Effect of Health Information Technology on Quality Health Care

Introduction

Health Information Technology (HIT) is designed to facilitate the storage of patient’s records in a safe and careful manner, minimize the input error and missing records, and improve the process of communication (Sun, 2016). Over last few years, there have been several health care policies and incentives that have sought to add weight to the adoption of an effective application of health IT in an attempt to enhance quality in the primary care settings. Among these policies include the Federal Health Information Technology of Economic and Clinical Health (HITECH) Act, enacted in 2009 under the American Recovery and Reinvestment Act. These acts sought to offers incentives for the adoption of meaningful use of EHRs (Higgins et al., 2015). The meaningful use highlighted the requirements for using EHR data to improve healthcare processes and outcomes by tracking and reporting the quality measures, e-prescribing, implementing decision support, and engaging in the health information exchange. The progress of meaningful use of EHRs can be noted in the event of 2014where the Centers for Medicare and Medicaid Services reported that it had issued $19.2 billion in meaningful use incentives to over 441,000 registered providers that were engaged in the Federal EHR meaningful use program (Higgins et al., 2015).

The adoption of health information technology was further cemented through the enactment of the Patient Protection and Affordable Care Act of 2010. The Act insisted on the importance of quality improvement and made proposals on the use of health information technology as a tool to improve patient safety, reduce medical errors, and enhance the delivery of patient-centered care (Higgins et al., 2015). To achieve this, the Office of the National Coordinator (ONC) for Health Information Technology opened up about 62 regional extension centers with an objective of offering EHR technical assistance to private practice facilities and federal facility centers that were qualified (Higgins et al., 2015). This enhanced access to health care for the communities that have been placed as medically undeserving. The effort to improve the adoption of health information technology can be seen through the works of the Agency for Healthcare Research & Quality (AHRQ). The agency had engaged in contracts and grants valued at more than $300 million to over 200 communities, hospital, providers, and healthcare systems in more than 48 states, with an aim of enhancing the understanding of health IT to improve the quality healthcare (Higgins et al., 2015). It is clear that effective health information technology is bound to have a positive impact on the quality of patient care.

Effects of Health Information Technology on Patient Care

Clearly, the use of health information technology has the potential to enhance patient safety, minimize medical errors, and improve patient outcomes. Evidence also indicates that health information technology is effective in improving patient care through the reduction of medication errors, minimizing drug reactions, and enhancing compliance to practice guidelines (Alotaibi & Federico, 2017). Health information technology has been identified as an essential tool for improving healthcare quality and safety. It opens a window of opportunity to enhance and transform healthcare information to improve clinical outcomes, facilities care coordination, improve practice efficiencies, and tracking data. The goal of health information technology is to provide healthcare providers with updated patient data to help them make clinical decisions. To understand better the effects of health information technology on patient care, it is important to consider the modeling the physicians on patient health and the exact effects of health information technology.

Modeling the Physician’s on Patient Health

The main Health Information Technology systems that are available for use by healthcare practitioners in healthcare facilities include the electronic physician’s order (CPOE) and clinical decision support (CDS). Other HIT systems include E-prescribing, electronic sign-out and hand-off tools, barcode medication administration (BCMA), smart pumps, automated medication dispensing reporting (ADC), and retained surgical items detectors.  Additionally, electronic medication administration record (eMar), patient data management system (PDMS), patient electronic, telemedicine, electronic incident reporting, and electronic health records (EHR) are also part of the HIT systems available for use by care providers (Alotaibi & Federico, 2017).

1. Electronic health records (EHR)

According to the Centers for Medicare and Medicaid Service, electronic health record is an electronic version of the patient’s medical history that is maintained by a healthcare facility over a period. The systems cover data such as relevant administrative data for the particular patient including demographics, progress notes, issues, medications, vital signs, medical history, immunization, laboratory information, and radiology report (Bajwa, 2014). Where the health records are maintained strictly within the facility, these are referred to as the electronic medical records (EMRs). However, in a situation where the health records are interconnected between the different healthcare facilities and can be accessed from outside, there are referred to as electronic health records (EHRs). The EHR allows the physicians to access and view the patient medical records on their devices. The physicians are also to enter data directly in the system making it part of the digital medical record. The physician further makes prescriptions by selecting the drugs from a list thereby, avoiding the difficulties posed by illegible handwriting, which was a major source of medical errors.

