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
iv
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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