Digital Waste? Unintended Consequences of Health Information Technology

Abstract

We exploit a large-scale natural experimentthe rollout of a nationwide electronic prescribing system in Finlandto study how digitization of prescriptions affects pharmaceutical use and health outcomes. We use comprehensive administrative data from patients treated with benzodiazepines, which are globally popular, effective but addictive psychotropic medications. We find no impact on benzodiazepine use on average, but among younger patients eprescribing increases repeat prescription use. Younger patients' health outcomes do not improve but adverse outcomes, such as prescription drug abuse disorders and suicide attempts, increase dramatically. Improving access to medication through easier ordering may thus increase medication overuse.

Overuse of reliever inhalers and associated healthcare utilization of asthma patients

“…In the last decade in Israel, patients have been able to submit an online request for a prescription (instead of scheduling face-to-face appointment with their primary physician). This innovative approach may have led to excessive use of prescription drugs in general and reliever inhalers specifically 19 . It may be possible to curb overuse of relievers if prescriptions for reliever inhalers can be obtained only through face-to-face visits with the primary care physician, who can estimate the actual need for the medication and ensure correct controller use.…”

Information Integration, Coordination Failures, and Quality of Prescribing

“…Our earlier work (Böckerman et al 2019) focuses on another central goal of e-prescribing: improvements in the efficiency of the prescribing process through digital generation and transfer of a patient's prescriptions between physicians and pharmacies. Compared to traditional paper prescriptions, e-prescribing reduces the hassle and time costs of renewing and filling prescriptions, also eliminating lost prescriptions.…”

“…Third, there is substantial and plausibly exogenous regional heterogeneity in the adoption time of the e-prescribing system. As explained in Böckerman et al (2019), the adoption time was determined by technical difficulties in the integration of the e-prescribing system with the pre-existing information technology systems in health care units and pharmacies, rather than by trends in prescribing and health outcomes.…”

“…We also contribute to the literature analyzing how information technology affects patient health (e.g. McCullough et al 2010;Miller and Tucker 2011;Agha 2014;McCullough et al 2016;Böckerman et al 2019). The paper closest to ours is McCullough et al (2016), who examine the effects of health information technology on mortality for the most complex patients whose diagnoses require cross-specialty care coordination.…”