Systematic Review: Health Information Technology
In the United States, the adoption of health information technology (IT) has been accelerated by financial incentives for individual healthcare providers and organizations that demonstrate that they use "certified" health IT to meet a set of criteria specified by the Centers for Medicare & Medicaid Services. Because of the rapidly expanding evidence base, the Office of the National Coordinator for Health Information Technology (division of U.S. Department of Health and Human Services) requested a systematic update of the literature. Thus, this review sought to update previous reviews and to examine recent evidence that relates health IT functionalities prescribed in meaningful use regulations to key aspects of healthcare, such as quality, safety, and efficiency. Investigators reviewed articles in PubMed from January 2010 through August 2013, and found 236 studies that were relevant to this review, including 147 articles on quality outcomes, 46 articles on safety outcomes, and 58 articles on efficiency outcomes, including cost. Most studies addressed clinical decision support (CDS), such as computerized alerts and reminders; computerized provider order entry (CPOE); or multifunctional health IT interventions, which examined broad IT interventions, such as electronic health records.
- Most published IT evaluation studies report positive effects on quality, safety, and efficiency.
- Strong evidence supports the use of clinical decision support and computerized provider order entry. Fifty-seven percent of the studies in this review evaluated CDS and CPOE, and most reported positive results.
- Insufficient reporting of implementation and context of use makes it impossible to determine why some health IT implementations are successful and others are not. Therefore, the most important improvement that can be made in health IT evaluations is increased reporting of the effects of implementation and context.
- The number of published health IT evaluation studies is increasing rapidly. Such studies increased by about 13% per year before 2007, and by about 25% per year from 2008 to 2012. Authors note that with the increasing adoption of electronic health records and other forms of health IT, it is no longer sufficient to ask whether health IT creates value, but rather the most useful studies will help us understand how to realize value from health IT.
- There is the potential for publication bias (i.e., negative studies are less likely to get published) in reviews of this type.
- All of the studies included in this review were weighted equally, regardless of study design or sample size.
- Health IT systems and the outcomes evaluated in this review were heterogeneous and often incompletely described.
Dr. Shekelle is part of HSR&D's Center for the Study of Healthcare Innovation, Implementation, and Policy in Sepulveda, CA, and the VA Greater Los Angeles Healthcare System.
Jones S, Rudin R, Perry T, and Shekelle P. Health Information Technology: An Updated Systematic Review with a Focus on Meaningful Use. Annals of Internal Medicine January 7, 2014;160(1):48-54.