1. E-prescription

The adoption of health information technology has made it possible for the prescribers to relay the prescriptions to the pharmacies electronically. This has ended the era of handwritten prescription notes, faxes, and calling to deliver the prescriptions. The adoption of this technology has been effective in the reduction of prescription errors due to the breakdown of communication between the physician and the pharmacy (Bajwa, 2014).

1. The clinical decision support (CDS) system

The adoption of EHR has led to the development of data repositories that stores large amounts of information about diagnostics and treatment of different illnesses and disorders. This is effective in assisting the physicians to carry out a diagnosis and make a decision on the most suitable treatment and method of healthcare delivery. In this case, the physician makes the decision while being informed by evidence rather than mere opinion. The CDS helps the physician gain access to reference material and information upon which they base their decision. The adoption of the EHR has made it possible for the physician to identify the adverse events and errors (Bajwa, 2014). This reliance on this system assists in encouraging the physicians to adhere to the standards and evaluate the clinical performance.

1. Virtual clinics and doctors

Virtual clinics are online clinics that offer 24-hour online access for patients to healthcare physicians who assist in making a diagnosis and prescribe treatment. Under this setup, the patients have indicated improvement in the experience of care by patients and have had an effect on the reduction of per capita health care costs. Among the application allowing this include virtual clinic, which enables the physicians within a healthcare network to provide answers to the patients in the real time, and the virtual doctor that offers valuable information on ways to enhance their health (Bajwa, 2014).

Modeling of Healthcare Information Technology on Patients

1. Personal Health Record (PHR)

This is a technological development with a web of EHR and HIE, that seeks to enhance the active participation of the patients in their healthcare decision-making. The electronic version of the PHR enables the patients to enter data on their health status and this is linked to the physicians EHR to allow the healthcare provider to review the information that the patient has assembled. This system is essential in encouraging the patient’s participation in making decisions affecting their care plans (Bajwa, 2014). The patients are thereby motivated to keep track of their health maintenance.

1. Patient portal

Patient portals are healthcare applications that enable the interaction between the patients and the physicians. These portals are accessible anytime through the internet. Majority of the patient’s portals are integrated into the websites of the providers and may be run as different modules connected to these websites. These portals allow the patients to access their medical details and to interact directly with the physicians over the internet (Bajwa, 2014).

1. Mobile Home Healthcare

The technology on mobile home health care allows patients to communicate about the status of their disease to the physicians while still at home. This is an effective approach in the management of chronic illnesses, especially among the elderly population. This has been used through linkages with blood pressure monitors, glucose monitors, weight scales, and pulse oximeters. The current devices require data to be transferred to the EMR/EHR (Bajwa, 2014).

                                                      Research Data and Statistics

Data Sources

The Office of the National Coordinator for Health Information Technology is an important source of data to understand better the adoption of health information technology in healthcare facilities and by physicians. The source of data will be a report to the Congress that highlights the Health IT progress by examining the HITECH Era as well as the future of Health IT. The report was a submission pursuant to the section 3001(c) of the Public Health Service Act and a section of the Hitech Act. The data describes the specific actions that the federal government and private facilities have taken to enable the adoption of a nationwide system for the electronic use and exchange of health information. The report highlights the barriers to the adoption of a nationwide system and offers recommendations on the achievement of the full implementation of the nationwide system. 

Data Statistics

The increased adoption of the health information technology was experienced after 2011 when the Medicare and Medicaid Services initiated a program providing incentives to providers for demonstrating the meaningful use of electronic health records. It was observed that the rate of adoption of the EHR between 2002 and 2011 among the office-based physicians had reached 38% (Fleming, 2012). By 2011, more than 50% of the physicians had installed EHR equipment thereby, tripling the percentages over a period of a decade. Physicians in small practices were noted to be less likely to have embraced the EHRs with a rate of 25.9% in comparison to an increase of 54.6% for practices with more than 10 physicians (Fleming, 2012). Over the decade, it was observed that primary care physicians increased their adoption by 8.6% more than non-primary care physicians. Physicians aged 45 years and below were found to have adopted the health information by 20.4% more than the physicians aged 55 years and above (Fleming, 2012). Through an analysis, it was revealed that the facilities with the most basic EHR systems increased from 15.1% in 2010 to 26.6% in 2011. It was also noted that the healthcare facilities that had made a reasonable proxy for the meaningful use increased from 4.1% in 2010 to 18.4% in 2011 (Fleming, 2012).

