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Effective implementation of health information technologies in U.S. hospitals
Abstract
Objectives::
Two issues pertaining to the effective implementation of health information technologies (HITs) in U.S. hospitals are examined. First, which information technology (IT) system is better-a homegrown or an outsourced one? In the second issue, the critical role of in-house IT expertise/capabilities in the effective implementation of HITs is investigated.
Study design/data collection::
The data on type of HIT system and IT expertise/capabilities were collected from a national sample of senior executives of U.S. hospitals. The data on quality of patient care were gathered from the Hospital Compare Web site.
Findings::
The quality of patient care was significantly higher in hospitals deploying a homegrown HIT system than hospitals deploying an outsourced HIT system. Furthermore, the professional competence and compelling vision of the chief information officer was found to be a major driver of another key IT capability of hospitals-professionalism of IT staff. The positive relationship of professionalism of IT staff with quality of patient care was mediated by proactive employee behavior.
Conclusion::
A homegrown HIT system achieves better quality of patient care than an outsourced one. The chief information officer's IT vision and the professional expertise and professionalism of IT staff are important IT capabilities in U.S. hospitals.
... Studies have shown HIT is positively associated with several hospital performance measures. For instance, a few studies have reported significant association between HIT and improved quality of care including lower readmission, reduced length of stay, and mortality rates (Appari et al., 2013;Bardhan and Thouin, 2013;Devaraj et al., 2013;Himmelstein et al., 2014;Jones et al., 2010;Khatri and Gupta, 2016;Lin et al., 2019;McKenna et al., 2018;Walker et al., 2005;Wani and Malhotra, 2018). Some of these studies, however, do not use EHR and HIE usage to measure HIT investments. ...
... Devaraj et al. (2013) use IT expenditure reported in the Solucient, Inc., database. Khatri and Gupta (2016) use survey questionnaires. Other authors have directly referred to HIE usage. ...
Background: The HITECH Act of 2009 promoted the use of health information technology (HIT). There is limited research on the effect of health information exchange (HIE) on healthcare outcomes and cost. Analyzing data from the recent past provides us an excellent opportunity to determine EHR and HIE’s impact on hospital operations.
Purpose: To investigate association between HIT (EHR and HIE) and quality of care, hospital efficiency, and patient flow.
Methodology: Multivariable regression models using panel data with year fixed effects and hospital individual effects were used. Outcome variables were readmission index and mortality index (quality of care), cost per inpatient day and cost per inpatient admission (hospital efficiency), and average length of stay (patient flow). We use two variables to measure HIT usage – proportion of functionalities owned/utilized under electronic health records (EHR) and HIE. We use four years of data (2014-17) on 115 acute care hospitals in Pennsylvania from five different data sources.
Results: We find evidence for efficiency (lower costs) improvement associated with HIE and for EHR associated with reduced mortality. Also, HIE is adversely associated with mortality. Other effects were not significant.
Conclusion: EHR and HIE usage in the hospitals may not be enough or optimal. The healthcare system may also suffer from integration issues. Diffusion of technology is a slow process and users may take time to understand and learn how to apply effectively. Managers and policy makers must be wary of the short- and long-term effect of technology investments on hospital efficiency and uality of care.
... Bu nedenle, dış kaynaklı BT, kısa vadede kurum içi BT'ye göre daha etkilidir, ancak uzun vadede verimlilik kazanımları tam tersidir (14). Benzer karşılaştırmanın yapıldığı bir başka araştırma, hasta bakım kalitesinin dış kaynaklı BT sisteminde daha düşük olduğunu göstermiştir (85). SONUÇ Literatürde yayın sayısı arttıkça ve derinleştikçe, bilgiye erişim daha karmaşık hale gelmektedir. ...
