Impact of health information technology on quality, efficiency, and costs of medical care

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This above article is a Systematic Review of the medical literature on the effects of using information technology within health care. The research was initiated by the a request from the Agency for Healthcare Research & Quality (AHRQ) to synthesize all available evidence regarding the costs and benefits of using Information Technology (IT) in health care. In order to address an sensibly-scoped question, the authors (members of the Southern California Evidence Based Practice Center, which includes the RAND Corporation, the University of California, Cedars-Sinai Medical Center, and the Los Angeles Veterans Affairs (VA) System) chose to focus on three factors that might affected by the use of IT within Health Care: costs, quality of care, and efficiency of delivery.

The authors’ literature search was detailed and exhaustive. It was initially performed in 2003 and updated in 2004. The searched several electronic databases including MEDLINE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Abstracts of Reviews of Effects (DARE), and Periodical Abstracts. They contacted content experts for additional, unpublished studies, and manually reviewed the reference list of available studies. Although they do not list the search strategies used, this information is available on-line. Because they searched only English-language journals, there is some risk of publication bias. There is no mention of funnel plots or other statistical methods used to evaluation for publication bias. They did not specifically include proceedings from meetings of professional organizations, although this information is becoming more readily available from existing databases. In all, they identified 867 articles (systematic reviews, descriptive studies, randomized- and non-randomized controlled trials, before-and-after studies, and other hypothesis driven reports), of which 257 met inclusion criteria.

Quality of studies was evaluated by two, independent reviewers who used standardized forms. The articles does not tell us the amount of inter-rater reliability, but does state that disagreements were resolved by consensus. The authors do not comment specifically on the quality of the included studies, but they do note that 24% of the studies came from institutions with well-established informatics backgrounds and internally-developed medical record systems (the Regenstrief Institute, the VA, LDS Hospital/Intermountain Care, and Brigham & Women’s hospital).

Since qualitative and descriptive studies were included in the review, there was considerable variability among the types of articles and studies. Among the various topics were the effects of Healthcare IT on: primary prevention, secondary prevention, screening, prevention of complications resulting from hospitalization, and the use of computerized records for public health surveillance.

Overall results were divided into three categories: Effects on Quality, Effects on Efficiency, and Effects on costs. The types of healthcare IT systems & functions investigated were: Decision support systems, Electronic Health Records, Computerized Provider Order Entry (CPOE), results management, and administrative functions.

The effects on quality were described as positive (improvements between 5 and 66%), and were mainly related to increased adherence to established guidelines through use of Decision Support systems. Other factors contributing to improved quality were the ability to aggregate data, such as with identifying infectious disease outbreaks.

Effects on efficiency (utilization of care and provider time) were mixed. Eight of ten studies reported decreased utilization rates (decreases between 8.5 and 24%) mainly due to CPOE systems. Effects on provider time varied from increases of ½ min per clinic visit to decreases of 11%. The article notes that overall time requirements seem to decrease as providers habituate to electronic system, but long-term studies to verify this effect are not available.

Effects on cost were the least well documented in the literature, confounded by some outdated studies more than 20 years old, limited in scope. Although the review listed some sporadic examples of cost savings, no clear pattern emerged.

Overall, the review concludes that the most clearly documented effect of use of healthcare IT in improving quality of care through (the surrogate measure of) increased adherence to practice guidelines. Data of efficiency and costs are mixed. All data and must be weighed against the limited, qualitative research that has been done and by the fact that almost 25% of the research done has been at institutions with Clinical Information Systems that have been locally designed and constructed over many years.