It has been established that among the physicians, 78% possesses certification for EHR while 96% of hospitals are certified (The Office of the National Coordinator for Health Information Technology, 2016). This is an indication that there has been a rapid digitization within the health systems, which could be linked to extensive collaboration and the effect of incentives provided by the Medicare and Medicaid EHR Incentives programs. The Regional Extension Center has also offered technical support to more than 120,000 health care providers. The HITECH funding programs have expanded the HIE-related infrastructure in terms of technical, legal, and policy structures to support the digitization of the healthcare system. 

Notably, evidence indicates that the health care system is experiencing an increased flow of health information. In 2008, it has been reported that only 41% of healthcare facilities shared health information electronically with outside providers. By 2015, this rate had doubled by more than 82% of the non-federal acute care facilities reportedly transmitting electronically laboratory results, radiology results, clinical summaries, and medication lists (The Office of the National Coordinator for Health Information Technology, 2016).

There has also been increased access to health information with the adoption of health information technology. Evidence shows that the increased access to electronic health information makes patients develop a deeper sense of trust in how their information is being managed. The digitizing of the U.S. health systems has empowered the individuals to take greater control of decision about their health and wellbeing. The report indicates that in 2012, only a quarter of facilities offered the patients with the ability to electronically view their information. As of 2016, this figure was 95%. The ability of patients to download their health information increased from 14% in 2012 to 87% in 2015. The capabilities to transmit the information have been noted to increase from 12% in 2013 to 71% in 2015.

Another study by Rittenhouse et al. (2017) revealed that by 2013, the adoption of health information technology had increased significantly for different EHR functionalities. The use of EHR to collect quality data was noted to have increased from 17% in 2002 to 42% in 2013 (Rittenhouse et al. 2017). The application of patient-oriented functionalities such as patient access to online medical details and the use of emails to reach out to patients were noted to have increased by 1 in every 5 practices. The use of e-prescribing was noted to have increased from 25% to 70% during the study period (Rittenhouse, et al. 2017). Diabetes and asthma registries have been noted to have increased significantly over the period of 2002 and 2013. By 2004, it has been revealed that the adoption of the basic health information technology systems such as laboratory and pharmacy information systems have been over 90% (Lee & Park, 2013). During these periods, the adoption of advanced clinical IT systems such as CPOE was quite low.

Effect of Health Information on Quality Care

Impact of Health Information Technology on Mortality and Expenditure

In their study, Lin et al. revealed that a number of base-line EHR functionalities were connected to a higher 30-day mortality rate. At the same time, the baseline functions of EHR lead to a 0.99 reduction in mortality rates. The inclusion of new EHR functionality was connected with lower mortality rates. The research revealed that for each new function that was increased during the study period, there was a 0.21% reduction in mortality rate per year per functionality (McKenna, Dwyer, & Rizzo, 2018). While considering the patient population across all ages and insurance types, results revealed that adoption of health information technology led to a reduction in the hospital severity-adjusted mortality by 0.3%. When the effect was checked for Medicare patient, the HIT adoption led to a reduction in the hospital’s severity-adjusted mortality rate by 0.5 percentage points (McKenna, Dwyer, & Rizzo, 2018).

The adoption of HIT has been noted to increase medical expenditures. The medical expenditure factors, in this case, include that screening and diagnostic tests, hospital visits, increased spending on treatment interventions, and outpatient physician services. It was noted that after the adoption of the HIT, the expenditure on diagnostic testing and imaging increased by 1.6% equivalent to about $160 per patient (Agha, 2014). A trend break model indicated that a rise in expenditure is slower amongst adopters after HIT adoption, although the coefficient is smaller. Under this sector, it has been noted that expenditure has the highest estimated 3-year effect of 1.3% (Agha, 2014). This approximate rise in the diagnostic testing reveals that HIT may reduce the effort costs of ordering and following additional tests, which may thereby; enhance a physician’s propensity to order for more intensive work-up.

