Health Information Technology: An Updated Systematic Review With a Focus on Meaningful Use

Jones, Spencer S.; Rudin, Robert S.; Perry, Tanja; Shekelle, Paul G

doi:10.7326/m13-1531

Cited by 379 publications

(309 citation statements)

References 34 publications

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“…In addition, there is an increasing number of reports on health IT functionalities (e.g. Clinical Decision Support Systems, Computerized Provider Order Entry Systems) that are not EHR-embedded or the reports do not provide explicit information on their system architecture, respectively [19]. What is missing today, are more detailed descriptions of the architecture of health IT applications under study, content and format of data contained within their repositories, their cross-linkage to other health IT applications and other data sources.…”

Section: Introductionmentioning

confidence: 99%

“…The problem is, however, that this approach neglects the great variety of EHR definitions and potentially available EHR functionalities. Therefore, recent research evaluating the implementation of eHealth distinguishes more sharply between the simple availability of "any type" of EHR system and types that meet the criteria of the "Meaningful Use" objectives and provide multifunctional health information capacity including the capability to perform health information exchange [1, [17][18][19]. Indeed, results in many countries show a substantial gap between the proportion of healthcare providers using EHRs and those having multifunctional capacity [1,5,20].…”

Section: Introductionmentioning

confidence: 99%

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Undirected health IT implementation in ambulatory care favors paper-based workarounds and limits health data exchange

Djalali

Rosemann

Senn

et al. 2015

International Journal of Medical Informatics

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BACKGROUND: The adoption and use of health information technology (IT) continues to grow around the globe. In Switzerland, the government nor professional associations have to this day provided incentives for health IT adoption. OBJECTIVE: We aim to assess the proportion of physicians who are routinely working with electronic health data and describe to what extent physicians exchange electronic health data with peers and other health care providers. Additionally, we aim to estimate the effect of physicians' attitude towards health IT on the adoption of electronic workflows. METHODS: Between May and July 2013, we conducted a cross-sectional survey of 1200 practice based physicians in Switzerland. Respondents were asked to report on their technical means and where applicable their paper-based workarounds to process laboratory data, examination results, referral letters and physician's letters. Physicians' view of barriers and facilitators towards health IT use was determined by a composite score. RESULTS: A response rate of 57.1% (n=685) was reached. The sample was considered to be representative for physicians in Swiss ambulatory care. 35.2% of the respondents documented patients' health status with the help of a longitudinal semi-structured electronic text record generated by one or more encounters in the practice. Depending on the task within a workflow, around 11-46% of the respondents stated to rely on electronic workflow practices to process laboratory and examination data and dispatch referral notes and physician's letters. The permanent use of electronic workflow processes was infrequent. Instead, respondents reported paper-based workarounds affecting specific tasks within a workflow. Physicians' attitude towards health IT was significantly associated with the adoption of electronic workflows (OR 1.04-1.31, p<0.05), but the effect sizes of factors related to the working environment (e.g., regional factors, medical specialty, type of practice) were larger. CONCLUSION: At present, only a few physicians in Swiss ambulatory care routinely work with electronic health data. Until more of their peers participate in electronic exchange of structured clinical information, most physicians will continue to stay in paper-based systems and workarounds. The survey found that physicians with a positive attitude towards health IT were more likely to adopt electronic workflows, but the impact is minor. It will likely be necessary to introduce financial incentives and develop national standards in order to promote the adoption by a critical mass of practicing clinicians. Abstract BackgroundThe adoption and use of health information technology (IT) continues to grow around the globe. In Switzerland, the government nor professional associations have to this day provided incentives for health IT adoption. ObjectiveWe aim to assess the proportion of physicians who are routinely working with electronic health dataand describe to what extent physicians exchange electronic health data with peers and other health care p...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Undirected health IT implementation in ambulatory care favors paper-based workarounds and limits health data exchange

Djalali

Rosemann

Senn

et al. 2015

International Journal of Medical Informatics

View full text Add to dashboard Cite

show abstract

“…[1][2][3] For example, EHRs often feature decision support systems that remind providers of guidelines for recommended care, and health information exchange may reduce duplicate testing. 4 Beyond these commonly cited benefits, EHRs may offer another, overlooked opportunity for improvement.…”

