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Information tech: Benefits and drawbacks for hospitals
Study shows hospitals want better IT
Health care technology researchers, who have taken a long and comprehensive look at the pros and cons of information technology (IT) use in health care systems, have found that health IT adoption has progressed considerably over the past decade.1
"As IT started being adopted, more and more hospitals became interested in the business case associated with adopting technology," says Nir Menachemi, PhD, MPH, an associate professor in the department of health care organization and policy at the University of Alabama at Birmingham School of Public Health in Birmingham, AL.
"These systems are very expensive to adopt and implement, so being able to know you'll get some kind of benefit that you can quantify from their adoption is very important for decision makers at hospitals," Menachemi says.
"Lots of studies that have linked IT to benefits of any kind — whether they're financial or clinical or operational benefits — have all come from studies that looked at single institutions," he notes. "The studies looked at before and after implementation to see what kind of advantages there are."
The studies were conducted at large academic medical centers where researchers had a lot of grant money or the institutions had the in-house expertise for developing IT, Menachemi says.
"They produced some very good and strong evidence that IT does improve whatever it was they studied in a given study," he says. "They produce pretty good, causal evidence between the development of IT and whatever benefit they studied."
Menachemi and co-investigators wanted to carry this research another step to see what the IT capabilities were of general hospitals and finally of specialized hospitals.
"With that information we were able to see across lots of hospitals to see whether those with more IT capabilities performed better," he explains.
In a study of IT applications used in Florida hospitals, Menachemi and co-investigators found that clinical IT adoption was related to more patient safety outcome measures. Moreover, hospitals with the most sophisticated and mature IT infrastructures performed the best on a large number of patient safety indicators.2
Children are not little adults
Children's hospitals are unique settings, Menachemi notes.
"We began to collect the IT data so we could quantify IT capability across a large number of children's hospitals," he says. "This was the first study to describe who among children's hospitals was doing what in terms of information technology."
Investigators looked at what the barriers were and the future IT adoption intentions in the specialized children hospital setting, he adds.
"We're laying the foundation for a series of articles looking at outcomes in this children hospital setting," Menachemi says. "We're looking at whatever systems the hospitals have, and we're not focused on a specific vendor."
The type of studies the investigators have been doing complement the single institution studies. But while single institution studies can link causality to information technology, Menachemi's research cannot.
"The big disadvantage of our study design is we cannot detect causality, but we do have [general information benefits] that causal studies do not have," Menachemi says.
"The single institution studies track outcomes before and after random assignment to the system, and those methodologies are designed for causal relationships," he explains. "The results have not been universally positive."
Some studies have identified unexpected bad outcomes associated with IT adoption, Menachemi notes.
"Some studies even show that error rates can go up, and there's a loss of productivity in the short run," he says. "So the literature isn't unanimously positive, although there is overwhelming evidence that IT plays an informed role in improving outcomes."
In a survey of 109 children's hospitals the most common clinical IT applications used by the hospitals were clinical scheduling, used by 86%; transcription, used by 85%; pharmacy information system, used by about 82%, and laboratory information system, used by about 81%.1
In many ways information technology would be ideally suited to the pediatric hospital setting because it makes it easier to provide clinicians with point-of-care information that is directed toward the right patient at the right time and place, Menachemi says.
"It's information that otherwise would be inefficient to bring at that moment in time to the person," he explains. "So the child's health environment benefits from this."
For example, children's weight and health are fragile in health care settings, and so it's very helpful to have information that can help clinicians decide on the precise prescription dosage based on a particular child's age and weight and condition.
Unfortunately, IT vendors have not yet lived up to the promise of their product, Menachemi says.
"One of the findings of our study was the biggest barrier to IT success was dissatisfaction with the products vendors have," he says. "They were unable to deliver based on the expectations of people in children's hospitals."
As a result, vendors now are trying to develop systems that will include child-friendly functionality.
Menachemi's research has also found that the biggest obstacles to IT success involve the health care institution's culture and the people factor.
Nearly 30% of respondents in the survey of children's hospitals said that lack of staffing resources was a major barrier to use of IT, and more than half of respondents said it was a minor barrier.
"Roughly 80% of the challenge isn't technological in nature, but sociological in nature," Menachemi says. "There are workflow redesigns that need to be carefully thought through and planned out."
Doctors and nurses have their daily routines, and they develop skills based on their experience and how they see things over time, he explains.
"As soon as you automate any part of the workflow information, you suddenly change the way they do their jobs, and with change comes some pushback -- particularly if the change isn't viewed as beneficial to the end user."
Not everyone will buy into the benefits of IT, at least not until the older group of health care professionals retire and make room for younger providers who have grown up with computers and technology, Menachemi says.
But studies are showing that IT is a positive factor in many different measures of performance, including quality of care, operational efficiencies, and financial performance, he says.
"One issue that keeps coming up when I interact with hospital executives is they want me to show them the evidence so they can show their board of directors and receive an allocation of funds to invest in IT," Menachemi says. "They think it can work, but they want evidence, and these types of studies are the evidence."