The adoption of health information technology has been associated with increased expenditures on hospital stays. On this note, it was observed that there was an increasing initial bump in the expenditure on inpatient care, later followed by a gradual settling to the baseline trend. The initial rise in expenditure was noted to be about 1.1%, which is lower than the estimated effect on diagnostic imaging (Agha, 2010). However, over a period of three years, the inpatient expenditures have been approximated to be 0.7% higher, which is not statistically significant (Agha, 2014).

Patterns of increase in expenditures have been observed on medications, durable medical equipment, operating room staffing, and blood transfusions. In this case, there is an observed initial increase before stabilization of the expenditures (Agha, 2014). Overall, evidence has indicated increased spending linked with intensive diagnostic work-ups and interventions. Inpatient hospital expenses and outpatient physician services do not change significantly. It has been noted that they are higher scope for a rise in expenditures with testing, imaging, operations, and inpatient pharmacy (Agha, 2014). 

Impact of Health Information Technology on Hospital Care

Among the health information technology that has had an impact on hospital care include the application of health information technology to enhance Patient-Centered Medical Home (PCMH). This has led to the revolutionization of the primary care to ensure that it is more respectful and responsive to a patient’s needs, preference, and values. Health information technology has played a vital role in supporting functions of primary care such as enhancing access and continuity, identifying and managing patient populations, planning and managing healthcare, supporting self-care and community support, tracking and coordinating care, and measuring and improving performance. Health information technologies provide substantial opportunities for primary care practices to achieve a patient-centered care status (Kraschnewski & Gabbay, 2013). The federal government offers incentives to healthcare facilities to adopt the meaningful use of certified EHRs to healthcare.

In enhancing access and continuity of care, the healthcare information technology is applied using a web-based personal health record or patient portal. The use of personal health records provides an opportunity to increase patient engagement and self-efficacy. The use of portable records provides an opportunity for real-time information exchange of clinical results such laboratory. This may be connected to the EHR to serve as a patient web portal. Patient web portal enhances the efficiency and productivity of care that is beneficial to both patient and health care providers. Patient portals provide an opportunity to process electronic requests for follow-up visits and prescriptions refills, as well as, educational information. It is, thereby, clear that the application of healthcare information technology enhances care access, continuity and enhances medication adherence (Kraschnewski & Gabbay, 2013).

Health information technology enables the identification and management of patient populations. These technologies facilitate the process of collection of patient information, which includes demographics and clinical data. This information is useful in population management, assessment, and documentation of patient risk factors, as well as identifying patients for proactive and point-of-care reminders (Kraschnewski & Gabbay, 2013). An example of health information technology is a web-based data collection that is adopted by the University of Pittsburgh primary care clinics and is used to screen patients for various conditions while in the waiting room. The inclusion of this system within the EHR of the healthcare facility allows it to get access to individual patient results. Such a system allows maintenance of a registry for health conditions of the diseases that they normally encounter. In the management of the population, a patient registry is very essential. A patient registry is an electronic organization of patients depicting their condition and their disease-specific clinical and laboratory quality measures (Kraschnewski & Gabbay, 2013). The patient registry enables the tracking of the patient and outcome allows the improvements in clinical efficiency and spotting of high-risk patients.

The use of health information technology in healthcare facilities facilitates the planning and management of care. This includes the identification of patients suffering from different health conditions and highlights the appropriate care management. The use of EHRs in providing point-of-care reminders enhances the ability to use team-based care. Team-based care is noted to be more effective when using the tools of EHR to allow different team members to offer ideal care throughout the clinical encounter. Pre-visit planning is another example of health information technology that facilitates the provision of care. This offers a summary of essential information about the patient as he/she enters the clinic room and generates an automated physician order depending on the patient’s health status (Kraschnewski & Gabbay, 2013).

Impact of Health Information Technology on Hospital Quality

A study carried out revealed an inverse relationship between EHR adoption in healthcare facilities and patient outcomes of prolonged length of stay (PLOS) and admission. Further analysis based on the relationship between nursing work environment, missed nursing care, and patient satisfaction indicated confounding effect of EHR on patient satisfaction (Hessels, Flynn, Cimiotti, Bakken, & Gershon, 2015). It has been indicated that there is a positive association between the adoption of the clinical information system, patient scheduling application, and adherence to best practices in the treatment of heart attacks, heart failures, and pneumonia (Bardhan & Thouin, 2013). Evidence also indicates that the adoption of financial management systems leads to a reduction in hospital operating expenses.