Section: Introductionmentioning

confidence: 99%

Nudging Physician Prescription Decisions by Partitioning the Order Set: Results of a Vignette-Based Study

et al. 2014

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BACKGROUND: Healthcare professionals are rapidly adopting electronic health records (EHRs). Within EHRs, seemingly innocuous menu design configurations can influence provider decisions for better or worse. OBJECTIVE: The purpose of this study was to examine whether the grouping of menu items systematically affects prescribing practices among primary care providers. PARTICIPANTS: We surveyed 166 primary care providers in a research network of practices in the greater Chicago area, of whom 84 responded (51 % response rate). Respondents and non-respondents were similar on all observable dimensions except that respondents were more likely to work in an academic setting. DESIGN: The questionnaire consisted of seven clinical vignettes. Each vignette described typical signs and symptoms for acute respiratory infections, and providers chose treatments from a menu of options. For each vignette, providers were randomly assigned to one of two menu partitions. For antibiotic-inappropriate vignettes, the treatment menu either listed over-the-counter (OTC) medications individually while grouping prescriptions together, or displayed the reverse partition. For antibiotic-appropriate vignettes, the treatment menu either listed narrow-spectrum antibiotics individually while grouping broad-spectrum antibiotics, or displayed the reverse partition. MAIN MEASURES: The main outcome was provider treatment choice. For antibiotic-inappropriate vignettes, we categorized responses as prescription drugs or OTC-only options. For antibiotic-appropriate vignettes, we categorized responses as broad-or narrow-spectrum antibiotics. KEY RESULTS: Across vignettes, there was an 11.5 percentage point reduction in choosing aggressive treatment options (e.g., broad-spectrum antibiotics) when aggressive options were grouped compared to when those same options were listed individually (95 % CI: 2.9 to 20.1 %; p=.008). CONCLUSIONS:Provider treatment choice appears to be influenced by the grouping of menu options, suggesting that the layout of EHR order sets is not an arbitrary exercise. The careful crafting of EHR order sets can serve as an important opportunity to improve patient care without constraining physicians' ability to prescribe what they believe is best for their patients.

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“…Information technology can reduce risks to patients by providing effective and timely clinical decision support (Jones et al 2014 ), improving coordination and communication, and may become a major driver of clinical performance and quality (Weiner et al 2012 ;Classen et al 2011 ). Various forms of tele-health facilitate and support people in their own homes (Baker et al 2011 ;Anker et al 2011 ).…”

Section: The Benefits and Risks Of Information Technologymentioning

confidence: 99%

New Challenges for Patient Safety

Vincent

Amalberti

2016

Safer Healthcare

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The developments described in the previous chapters are required because our present vision of safety is not adequate for the challenges we face. Our arguments for these developments rest on analyses of the nature of safety in healthcare as it is delivered today. However, as is well known, healthcare is changing rapidly and there are many new opportunities, pressures and challenges. We believe that these coming changes will have further implications for how safety is understood and practiced which will increase the urgency and importance of the transition to a broader vision.In this chapter we briefl y summarise some of the recent and forthcoming developments in healthcare. These have been widely discussed and we are only concerned to summarise some key points. The primary purpose of the chapter is to consider the implications for patient safety and for the strategies and practices we set out in the remainder of the book. The Changing Nature of HealthcareThe problems faced by healthcare, and many of the challenges for patient safety, arise in part from the very success of modern medicine in combating disease. Because of improvements in diet, nutrition, medicine and environment many people are living longer but also living with one or more chronic conditions such as diabetes, cardiovascular disease and cancer. Diseases which were once fatal are now becoming chronic conditions.The survival rate for cancers, infections and AIDS, strokes, cardiovascular disease and many other previously fatal diseases have improved signifi cantly even in the last decade. For instance a recent French study of 427,000 new adult cancer cases diagnosed between 1989 and 2004, showed signifi cant improvements in 5 year survival for most cancers, especially prostate cancer (Grosclaude et al. 2013 ).In the French population of 65 million people over 320,000 new cancers are diagnosed every year; of these 150,000 are designated as 'cured' within the same 130 year and a further 150,000 can expect to survive at least 5 years. Similar improvements in survival and quality of life in AIDS patients have been seen in developed countries with the introduction of HAART therapies (Highly Active Antiretroviral Therapy) (Borrell et al. 2006 ). Most people treated for chronic conditions are going back to work, family and home, with the personal ambition of leading as healthy life as possible. These developments present huge challenges for healthcare systems in providing care and yet remaining affordable.The traditional hospital cannot remain the main provider of care and core of the medical system simply because it would be unaffordable. Hospitals are still of course essential in any future vision of healthcare but will increasingly focus on investigations and procedures that require a very high level of expertise and sophisticated technology. The proportion of beds devoted to high dependency and intensive care will increase while the overall number of beds will reduce (Ackroyd-Stolarz et al. 2011 ).Medical innovations have lead progressively to shorter h...

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Health Information Technology: An Updated Systematic Review With a Focus on Meaningful Use

Abstract: Office of the National Coordinator.

Cited by 379 publications

References 34 publications

Undirected health IT implementation in ambulatory care favors paper-based workarounds and limits health data exchange

Undirected health IT implementation in ambulatory care favors paper-based workarounds and limits health data exchange

Nudging Physician Prescription Decisions by Partitioning the Order Set: Results of a Vignette-Based Study

New Challenges for Patient Safety

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