Amaç: Araştırmanın temel amacı 1992-2021 yılları arasında sağlık hizmetlerinde dış kaynak kullanımı alanında yapılmış yayınlarda ele alınan temaların, günümüze kadar nasıl geliştiğini ve birbirleri ile olan ilişkisini bibliyometrik bir analiz ile incelemektir. Gereç ve Yöntemler: Araştırmada kullanılan veriler ikincil veri niteliğinde olup, Web of Science (WoS) Core Collection veri tabanından elde edilmiştir. Konu ile ilgili dahil etme ve hariç tutma kriterleri sonrası 680 yayına ulaşılmış ve bu yayınlarla analiz yapılmıştır. Analizde bibliyometrik analiz sağlayan yazılımlardan biri olan SciMAT kullanılmıştır. Stratejik diyagramlar, küme ağları ve tematik gelişim haritası son 29 yılı kapsayacak şekilde 4 periyot (1992-2000, 2001-2010, 2011-2016, 2017-2020) olarak analiz edilmiştir. Bulgular: İlk dönemde (1992-2000) “cost” motor tema iken, sonraki dönemlerde motor temalar “cloud computing, access control, public key encryption, privacy preserving, big data, electronic medical record, technology”dir. Tematik gelişim haritasından yararlanarak elde edilen temalar; sağlık hizmetlerinde bulut bilişim, dış kaynak kullanımına dayalı riskler, genel işleyişle ilgili problemler ve maliyet konularıdır. Maliyet ile ilgili sonuçlar kesinlikten uzaktır. Sonuç: Hastane yöneticilerinin bulut bilişim konusunda bilinçlenmeleri, dış kaynak kullanımı (DKK) ile maliyetlerin azaltılmasını hedeflerken aynı zamanda hizmetlerin kalite düzeylerine dikkat etmeleri önem arz etmektedir. DKK’dan kaynaklı oluşabilecek risklerin minimum düzeyde kalabilmesi için sağlık kurumları ve firmalar arasında gerçekleşen DKK anlaşmalarında risklere yönelik ihtiyati tedbirlerin alınmasında fayda vardır.
... In older Americans, many aging adults stay in nursing homes. A homegrown Health Information Technology system achieves a better quality of patient care than an outsourced one (Khatri & Gupta, 2016). ...
The underlying law of the nation ensures that older Filipinos are treated fairly. As a segment of the minority group, the Philippine Constitution of 1987 ensures the promotion and preservation of elderly Filipino citizens' rights and welfare. The clinical decision support system ensures consistency, speed, and safety in treatment by allowing the flow of information. Clinical information systems are lacking in many nursing facilities. Thus, the majority of older citizens living in these facilities are missing out on the benefits that these services are supposed to give, such as improved patient care, higher efficiency, and improved information access. Early adopters of nursing home information systems should share their experiences so that other systems can benefit from their design and evaluation. The main goal of this study was to create a clinical decision support system based on the experiences of a few nursing homes. Some prerequisite objectives have to meet to accomplish that goal. Identifying the clinical information difficulties that Nursing Homes face. Developing a decision-making assistance system that will improve the speed and efficiency with which nursing homes make decisions figuring out how the new system will assist nursing homes in providing high-quality care.
... The extent to which technology can be integrated into the workflow efficiently, effectively, and satisfactorily by clinical users is an area of concern for diverse practices 24 and health care systems. 25 The design of IT interventions must also account for clinician-patient communication. 26 For example, the employment of medical scribes to enter data into the EHR, has had a positive impact on physician and patient satisfaction, as well as on provider productivity. ...
Over the last decade, health information technology (IT) has dramatically transformed medical practice in the United States. On May 11-12, 2017, the National Institute on Minority Health and Health Disparities, in partnership with the National Science Foundation and the National Health IT Collaborative for the Underserved, convened a scientific workshop, "Addressing Health Disparities with Health Information Technology," with the goal of ensuring that future research guides potential health IT initiatives to address the needs of health disparities populations. The workshop examined patient, clinician, and system perspectives on the potential role of health IT in addressing health disparities. Attendees were asked to identify and discuss various health IT challenges that confront underserved communities and propose innovative strategies to address them, and to involve these communities in this process. Community engagement, cultural competency, and patient-centered care were highlighted as key to improving health equity, as well as to promoting scalable, sustainable, and effective health IT interventions. Participants noted the need for more research on how health IT can be used to evaluate and address the social determinants of health. Expanding public-private partnerships was emphasized, as was the importance of clinicians and IT developers partnering and using novel methods to learn how to improve health care decision-making. Finally, to advance health IT and promote health equity, it will be necessary to record and capture health disparity data using standardized terminology, and to continuously identify system-level deficiencies and biases.
