exploration and adoption of various hospital HIT capabilities that measurably improves hospital quality of care.

Exploring the Impact of the Prescription Automatic Screening System in Health Care Services: Quasi-Experiment

BACKGROUND

Hospitals have deployed various types of technologies to alleviate the problem of high medical costs. The cost of pharmaceuticals is one of the main drivers of medical costs. The Prescription Automatic Screening System (PASS) aims to monitor physicians' prescribing behavior, which has the potential to decrease prescription errors and medical treatment costs. However, a substantial number of cases with unsatisfactory results related to the effects of PASS have been noted.

OBJECTIVE

The objectives of this study were to systematically explore the imperative role of PASS on hospitals' prescription errors and medical treatment costs and examine its contingency factors to clarify the various factors associated with the effective use of PASS.

METHODS

To systematically examine the various effects of PASS, we adopted a quasi-experiment methodology by using a 2-year observation dataset from 2 hospitals in China. We then analyzed the data related to physicians' prescriptions both before and after the deployment of PASS and eliminated influences from a variety of perplexing factors by utilizing a control hospital that did not use a PASS system. In total, 754 physicians were included in this experiment comprising 11,054 patients: 400 physicians in the treatment group and 354 physicians in the control group. This study was also preceded by a series of interviews, which were employed to identify moderators. Thereafter, we adopted propensity score matching integrated with difference-in-differences to isolate the effects of PASS.

RESULTS

The effects of PASS on prescription errors and medical treatment costs were all significant (error: 95% CI -0.40 to -0.11, P=.001; costs: 95% CI -0.75 to -0.12, P=.007). Pressure from organizational rules and workload decreased the effect of PASS on prescription errors (95% CI 0.18-0.39; P<.001) and medical treatment costs (95% CI 0.07-0.55; P=.01), respectively. We also suspected that other pressures (eg, clinical title and risk categories of illness) also impaired physicians' attention to alerts from PASS. However, the effects of PASS did not change among physicians with a higher clinical title or when treating diseases demonstrating high risk. This may be attributed to the fact that these physicians will focus more on their patients in these situations, regardless of having access to an intelligent system.

CONCLUSIONS

Although implementation of PASS decreases prescription errors and medical treatment costs, workload and organizational rules remain problematic, as they tend to impair the positive effects of auxiliary diagnosis systems on performance. This again highlights the importance of considering both technical and organizational issues to obtain the highest level of effectiveness when deploying information technology in hospitals.

The Digitization of Patient Care: A Review of the Effects of Electronic Health Records on Health Care Quality and Utilization

Electronic health records (EHRs) adoption has become nearly universal during the past decade. Academic research into the effects of EHRs has examined factors influencing adoption, clinical care benefits, financial and cost implications, and more. We provide an interdisciplinary overview and synthesis of this literature, drawing on work in public and population health, informatics, medicine, management information systems, and economics. We then chart paths forward for policy, practice, and research.

IT-Enabled Clinical Decision Support: An Empirical Study on Antecedents and Mechanisms

Modern hospitals increasingly make use of innovations and information technology (IT) to improve workflow and patient's clinical journey. Typical innovative solutions include patient records and clinical decision support systems to enhance the process of decision making by doctors and other healthcare practitioners. However, currently, it remains unclear how hospitals could facilitate and enable such a decision support capability in clinical practice. We ground our work on the resource-based view of the firm and put forth the notion of IT-enabled capabilities which emphasizes critical IT investment and capability development areas that hospitals could exploit in their quest to improve clinical decision support. We develop a research model that explains how “health information exchange” and enhanced “information capability” collectively drive a hospital's “clinical decision support capability.” We used partial least squares path modeling on large-scale cross-sectional data from 720 European hospitals. Outcomes suggest that health information exchange positively impacts information capability. In turn, information capability complementary partially mediates the relationship between information exchange and clinical decision support. Hence, this research contributes to the literature on clinical decision support and provides valuable insights into how to support such innovative technologies and capabilities in clinical practice. We conclude with a discussion and conclusion. Also, we outline the inherent limitations of this study and outline directions for future research.

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.

Adoption and learning across hospitals: The case of a revenue-generating practice

Performance-raising practices tend to diffuse slowly in the health care sector. To understand how incentives drive adoption, I study a practice that generates revenue for hospitals: submitting detailed documentation about patients. After a 2008 reform, hospitals could raise their Medicare revenue over 2% by always specifying a patient's type of heart failure. Hospitals only captured around half of this revenue, indicating that large frictions impeded takeup. Exploiting the fact that many doctors practice at multiple hospitals, I find that four-fifths of the dispersion in adoption reflects differences in the ability of hospitals to extract documentation from physicians. A hospital's adoption of coding is robustly correlated with its heart attack survival rate and its use of inexpensive survival-raising care. Hospital-physician integration and electronic medical records are also associated with adoption. These findings highlight the potential for institution-level frictions, including agency conflicts, to explain variations in health care performance across providers.

The Effectiveness of Health Care Information Technologies: Evaluation of Trust, Security Beliefs, and Privacy as Determinants of Health Care Outcomes

Background

The diffusion of health information technologies (HITs) within the health care sector continues to grow. However, there is no theory explaining how success of HITs influences patient care outcomes. With the increase in data breaches, HITs’ success now hinges on the effectiveness of data protection solutions. Still, empirical research has only addressed privacy concerns, with little regard for other factors of information assurance.

