Re-examining health IT policy: what will it take to derive value from our investment?

Riskin, Loren; Koppel, Ross; Riskin, Daniel J.

doi:10.1136/amiajnl-2014-003065

Cited by 20 publications

(11 citation statements)

References 25 publications

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“…As others, we believe that these returns are overestimated and biased [24,25]. Major limitations of financial efficiency studies are summarized here.…”

Section: The Use-financial Efficiency Circlementioning

confidence: 99%

“…As stated by Riskin et al "while there is a broad agreement that quality is important, national discussions seldom focus on what is actually measured and how those measurements are used" [25]. Most efforts have concentrated on processes (e.g., hemoglobin A1 measurements for diabetic patients) instead of outcome measures (e.g., the reduction of diabetes-associated complications) which should constitute the real target of health IT systems and of any quality improvement effort.…”

Section: The Use-quality Circlementioning

confidence: 99%

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The Virtuous Circles of Clinical Information Systems: a Modern Utopia

Degoulet

2016

Yearb Med Inform

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SummaryContext: Clinical information systems (CIS) are developed with the aim of improving both the efficiency and the quality of care. Objective: This position paper is based on the hypothesis that such vision is partly a utopian view of the emerging eSociety. Methods: Examples are drawn from 15 years of experience with the fully integrated Georges Pompidou University Hospital (HEGP) CIS and temporal data series extracted from the data warehouses of Assistance Publique -Hôpitaux de Paris (AP-HP) acute care hospitals which share the same administrative organization as HEGP. Three main virtuous circles are considered: user satisfaction vs. system use, system use vs. cost efficiency, and system use vs quality of care. Results: In structural equation models (SEM), the positive bidirectional relationship between user satisfaction and use was only observed in the early HEGP CIS deployment phase (first four years) but disappeared in late post-adoption (≥8 years). From 2009 to 2013, financial efficiency of 20 AP-HP hospitals evaluated with stochastic frontier analysis (SFA) models diminished by 0.5% per year. The lower decrease of efficiency observed between the three hospitals equipped with a more mature CIS and the 17 other hospitals was of the same order of magnitude than the difference observed between pediatric and non-pediatric hospitals. Outcome quality benefits that would bring evidence to the system use vs. quality loop are unlikely to be obtained in a near future since they require integration with population-based outcome measures including mortality, morbidity, and quality of life that may not be easily available. Conclusion: Barriers to making the transformation of the utopian part of the CIS virtuous circles happen should be overcome to actually benefit the emerging eSociety. KeywordsEvaluation of clinical information systems; return on investment; outcome research; acceptance models; information system success criteria Yearb Med Inform 2016:256-63 http://dx

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“…As others, we believe that these returns are overestimated and biased [24,25]. Major limitations of financial efficiency studies are summarized here.…”

Section: The Use-financial Efficiency Circlementioning

confidence: 99%

Section: The Use-quality Circlementioning

confidence: 99%

The Virtuous Circles of Clinical Information Systems: a Modern Utopia

Degoulet

2016

Yearb Med Inform

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“…Experts have suggested waiting 7-8 years before HIT could start meeting some of the productivity expectations. This suggestion was back by another set of researchers [150] that also recommended evaluating longer-term impact of HIT such as economic benefit, reductions in healthcare resource usage, and impact on clinical efficiency and quality over interim measures such as rate of EHR adoption [150]. Yet another article recommended cognizance of how various entities and levels "integrate" and "intersect" while developing any HIT interventions within a multilevel health system [151].…”

Section: Towards Achieving Health Information Technology's Potentialmentioning

confidence: 99%

Role of Data in Improving Care within a Health System: A Case Study of the Australian Health System

Das¹

2017

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“…More recently, as these EHRs have become more ubiquitous, usability rather than low adoption has been identified as an ongoing problem. Riskin et al [53] have highlighted continuing issues including electronic records being difficult to read and cumbersome to use with difficulties for users in being able to rapidly identify essential information. They also identified how these usability problems have been associated with new forms of technology-induced errors resulting from poor information presentation and design and limited appropriate tailoring to end users, their work tasks, or their contexts of use.…”

Section: Technology Human Factors and Usability: Old And New Problemsmentioning

confidence: 99%

Are We There Yet? Human Factors Knowledge and Health Information Technology – the Challenges of Implementation and Impact

Turner¹,

Kushniruk²,

Nohr³

2017

Yearb Med Inform

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SummaryObjective: To review the developments in human factors (HF) research on the challenges of health information technology (HIT) implementation and impact given the continuing incidence of usability problems and unintended consequences from HIT development and use. Methods: A search of PubMed/Medline and Web of Science® identified HF research published in 2015 and 2016. Electronic health records (EHRs) and patient-centred HIT emerged as significant foci of recent HF research. The authors selected prominent papers highlighting ongoing HF and usability challenges in these areas. This selective rather than systematic review of recent HF research highlights these key challenges and reflects on their implications on the future impact of HF research on HIT.Results: Research provides evidence of continued poor design, implementation, and usability of HIT, as well as technologyinduced errors and unintended consequences. The paper highlights support for: (i) strengthening the evidence base on the benefits of HF approaches; (ii) improving knowledge translation in the implementation of HF approaches during HIT design, implementation, and evaluation; (iii) increasing transparency, governance, and enforcement of HF best practices at all stages of the HIT system development life cycle. Discussion and Conclusion: HF and usability approaches are yet to become embedded as integral components of HIT development, implementation, and impact assessment. As HIT becomes ever-more pervasive including with patients as end-users, there is a need to expand our conceptualisation of the problems to be addressed and the suite of tactics and strategies to be used to calibrate our pro-active involvement in its improvement. KeywordsHuman factors engineering; usability; patient safety; health information technology Yearb Med Inform 2017:84-91 http://dx

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Re-examining health IT policy: what will it take to derive value from our investment?

Cited by 20 publications

References 25 publications

The Virtuous Circles of Clinical Information Systems: a Modern Utopia

The Virtuous Circles of Clinical Information Systems: a Modern Utopia

Role of Data in Improving Care within a Health System: A Case Study of the Australian Health System

Are We There Yet? Human Factors Knowledge and Health Information Technology – the Challenges of Implementation and Impact

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