Ninety-seven studies used a randomized design; 11 were other controlled clinical trials, 33 used a pre-post design, 20 used a time series, and another 17 were case studies with a concomitant control. The use of health information technology has been promoted as a great promise to improve the efficiency, cost-effectiveness, quality and safety of healthcare in our country’s healthcare system. Realizing these benefits is especially important in the context of reports that show five years of consecutive double-digit annual increases in health care costs and an increase in the number of adverse health events.1, 2 At the same time, reports have suggested that 50 percent of all health care dollars are wasted on inefficient processes. Lawmakers and organizational leaders at the federal and state levels have emphasized the need for health care to follow the example of many non-health care industries, in which the implementation of information technology has played an important role in increasing the accessibility of business-critical information. While the use of electronic health records in healthcare is limited, there is a renewed belief among government, vendor groups and healthcare buyers that widespread adoption is critical to delivering consistent, high-quality care. However, without other major changes in the way healthcare services are provided, the implementation of EHR is unlikely to improve quality.
In the run-up to the intervention, no differences were observed in the order of the tests. During the intervention period, doctors randomly assigned to the decision support tool ordered 17 percent fewer tests. In the post-intervention period, after EHR decision support was removed, physicians who had been in the intervention group ordered only 7 percent fewer tests than at baseline. This decrease in effect suggests that knowledge of the costs diagnostic imaging obtained by the test physicians during the intervention was not sufficient to change the practice over time. Instead, it was the presence of additional cost information within the care structure that most affected performance. Schriger and colleagues30 implemented an electronic medical record in the emergency department of a university hospital that provided documentation advice and recommendations for laboratory testing and treatment.
The last EHR study was conducted in outpatient medicine practice at Beth Israel Deaconess Medical Center in Boston, an academic medical center.51 Development of the clinical computer system began in the 1970s and was internal. The functionality of the system at the time of the investigation included documentation, result management, order entry, management of administrative data for decision support and electronic communication by e-mail. Electronic documentation and result management capabilities were available over the Internet. Assessing the effects of EHR adoption was itself a form of structural change in this study.
From a financial perspective, however, the hospital spent money on a system that had no effect on the cost or income of the current stay because the pneumococcal vaccine is not administered in the hospital. In order to benefit from this procedure, the hospital must create a reputation of higher quality and convert it into profit. This is an example of the potential for a mismatch between who pays and who builds cost savings by using HIT. A more extreme example is a hospital’s implementation of a HIT intervention that prevents future hospitalizations.
This record contains the complete medical history of an individual patient and should include everything from previous treatments to allergies and current prescriptions. A well-developed EHR can provide a comprehensive perspective on a patient’s medical history and physical makeup. However, this type of data collection only scratches the surface of how information technology systems can be applied to healthcare. There are apps that allow healthcare facilities to perform common functions such as tracking surgeries, scheduling staff, maintaining communications with both staff and patients, tracking real-time inventory information, and more. A health information technology system can affect all facets of a healthcare institution’s operations.
Such a redesign and redesign of processes is difficult and labour-intensive and is also hampered by the complexity and fragmentation of our current healthcare system. Therefore, despite the potential benefits of widespread use of EHRs, better empirical evidence is needed to confirm that the use of EHRs actually improves quality and, perhaps more fundamentally, to understand what capabilities EHRs should have to improve quality. At present, the depth and breadth of empirical evidence regarding the use of EHR and its attributable impact on the quality of care remains unclear. In other words, we couldn’t find a single study that used a randomized or controlled clinical trial design, reported data from a site that wasn’t one of the leading academic or institutional or U.K. HIT systems, reported cost results, and evaluated a HIT system that included at least four of IOM’s eight categories of functionality. Medical test orders in an emergency department77 showed a significant improvement in the profitability of internist ordering behavior.
The term is usually broadly defined to include medications, devices, surgical procedures, and organizational support systems within which medical care is provided. Identifying changes in costs attributable to these items over a period of time is virtually impossible. Even if the most important innovations could be listed, it would be extremely difficult to track their overall economic impact.
In addition, the report was requested by the Leap Frog Group and the Centers for Medicare and Medicaid Services. Reports and assessments provide organizations with comprehensive, science-based information about common and expensive medical conditions and new healthcare technologies. EPCs systematically review the relevant scientific literature on the topics assigned to them by the AHRQ and, where necessary, carry out additional analyses before developing their reports and assessments.
Easy access to information facilitates collaboration between multiple healthcare providers. This transparency helps eliminate errors and risks, such as prescriptions and conflicting treatments. Healthcare providers use monitoring technology to trigger alerts when such discrepancies occur in patients’ electronic health records. However, multiple use-related processes were investigated and showed significant changes after EHR implementation. Overall, they suggest improvements in the quality of care due to a decrease in excess health services.