Effect of Health Information Technology on Quality Health Care

Abstract

 In the health-care administration field, the mission is to improve the health of patients through research and scientific discovery. Normally the tools and costs for quality healthcare are expensive and if a patient seeks proper care, information technology in health care can be an innovative way of preventing and solving health care issues. In return, this adds high reliability in the safety of patient-centric quality medical care in a healthcare environment. Among the health information systems that are commonly used by physicians include electronic health records, e-prescription, clinical decision support (CDS) system, and virtual clinics and doctors. The health information technology modeled on patients include personal health records, patient portal, and mobile home healthcare. The adoption of health information technology in health care leads to lower mortality rates, as well as, an increase in some expenditure. Health information technology affects hospital care by supporting the provision of primary care through enhanced access and continuity, managing patients’ population, and management of patient records. The aspects of health information technology that influence hospital quality include providing immunization alerts, drug alerts, and improved documentation. The health quality aspects influenced by HIT include the general health wellness of children, child immunization administration, medication prescription errors, and hospital-acquired pressure ulcer. 

Introduction

Health Information Technology (HIT) is designed to facilitate the storage of patient’s records in a safe and careful manner, minimize the input errors, missing records, and improve the process of communication (Sun, 2016). Over the last few years, several health care policies and incentives have sought to add weight to the adoption and 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 offer incentives for the adoption and meaningful use of Electronic Health Records (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 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 HIT 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 HIT 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 health IT understanding to improve the quality healthcare (Higgins et al., 2015). The purpose of the paper will be to highlight the impact of health information technology in the healthcare sector. The paper discusses the different forms of the HIT used by physicians and those modeled on patients. The paper is also organized into sections that discuss the impact of health information technology on mortality and expenditure, hospital care, and quality of services in healthcare facilities.

Research Question

What effects does health information technology have on quality health care?

Research Methodology

We examined several different and complex elements of quality management, quality health care, and the effects of health information technology on quality health care. The research consists of various literature reviews and scholarly journal publications.

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” (Alotaibi & Federico, 2017).  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).

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). In cases 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 the hospital facility, there are referred to as electronic health records (EHRs). The EHR allows physicians to access and view the patient medical records on their devices. The physicians are also able to enter data directly in the system making it part of the digital medical record. Further, physicians can make prescriptions by selecting the drugs from a list, thereby, eliminating the challenges posed by illegible handwriting, which was a major source of medical errors.

E-prescription

The adoption of health information technology has made it possible for the prescribers to relay electronic drug prescriptions to the pharmacy. 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 medication errors due to the breakdown of communication between the physician and the pharmacy (Bajwa, 2014).

The clinical decision support (CDS) system

The adoption of EHR has led to the development of data repositories that store 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 adverse events and errors and act accordingly (Bajwa, 2014). The reliance on this system encourages physicians to adhere to the standards and evaluate the clinical performance.

Virtual clinics and doctors

Virtual clinics are online clinics that offer 24-hour online access for patients through physicians who assist in making a diagnosis and prescribe treatment. Under this setup, there has been a significant improvement in patient care outcomes and the reduction of per capita health care costs. Among the applications allowing this include the virtual clinic, which enables physicians within a healthcare network to provide answers to the patients in real time, as well as, the virtual doctor that offers valuable information on ways to enhance their health (Bajwa, 2014).

Modeling of Healthcare Information Technology on Patients

Personal Health Record (PHR)

This technological development integrates the EHR and HIT, and seeks to enhance the active participation of the patients in their healthcare decision-making. The electronic version of the Personal Health Record (PHR) enables the patients to enter data on their health status, which is linked to the physician’s 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.

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 patients to access their medical details and to interact directly with the physicians over the internet (Bajwa, 2014).

Mobile Home Healthcare

The technology on mobile home health care allows patients to communicate about the status of their disease to physicians while still at home. This is an effective approach in the management of chronic illnesses, especially among the elderly population. This has been utilized through linkages with blood pressure monitors, glucose monitors, weight scales, and pulse oximeters. The current devices require data to be transferred to the Electronic Medical Records 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 in the understanding of the adoption of the HIT in healthcare facilities and by physicians. The source of data is a report to 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 section 3001(c) of the Public Health Service Act and a section of the Hitech Act, which describes the specific actions that the federal government and private facilities have taken to enable the adoption of EHR at the national level. 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

1. Factors influencing the adoption of HIT

Factor		Rate of adoption
Size of practice	Small (< 10 physicians)	25.9%
Large (> 10 physicians	54.6%
Specialization	Primary care physicians	Primary care physicians had an 8.6% higher than non-primary physicians.
Non-primary care physicians
Age of providers	< 45 years physicians	Physicians aged below 45 years adopted HIT 20.4% less than those aged 55 years and above

Evidently, among 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 HIT-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. For instance, in 2008, reports indicated 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 laboratory results, radiology results, clinical summaries, and medication lists electronically (The Office of the National Coordinator for Health Information Technology, 2016).

1. Abilities of HIT systems

Factor	Period	Rate
Ability to electronically view medical information	2012	25%
2016	95%
Ability of downloads patients’ health information	2012	14%
2015	87%
Capacity to transmit medical information	2013	12%
2015	71%
Use of HIT to collect quality data	2002	17%
2013	42%
Ability of e-prescribing	2002	25%
2007	70%

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 decisions about their health and wellbeing.

