What It Will Take To Achieve The As-Yet-Unfulfilled Promises Of Health Information Technology

Health Affairs (Impact Factor: 4.97). 01/2013; 32(1):63-8. DOI: 10.1377/hlthaff.2012.0693
Source: PubMed


A team of RAND Corporation researchers projected in 2005 that rapid adoption of health information technology (IT) could save the United States more than $81 billion annually. Seven years later the empirical data on the technology's impact on health care efficiency and safety are mixed, and annual health care expenditures in the United States have grown by $800 billion. In our view, the disappointing performance of health IT to date can be largely attributed to several factors: sluggish adoption of health IT systems, coupled with the choice of systems that are neither interoperable nor easy to use; and the failure of health care providers and institutions to reengineer care processes to reap the full benefits of health IT. We believe that the original promise of health IT can be met if the systems are redesigned to address these flaws by creating more-standardized systems that are easier to use, are truly interoperable, and afford patients more access to and control over their health data. Providers must do their part by reengineering care processes to take full advantage of efficiencies offered by health IT, in the context of redesigned payment models that favor value over volume.

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    • "Some of these articles highlight the importance of giving patients more control over their health information which is restored in EHRs. For example, Kellerman and Spencer [15] think that patients should have possibility to view, download, and transmit their health information from EHRs. Ingram ad Arikan [16] call for more open and responsible manner of collecting, sharing, and using personal health data for electronic health records. "
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    ABSTRACT: In this paper, we do a literature review on electronic health records (EHR) and patient involvement. It seems that patients are not included as much as one would presume. After our analysis of both literature and ethical nature, we suggest that research on why this is so and whether they should be included needs to be done.
    Ethicomp 2015, Leicester, UK; 09/2015
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    • "Governments and healthcare authorities are promoting HIT systems to achieve better control (Sheikh et al. 2011) and reduce costs. In the US reducing healthcare cost might prove to be a source of conflict between top authorities and local practices, if the reimbursement model was not modified (Kellermann and Jones 2013). This calls for paving the way before HIT systems through process redesign, which is an obvious organizational endeavor. "
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    ABSTRACT: Health Information Technology (HIT) System implementations are challenged by numerous interrelated technical, social, and organizational factors. Together they form sociotechnical systems that require equal attention to HIT systems and their context as they adapt to each other in a process that has not yet been thoroughly understood. This lack of understanding is evident from lack of adoption, post-implementation unintended consequences and failed implementation projects. There are numerous factors behind this lack of understanding, mainly because healthcare processes are highly unpredictable. In addition to technical factors related to degree of system openness which affects systems' interoperability. Understanding these factors is an important step towards achieving effective implementation process for important systems such as nationwide electronic health record with all aspired features. This paper represents a framework synthesized from literature to contribute to efforts to understand HIT systems' implementation process. The framework outlines four aspects of the implementation process: technical, social, organizational, and project management and assembles factors hindering the implementation process according to these aspects.
    International Conference of eHealth 2015, Las Palmas de Gran Canaria, Spain; 07/2015
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    • "An EHR has the ability to support care-related activities(Gray et al., 2014; Sundvall, 2013). It can deliver evidence-based support and contribute to clinical quality management(Sinaci et al., 2013).With the growing digitalization of health records (HRs), several regional and national healthcare networks using eHealth with interoperable approacheshave been established internationally (Dogac et al., 2011; Kellermann et al., 2013; Kuo, 2011). Healthcare professionals manage complete EHRs of patients independently from institutions that generate each clinical session(Ge et al., 2013; Wollersheim et al., 2009). "
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    ABSTRACT: This work investigates, whether openEHR with its reference model, archetypes and templates is suitable for the digital representation of demographic as well as clinical data. Moreover, it elaborates openEHR as a tool for modelling Hospital Information Systems on a regional level based on a national logical infrastructure. OpenEHR is a dual model approach developed for the modelling of Hospital Information Systems enabling semantic interoperability. A holistic solution to this represents the use of dual model based Electronic Healthcare Record systems. Modelling data in the field of obstetrics is a challenge, since different regions demand locally specific information for the process of treatment. Smaller health units in developing countries like Brazil or Malaysia, which until recently handled automatable processes like the storage of sensitive patient data in paper form, start organizational reconstruction processes. This archetype proof-of-concept investigation has tried out some elements of the openEHR methodology in cooperation with a health unit in Colombo, Brazil. Two legal forms provided by the Brazilian Ministry of Health have been analyzed and classified into demographic and clinical data. LinkEHR-Ed editor was used to read, edit and create archetypes. Results show that 33 clinical and demographic concepts, which are necessary to cover data demanded by the Unified National Health System, were identified. Out of the concepts 61% were reused and 39% modified to cover domain requirements. The detailed process of reuse, modification and creation of archetypes is shown. We conclude that, although a major part of demographic and clinical patient data were already represented by existing archetypes, a significant part required major modifications. In this study openEHR proved to be a highly suitable tool in the modelling of complex health data. In combination with LinkEHR-Ed software it offers user-friendly and highly applicable tools, although the complexity built by the vast specifications requires expert networks to define generally excepted clinical models. Finally, this project has pointed out main benefits enclosing high coverage of obstetrics data on the Clinical Knowledge Manager, simple modelling, and wide network and support using openEHR. Moreover, barriers described are enclosing the allocation of clinical content to respective archetypes, as well as stagnant adaption of changes on the Clinical Knowledge Manager leading to redundant efforts in data contribution that need to be addressed in future works. Copyright © 2015. Published by Elsevier Inc.
    Journal of Biomedical Informatics 04/2015; 55. DOI:10.1016/j.jbi.2015.04.004 · 2.19 Impact Factor
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