Objective

The objective of this study was to study the effectiveness of HITs using the DeLone and McLean Information Systems Success Model (DMISSM). We examined the role of information assurance constructs (ie, the role of information security beliefs, privacy concerns, and trust in health information) as measures of HIT effectiveness. We also investigated the relationships between information assurance and three aspects of system success: attitude toward health information exchange (HIE), patient access to health records, and perceived patient care quality.

Methods

Using structural equation modeling, we analyzed the data from a sample of 3677 cancer patients from a public dataset. We used R software (R Project for Statistical Computing) and the Lavaan package to test the hypothesized relationships.

Results

Our extension of the DMISSM to health care was supported. We found that increased privacy concerns reduce the frequency of patient access to health records use, positive attitudes toward HIE, and perceptions of patient care quality. Also, belief in the effectiveness of information security increases the frequency of patient access to health records and positive attitude toward HIE. Trust in health information had a positive association with attitudes toward HIE and perceived patient care quality. Trust in health information had no direct effect on patient access to health records; however, it had an indirect relationship through privacy concerns.

Conclusions

Trust in health information and belief in the effectiveness of information security safeguards increases perceptions of patient care quality. Privacy concerns reduce patients’ frequency of accessing health records, patients’ positive attitudes toward HIE exchange, and overall perceived patient care quality. Health care organizations are encouraged to implement security safeguards to increase trust, the frequency of health record use, and reduce privacy concerns, consequently increasing patient care quality.

Understanding optimisation processes of electronic health records (EHRs) in select leading hospitals: a qualitative study

Background

Little is known about optimisation of electronic health records (EHRs) systems in the hospital setting while adoption of EHR systems continues in the United States.

Objective

To understand optimisation processes of EHR systems undertaken in leading healthcare organisations in the United States.

Methods

Informed by a grounded theory approach, a qualitative study was undertaken that involved 11 in-depth interviews and a focus group with the EHR experts from the high performing healthcare organisations across the United States.

Results

The study describes EHR optimisation processes characterised by prioritising exponentially increasing requests with predominant focus on improving efficiency of EHR, building optimisation teams or advisory groups and standardisation. The study discusses 16 types of optimisation that interdependently produced 16 results along with identifying 11 barriers and 20 facilitators to optimisation.

Conclusions

The study describes overall experiences of optimising EHRs in select high performing healthcare organisations in the US. The findings highlight the importance of optimising the EHR after, and even before, go-live and dedicating resources exclusively for optimisation.

The Effect of Access to Electronic Health Records on Throughput Efficiency and Imaging Utilization in the Emergency Department

STUDY OBJECTIVE

To evaluate whether the availability of Electronic Health Records (EHRs) reduces throughput time and utilization of advanced imaging for patients in an academic ED.

DATA SOURCES

All patients arriving at an academic Emergency Department (ED) via ambulance between June 1, 2011, and June 4, 2012, were included in the study. This accounted for 9,970 unique ambulance patient visits.

STUDY DESIGN

Retrospective noninterventional analysis of patients in an academic ED. The primary independent variable was whether the patient had a prior EHR at the study hospital. Main outcomes were throughput time, number of advanced diagnostic imaging studies (CT, MRI, ultrasound), and the associated cost of these imaging studies. A set of controls, including age, gender, ICD9 codes, acuity measures, and NYU ED algorithm case severity classifications, was used in an ordinary least-squares (OLS) regression framework to estimate the association between EHR availability and the outcome measures.

PRINCIPAL FINDINGS

A patient with a prior EHR experienced a mean reduction in CT scans of 13.9 percent ([4.9, 23.0]). There was no material change in throughput time for patients with a prior EHR and no difference in utilization of other imaging studies across patients with a prior EHR and those without. Cost savings associated with prior EHRs are $22.52 per patient visit.

CONCLUSION

EHR availability for ED patients is associated with a reduction in CT scans and cost savings but had no impact on throughput time or order frequency of other imaging studies.

Hospitalization event notifications and reductions in readmissions of Medicare fee-for-service beneficiaries in the Bronx, New York

Objective

Follow-up with a primary care provider after hospital discharge has been associated with a reduced likelihood of readmission. However, primary care providers are frequently unaware of their patients' hospitalizations. Event notification may be an effective tool for reducing readmissions by notifying primary care providers when their patients have been admitted to and discharged from a hospital.

Materials and Methods

We examined the effect of an event notification system on 30-day readmissions in the Bronx, New York. The Bronx has among the highest readmission rates in the country and is a particularly challenging setting to improve care due to the low socioeconomic status of the county and high rates of poor health behaviors among its residents. The study cohort included 2559 Medicare fee-for-service beneficiaries associated with 14 141 hospital admissions over the period January 2010 through June 2014. Linear regression models with beneficiary-level fixed-effects were used to estimate the impact of event notifications on readmissions by comparing the likelihood of rehospitalization for a beneficiary before and after event notifications were active.

Results

The unadjusted 30-day readmission rate when event notifications were not active was 29.5% compared to 26.5% when alerts were active. Regression estimates indicated that active hospitalization alert services were associated with a 2.9 percentage point reduction in the likelihood of readmission (95% confidence interval: -5.5, -0.4).

Conclusions

Alerting providers through event notifications may be an effective tool for improving the quality and efficiency of care among high-risk populations.