Common characteristics shared by the HIT systems evaluated by the four academic institutions: they were all multifunctional and included medical decision making support, all were internally developed by research experts and all had capabilities that had been improved upon and added incrementally over time.
The data supported five primary goals:
- Increasing delivery of healthcare according to established protocols and guidelines;
- Enhancing capacity to perform surveillance and monitoring of disease conditions and care delivery;
- Reducing medication error rates;
- Decreasing utilization of care; and
- Producing a mixed effect on time utilization.
Major findings: (see Figure 1, below).
click for large version
click for large version
The authors of the article summarized 22 other studies in Appendix 22 from other institutions. The benefits noted were very similar to those found in the studies from the benchmark institutions; however, one major difference was the use of pre/post time-series designs that did not have a control or comparative group. Internally and commercially, HIT systems were evaluated in most of these studies with thirteen focusing on the former and nine on the later.
Summary and discussion: This study raises several questions worthy of further research and study:
- How are systems to interface with regard to the portability of health care information?
- Which are better: internally devised systems or commercially available systems?
- Who is going to be responsible for establishing standard guidelines for the implementation of HIT systems across the diverse healthcare systems in the United States? and
- How are the data to be used and analyzed by insurers and even public health entities?
HIT has shown many benefits with regard to quality of patient care issues and efficiency. Studies from these four benchmark institutions had one important limitation, however, and that is that the development of an internally developed HIT system took many years and is unlikely to be applicable to other institutions that have fewer resources and are struggling to implement the technology in a timely manner.
As the authors of the article acknowledge, it is not clear if HIT systems, though useful as tools, alter states of disease and health. More research looking at the direct impact of HIT information on morbidity and mortality is needed. As the authors state, this raises the question of a national HIT system, thereby making adoption of HIT a bipartisan initiative.
Providers need better evidence on information systems in order to make informed decisions about acquiring and implementing technology in community settings. The authors of this article made the first attempt to collate and appraise such evidence. Additional research is needed in academic, governmental, and community settings in both acute and nonacute facilities. As the authors point out, a uniform standard should be devised at the federal, state, and local level to report research on the implementation of HIT systems similar to the CONSORT and Quorum statement.
References
- Chaudry B, Wang J, Wu S, et al. Systematic review: impact of health information technology on quality, efficiency and costs of medical care. Ann Intern Med. 2006 May 16;144(10):742-752.
- Bates DW, Leape LL Cullen DJ. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA. 1998 Oct 21;280(15):1311-1316.