Difference between revisions of "Toward an effective strategy for the diffusion and use of CIS"

Revision as of 16:05, 23 February 2008

Implementation

Davidson,SM, Heineke,J. Toward an Effective Strategy for the Diffusion and Use of Clinical Information Systems.JAMIA 2007, Jun 14(3):361-7.

Question: Why has the full benefit of IT(especially EHR) is health care not yet been realized despite 40 years of efforts in this endeavor? “What driving and restraining factors affect the spread, use and effects of information technology in the health care sector in the U.S.”?(the authors)

Abstract: The authors believe that the full impact of IT care has not been realized because the path from availability of applications to their anticipated benefit passes through a series of stages, any of at which progress can be stopped. This paper presents a comprehensive framework of those steps, which researchers, practioners and policymakers should use to focus their efforts on unanswered questions.

Data Source/Setting: This viewpoint paper was presented at the Third International Conference on Technology in January, 2007.

Summary: The authors outline the following steps between the availability of health information system applications and the production of benefits, a process which is not strictly linear:

Step 1: Make Health Information System Applications Available

Step 2: Adopt Health Information System Application

Step 3: Use HIS Application

Step 4: Change Work Processes

Step 5: Improve Quality, Enhance Efficiency, Reduce Costs

The paper involves a discussion of each step, and the research questions which remain unanswered at each step. For instance, in step 1, it is noted that much of the commercial development of systems has been on practice management applications instead of clinical management applications(because their ability to enhance revenues and increase return-on-investment is less, and involve physicians). In step 2, it is noted that there is no”business case” for improving the effectiveness or quality of care with or without IT. In steps 3 and 4, it is noted that there is an expanding literature in this area, but that many questions remain(i.e. what functionalities are being used by physicians, how are these changing work processes?). The authors feel that Step 5 studies are premature, and are giving a distorted picture because questions in preceding steps have not yet been fully answered.

Conclusion: This paper is a thorough review of a conceptual framework developed by the authors to research why the full impact of IT in healthcare has not been realized, and that focus on the effects of IT on the quality, efficiency and cost of health care are premature and distorted(“productivity paradox”) because too many key questions involving HIT in the organizations using them and the physicians using them remain unanswered.

Comments: This is a monumentally important paper. Current implementation literature has uncovered only a “tip of the iceburg” to understand why HIT diffusion over the past 40 years has been so slow and unsuccessful, and why the magnitude of gains in quality, efficiency and cost of care has been modest at best. The research agenda it sets forward is important for policy makers, institutions, and physicians alike.

Sandy Mendel