Since the implementation of the HITECH Act, adoption rates of the electronic medical record have increased significantly, but have patients experienced a commensurate increase in quality and decrease in errors as a result of the presence of that technology?
Two researchers from the School of Health Administration at the San Marcos-based Texas State University sought to answer this question with a study, recently published in the Journal of Medical Internet Research, examining the effect of the adoption of health information technology on medical outcomes since 2011.
For the study, the researchers analyzed 37 peer-reviewed articles published in the last five years that defined a health IT intervention and an effect on medical outcomes in terms of efficiency or effectiveness.
In the U.S. in 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act made incentive payments available to providers who adopted the meaningful use of a certified electronic health record (EHR), stimulating widespread adoption of HIT across various health care settings.
“Since the implementation of the HITECH Act, adoption rates of the electronic medical record in the United States have shown greater than arithmetic growth, but have patients experienced a commensurate increase in quality and decrease in errors as a result of the presence of that technology?” the study authors wrote.
As part of the analysis, researchers examined 12 different categories of health IT, with a total of 38 occurrences. Web-based interventions were analyzed most frequently at eight of 38 occurrences (21 percent). Telemedicine and software programs were the next most frequently identified interventions, occurring seven of 38 occurrences (18 percent), and six of 38 occurrences (16 percent), respectively.
Clinical decision support systems were analyzed at a frequency of five of 38 occurrences (13 percent). mHealth occurred three of 38 occurrences (8 percent). Telemedicine and electronic ordering health IT interventions occurred two of 38 occurrences (5 percent). Health information exchange (HIE), health IT, robot assistance, videoconferencing, and remote screening were all identified once for the lowest frequency at 3 percent individually.
What’s more, for the study, evidence of efficiency or effectiveness that were grouped under physical outcomes included body mass index, blood pressure, hypertension, infection, mortality, vaccines, cardiovascular disease, diabetes distress, quality of life, A1C level and asthma control, among others. Occurrences also were grouped under psychological conditions, such as depression, and under continuity of care, such as medication administration, medication adherence, readmission, length of stay, and reduced office visits. The most common outcome category was physical, which appeared 39 of 65 occurrences (60 percent).
The researchers identified at least one improved medical outcome as a result of health IT adoption in 81 percent (25/37) of research studies that met inclusion criteria, thus strongly supporting our hypothesis. No statistical difference in outcomes was identified as a result of health IT in 19 percent of included studies. Twelve categories of health IT and three categories of outcomes occurred 38 and 65 times, respectively.
The researchers concluded that health care providers will continue to be incentivized to adopt health IT as policy makers respond to quality, and safety concerns and reimbursement methods transition toward value-based purchasing.
“HIT has the potential to improve the quality and safety of health care services. Providers who leverage HIT to improve medical outcomes can position themselves for sustainability in the future,” the study authors wrote, noting that further research is needed to continue to reveal and define the relationship between the adoption of HIT and medical outcomes.
“This will be especially true as the industry establishes new and innovative ways to integrate technological advances and works toward greater interoperability as the United States prepares for stage 3 of meaningful use, as all providers seek a link between the application of HIT in health care and its effect on outcomes, and as other nations such as Switzerland, Denmark, and Germany reconcile national medical programs such as a nationwide EHR, regional electronic patient record system, and national medical chip cards, respectively, against outcomes,” the study authors wrote.