1. Impact of HIT on Mortality

Factor	Reduction on mortality rate
Basic functionality of HIT	0.99%
Increase in a single functionality in the HIT system	0.21%
Impact on general patients (across the population, age, and insurance)	0.3%
Impact on Medicare patients	0.5%

1. Impact of HIT on Hospital Quality

HIT Element	Impact on a Health Quality aspect
Immunization alerts	12% increase in general wellness of the child
	22% increase in sick child immunization administration
Drug alerts	22% decrease in medication prescription errors
Improved documentation	13% decrease in Hospital-acquired pressure ulcer

Discussion of the Impact of Health Information Technology in Healthcare

1. Impact of Health Information Technology on Mortality and Expenditure

In their study, Lin et al. (2018) revealed that a number of base-line EHR functionalities were connected to a higher 30-day mortality rate. The inclusion of new EHR functionality was connected with lower mortality rates. While considering the patient population across all ages and insurance types, results revealed that the adoption of HIT led to a reduction in the hospital severity-adjusted mortality by 0.3% (McKenna, Dwyer, & Rizzo, 2018). The severity-adjusted mortality takes is a mortality rate that has been adjusted for the predicted risk of death. 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%, which is not statistically significant (McKenna, Dwyer, & Rizzo, 2018).

The adoption of HIT leads to an increase in medical expenditure. The medical expenditure factors, in this case, include 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 enhance a physician’s propensity to order for more intensive work-up.

The adoption of health information technology leads to an increase in expenditures related to 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). 

1. 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 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, and planning and managing healthcare. Others include supporting self-care and community support, tracking and coordinating care, and measuring and improving performance. Health information technologies provide meaningful 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 test results. 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 patients and healthcare providers. It is, thereby, clear that the application of healthcare information technology enhances care access, continuity, 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 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. The system allows maintenance of a registry for health conditions of the diseases that they normally encounter. In the management of a 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 the outcome allows the improvement 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).

1. 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).

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. Research has revealed that immunization alerts contributed to a 12% increase in the wellness of a child and a 22% increase in the 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 a 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 reverting 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 full 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 and personalized care (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. This can be achieved by providing input where evidence-based, personalized care and 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 noted 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. 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).

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 leads to an 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 influences 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 is influential in enhancing care in healthcare facilities.

References

Agha, L. (2014). The effects of health information technology on the costs and quality of medical care. Journal of health economics, 34, 19-30.

Alotaibi, Y. K., & Federico, F. (2017). The impact of health information technology on patient safety. Saudi medical journal, 38(12), 1173-1180.

Bajwa, M. (2014). Emerging 21st-century medical technologies. Pakistan journal of medical sciences, 30(3), 649- 655.

Bardhan, I. R., & Thouin, M. F. (2013). Health information technology and its impact on the quality and cost of healthcare delivery. Decision Support Systems, 55(2), 438-449.

Bowles, K. H., Dykes, P., & Demiris, G. (2015). The use of health information technology to improve care and outcomes for older adults. Research in gerontological nursing, 8(1), 5-10.

Feldman, S. S., Buchalter, S., & Hayes, L. W. (2018). Health Information Technology in Healthcare Quality and Patient Safety: Literature Review. JMIR medical informatics, 6(2), 1-24.

Fleming, C. (2012). Trends In The Adoption Of Health Information Technology. Health Affairs.

Hessels, A., Flynn, L., Cimiotti, J. P., Bakken, S., & Gershon, R. (2015). Impact of health information technology on the quality of patient care. On-line journal of nursing informatics, 19, 1-19.

Higgins, T. C., Crosson, J., Peikes, D., McNellis, R., Genevro, J., & Meyers, D. (2015). Using health information technology to support quality improvement in primary care (No. aad2d999a1ec484b873fa85d57540fc1). Mathematica Policy Research.

Kraschnewski, J. L., & Gabbay, R. A. (2013). Role of health information technologies in the Patient-centered Medical Home. Journal of diabetes science and technology, 7(5), 1376-1385.

Lee, J., & Park, Y. T. (2013). Measure of clinical information technology adoption. Healthcare informatics research, 19(1), 56-62.

Lin, S. C., Jha, A. K., & Adler-Milstein, J. (2018). Electronic health records associated with lower hospital mortality after systems have time to mature. Health Affairs, 37(7), 1128-1135.

McKenna, R. M., Dwyer, D., & Rizzo, J. A. (2018). Is HIT a hit? The impact of health information technology on inpatient hospital outcomes. Applied Economics, 50(27), 3016-3028.

The Office of the National Coordinator for Health Information Technology. (2016). 2016 Report to Congress on Health IT Progress: Examining the HITECH Era and the Future of Health IT. Retrieved from https://www.healthit.gov/sites/default/files/2016_report_to_congress_on_healthit_progress.pdf

Rittenhouse, D. R., Ramsay, P. P., Casalino, L. P., McClellan, S., Kandel, Z. K., & Shortell, S. M. (2017). Increased health information technology adoption and use among small primary care physician practices over time: a national cohort study. The Annals of Family Medicine, 15(1), 56-62.

Sun, R. (2016). The Effect of Health Information Technology on Hospital Quality of Care. Cuny Academic Works.  Retrieved from https://academicworks.cuny.edu/cgi/viewcontent.cgi?article=2324&context=gc_etds