Does Health Information Technology Improve Outcomes and ...

Running head: DOES HIT IMPROVE OUTCOMES AND DECREASE COSTS?

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Does Health Information Technology Improve Outcomes and Decrease Costs? T. Marc Skinner

Graduate Student, Army-Baylor MHA/MBA Program

DOES HIT IMPROVE OUTCOMES AND DECREASE COSTS?

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Abstract Purpose Statement: Health information technology (HIT) has undergone tremendous change. Prior literature reviews have demonstrated a generally positive effect of HIT on patient outcomes (Buntin, Burke, Hoaglin, & Blumenthal, 2011); however, I identified no literature review since that study, keeping pace with technological change. The purpose of this study is to provide an updated review of HIT and its effects on mortality rate, adverse patient events, readmission rate, medication errors, preventive medicine delivery, and cost containment. Why you are doing the study: The last published review I identified concerning HIT was published in 2011 (Buntin, Burke, Hoaglin, & Blumenthal). I provide an update to that review in this paper. Method: I searched Google Scholar, ABI/Inform Complete, and PubMed, with results limited to 2008 to the present, and to peer-reviewed, English-language publications. The search engines sorted results by relevance, with articles selected based on title and abstract review. Findings: Health information technology use is positively associated with improvements in mortality rate, adverse patient events, readmission rate, medication errors, and preventive medicine delivery, all while simultaneously decreasing costs. Encinosa and Bae did not show an improvement in these variables until after a patient safety event had occurred (2011). Contributions: The preponderance of evidence supports the use of HIT to improve the quality of care while decreasing costs. The magnitude of recent technological change, and the increased pressure on the health care market by the Affordable Care Act for HIT use, necessitated a review demonstrating the benefits of HIT.

Keywords: health information technology, health care costs, outcomes

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Does Health Information Technology Improve Outcomes and Decrease Costs? Health information technology (HIT) has continued to evolve over the years, but adoption by heath care organizations has remained slow (Byrne, et al., 2010). Health information technology consists of several different components, including a clinical decision support system that assists physicians in making evidence-based decisions, an electronic health record, and computerized physician order entry to help eliminate errors when prescribing and dispensing medications. Authors of studies investigating HIT use have reported both the benefits (Lee & Meuter, 2010) and lack of benefits (Amarasingham, Plantinga, Diener-West, Gaskin, & Powe, 2009) of HIT to health care delivery. I identified several literature reviews concerning the benefits of HIT; the most recent study I found was published in 2011 (Buntin, Burke, Hoaglin, & Blumenthal). Technology has continued to advance, but I did not identify an updated literature review incorporating evidence from newer studies. The purpose of this paper is to provide an updated literature review on the effects of HIT on health care delivery as it pertains to outcomes and process measures (mortality rates, adverse patient events, hospital readmission rates, medication errors, and preventive care), and cost containment.

Methods I conducted a search using Google Scholar, ABI/Inform Complete, and PubMed. Search terms included the following: information technology, information systems, patients, clinicians, and improved outcomes. I limited search results to peer-reviewed literature from 2008 to the present, with English as the language. Google Scholar returned 17,600 articles, ABI/Inform returned 6,263 articles, and PubMed returned 7,380 articles. Search engines returned results sorted by relevance. I searched through the first 100 results for each search engine, screening articles to ensure that selected articles provided salient information. I used the references from

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selected articles to identify source articles when necessary. I then conducted a qualitative review of selected articles and synthesized an updated topical review.

Findings Mortality

The use of HIT by health care organizations is associated with decreased mortality rates. Amarasingham and colleagues reported a decrease in the odds ratio for mortality (2009). In another study, investment in an electronic health record was associated with a decrease in mortality rates (Menon & Kohli, 2013). Encinosa and Bae, in contrast to previously published studies, reported that the use of HIT only decreased the probability of death after a patient safety event had occurred (2011). Adverse Patient Events

Adverse patient events are variably defined in the literature, ranging from adverse drug reactions, to patient falls, or injury from equipment failure; all agree that one goal of HIT is to decrease or eliminate adverse patient events. While the majority of literature reports an overall decrease in adverse patient events (Buntin, Burke, Hoaglin, & Blumenthal, 2011), Encinosa and Bae found that HIT had no impact on the probability of an adverse patient event occurring (2011). Amarasingham and colleagues reported conflicting findings, with an overall 16% decrease in the odds ratio for adverse patient events for all conditions with the use of HIT, with the exception of complications from heart failure (2009). In an interesting study that investigated the benefits of HIT use between inpatient and outpatient health care facilities, the authors reported a decreased likelihood of obstetrical trauma when the outpatient electronic health record communicated patient information to the inpatient electronic health record (Deily, Hu, Terrizzi, Chou, & Meyerhoefer, 2013).

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Hospital Readmission Rate Hospital readmission rate is a quality measure that the Affordable Care Act is

incentivizing by decreasing reimbursement for hospitals with an excessive readmission rate (Shi & Singh, 2015). In an era of tighter margins of profitability, hospitals need to decrease readmission rates in order to preserve Medicare reimbursements. Health information technology implementation and use was associated with decreased readmission rates in one study (Menon & Kohli, 2013). In another study, Encinosa and Bae reported a 39% decrease in readmission rates only after a patient safety event had occurred (2011). Medication Errors

The Institute of Medicine reported medication prescription or dispensing error rates in hospitals in the range of 0.61 to 53 per 1,000 orders, and administration errors of 2.4-11.1 per 100 opportunities (2007). Health information technology use, specifically computerized physician order entry, is associated with a 15% decrease in dispensing errors (Lee & Meuter, 2010). Another aspect of HIT, clinical decision support, demonstrated a significant correlation with the use of evidence-based medicine delivery (timing and dose for aspirin and beta-blocker) for patients with an acute myocardial infarct (Yu, Berner, Allison, Weissman, & Houston, 2009). Preventive Medicine

Preventive medicine is a benefit mandated by the Affordable Care Act (Shi & Singh, 2015). There is a trend in health care delivery towards preventing disease rather than just treating disease. According to Shi and Singh (2015), prevention is either primary (prevent a disease), secondary (early detection and treatment of disease), or tertiary (prevent or manage comorbidities). The Department of Veteran's Affairs conducted a study investigating the effect of HIT on tertiary prevention measures for patients with diabetes mellitus. The authors reported

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