Application of IT in health has been used to promote quality and safety with an aim of preventing quality and safety events from occurring. The use of automated reminders and alerts has been noted to avail essential information in support of safe and effective clinical decisions. These alerts from the electronic health records represent a standard mechanism for the application of health information technology to prevent any potentially missed quality and patient safety events. Evidence indicates that immunization alerts contributed to a 12% increase in the wellness of a child and a 22% rise in the sick child immunization administration. Drug alerts have been linked to a 22% decrease in medication prescription errors (Feldman, Buchlater, & Hayes, 2018). The drug alert is in the form of soft stops and hard stops. The soft stops offer key information concerning a potential quality or patient safety issue and offer choice requiring the user to acknowledge the alert to proceed. A hard stop prevents the user from proceeding with an order or intervention that could be potentially dangerous to a patient. On one hand, soft stops such as alert fatigue, poor implementation, or poor design can be ignored or overridden. However, evidence shows that hard-stops have been more successful in the reverting an unsafe plan or preventing the occurrence of a potentially dangerous intervention (Feldman, Buchlater, & Hayes, 2018).

Health information technology (HIT) has been proven to improve care and outcomes for older adults. EHR systems have been found to lead to enhanced documentation of both fall risk assessments. Studies have revealed that the improved documentation associated with the use of EHR was found to cause a 13% decrease in hospital-acquired pressure ulcer rates (Bowles, Dykes, Demiris, 2015). A geriatric care improvement program such as the Nurses Improving Care for Health system Elders had been integrated with EHR. The integration created capabilities of entering data in a structured, coded format, and assisted the clinical decision support to ensure that the elderly patients receive evidence-based, personalized care, and allow nursing documentation to act as evidence for future practice (Bowles, Dykes, Demiris, 2015). Gerontological nurse experts may be in a position to influence essential outcomes and standardize how to assess and treat older patients by providing input where evidence-based, personalized care and ensuring nursing documentation is reused for future practice. In a long-term care facility that adopted the EHR that integrated the evidence-based assessment tools, it was noticed that the malnourished residents reduced significantly. Adoption of such tools has been noted to allow the caregivers an opportunity to assess the quality parameters over time and use research and knowledge generation using large data-sets. It has been noted that the use of home telehealth allows detection of key clinical symptoms that take place between regular physician visits (Bowles, Dykes, Demiris, 2015).

Conclusion

The discussion above is meant to establish the effects of the adoption of health information technology on quality health care. Health Information Technology (HIT) is designed to facilitate the storage of patient’s records in a safe manner, minimize the input error and missing records, and improve the process of communication. The policies that largely contributed to the adoption of HIT include the Federal Health Information Technology of Economic and Clinical Health (HITECH) Act enacted in 2009 under the American Recovery and Reinvestment Act. EHR data has been used to improve healthcare processes and outcomes using tracking and reporting the quality measures, e-prescribing, implementing decision support and engaging in the health information exchange. Among the commonly adopted health information technology systems include the electronic physician’s order (CPOE), clinical decision support (CDS), E-prescribing, electronic sign-out, and hand-off tools, barcode medication administration (BCMA), and smart pumps. Others include automated medication dispensing reporting (ADC), retained surgical items detectors, electronic medication administration record (eMar), patient data management system (PDMS), patient electronic, telemedicine, electronic incident reporting, and electronic health records (EHR).

It has been revealed that the rapid digitization within the health systems could be linked to extensive collaboration and the effect of incentives provided by the Medicare and Medicaid EHR Incentives programs. Adoption of new EHR functionality was connected with lower mortality rates. The adoption of HIT has been noted to increase the medical expenditures for cost related to screening and diagnostic tests, hospital visits, increased spending on treatment interventions, and outpatient care physician services. In relation to hospital care, the use of health information technology has been found to influence Patient-Centered Medical care, access and continuity of care, identification and management of patient populations, and planning and management of care. In terms of hospital quality, the adoption of EHR has been noted to influence patient outcomes of prolonged length of stay (PLOS) and admission, prevention of occurrence of quality and safety events, and improving care and outcomes for older adults. In general, the adoption of health information technology in facilities has been noted to be very influential in enhancing care in healthcare facilities.

References

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