Health Information Technology: An Updated Systematic ...

Health Information Technology: An Updated

Systematic Review with a Focus on Meaningful Use

Functionalities

Prepared for:

Office of the National Coordinator for Health Information Technology

U.S. Department of Health and Human Services

200 Independence Avenue S.W.

Suite 729-D

Washington, D.C. 20201

Contract No. HHSP23337020T

Prepared by:

Southern California Evidence-based Practice Center

RAND Corporation

1776 Main Street

Santa Monica, CA 90407

Investigators:

Evidence-Based Practice Center Director

and Principal Investigator

Paul G. Shekelle, MD, PhD

Co-Principal Investigator and Project

Manager

Spencer S. Jones, PhD

Literature Reviewer

Robert S. Rudin, PhD

Librarian

Roberta Shanman, MLS

Programming and data entry

Martha Timmer, MS

Staff Assistants

Aneesa Motala, BA

Tanja Perry, BHM

None of the investigators has any affiliations or financial involvement that conflicts

with the material presented in this report.

iii

Acknowledgments

The authors gratefully acknowledge the following individuals for their contributions to this

project:

Technical Expert Panel

Louise L. Liang, MD

Senior Vice President Quality and Clinical Systems Support - Retired

Kaiser Permanente, Oakland, CA

Paul Tang, MD, MS

Vice President, Chief Innovation and Technology Officer

Palo Alto Medical Foundation

Palo Alto, CA

Philip Aponte, MD

Vice President of Informatics

Baylor Health Care System

Dallas, TX

David W. Bates, MD, MSC

Senior Vice President for Quality and Safety and Chief Quality Officer

Brigham and Women's Hospital

Boston, MA

George Hripcsak, MD, MS

Chair, Department of Biomedical Informatics

Vivian Beaumont Allen Professor of Biomedical Informatics

Director, Medical Informatics Services, NYP/Columbia

Columbia University

New York, NY

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Health Information Technology: An Updated

Systematic Review with a Focus on Meaningful Use

Functionalities

Structured Abstract

Objectives

The purpose of the project described in this report was to update previous systematic reviews

focusing on the effects of health information technology (health IT) on key aspects of care,

including health care quality, safety, and efficiency. This report provides our current

understanding of the effects of health IT across a number of dimensions of care. Unlike reviews

conducted prior to the introduction of the federal Meaningful Use Incentive Programs, this

review focused specifically on identifying and summarizing the evidence relating to the use of

health IT as outlined in the Meaningful Use regulations.

Data Sources

We performed a systematic search of the English-language literature indexed in MEDLINE from

January 2010 to August 2013. We also searched the Cochrane Central Register of Controlled

Trials, the Cochrane Database of Abstracts of Reviews of Effects, and the Periodical Abstracts

Database; and hand-searched personal libraries kept by content experts and project staff. We also

asked content experts to identify evidence outside the peer-reviewed literature. Finally, a

technical expert panel identified additional published articles and non-peer reviewed resources.

Review Methods

The systematic review was carried out in three stages by two health IT subject matter experts,

with input from a panel of five nationally-known health IT experts. The reviewers used a webbased system to conduct the screening process. The first stage involved independent, dual-rater

screening of articles based on their titles against a set of defined on the inclusion/exclusion

criteria. The next stage involved screening each article at the abstract level using a standardized

abstraction form. The final stage of the screening process involved a full text review and

classification using a standardized abstraction form. Inclusion/exclusion or classification

discrepancies between the two reviewers were resolved by consensus. We conducted multiple

update searches using the same search terms through October 2013 using a computer-aided

screening system that extends a previously described approach for facilitating systematic review

updating.

Results

The systematic review identified 12,678 titles, and through the screening process, we identified

236 studies meeting the eligibility criteria: assessing the effect of health IT on healthcare quality,

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