... The timely transfer of information on rare infectious disease incidences to the public health authorities is necessary to ensure effective public health response [2]. A good public health information system (HIS) like any health information technology has great potential to improve quality and reduce the cost of healthcare [3]. Healthcare organizations are investing and participating in a growing number of inter-organizational healthcare systems such as community health information networks and integrated delivery systems [4]. ...
This paper investigates strategies for improving supply chain delivery timeliness when the delivery time follows an asymmetric Laplace distribution. Delivery performance is measured using a cost-based analytical model which evaluates the expected cost for early and late delivery. This paper presents a set of propositions that define the effect of changes to the parameters of the delivery time distribution on the expected penalty cost for untimely delivery when a supplier uses an optimally positioned delivery window to minimise the expected cost of untimely delivery. The scale parameter increases the expected penalty cost, skewness decreases the cost and the location parameter has no effect on the expected penalty cost. The effects are illustrated in a numerical example with real-world supplier data. The results can be used in developing strategies for improving delivery performance from a supplier’s perspective and define how the delivery time distribution parameters can be modified to decrease the expected penalty cost of untimely delivery. The paper proposes a general approach to modelling delivery performance improvement and can be applied to other delivery time distribution forms. The approach can serve as guidance for practitioners undertaking a programme to improve delivery performance.
... The timely transfer of information on rare infectious disease incidences to the public health authorities is necessary to ensure effective public health response [2]. A good public health information system (HIS) like any health information technology has great potential to improve quality and reduce the cost of healthcare [3]. Healthcare organizations are investing and participating in a growing number of inter-organizational healthcare systems such as community health information networks and integrated delivery systems [4]. ...
Timely reporting of rare infectious disease cases to the public health system, especially after identification at laboratories, is essential to initiate quick and effective public health response. To ensure that the public health reporting system is appropriately monitoring the rare infectious diseases under surveillance, it is recommended to have a regular assessment of timeliness, especially after the rare infectious case is confirmed. This study aimed to evaluate the timeliness of data reported to the Ohio Disease Reporting System (ODRS), a public health reporting system in Ohio, for managing rare infectious diseases. In a cross-sectional analysis of rare infectious disease reporting data in four local health jurisdictions (LHJs) in the state of Ohio, wide delays were found between various reporting steps, particularly when the laboratories were not using the electronic method of reporting, and the delay observed was mainly at the hospital level and at the LHJ level. This study highlights the supply chain nature of information transfer and calculates the delay at various interacting points of the information supply chain system. The results establish that a centralized approach with an electronic disease reporting system conveys information faster than traditional reporting channels (decentralized approach). Delays of the decentralized approach are isolated at various stakeholder levels and with respect to various types of rare infectious diseases for better understanding of the information supply chain system for managing rare infectious diseases.
... Because of this admirable role of pharmacy professionals, the local population and health authorities of individual states are convinced to deploy appropriate pharmaceutical patient's care. The objectives, visions and mission statements are designed with major aspiration of improving the overall public health to achieve MDG's [12,13]. Providing the clinical and pharmaceutical care at affordable, accessible and equitable ways is also potentially desired. ...
The current health practice of Punjab Province of Pakistan needs a serious attention to control the unnecessary drug usage, improve pharmaceutical care and establish excellent public health system. Hence, the health officials of Govt. of Pakistan have established “Drug Regulatory Authority”, and Punjab Health Department has chalked out Punjab Drug Rule, 2007 to deployed a revised health structure in Punjab. But, unluckily, the medical physicians, drug store owners and bureaucracy have not put it into actual practice. Punjab Health Department has made amendments in the Drug Rules, 2007; substituted the word “three” by the “ten” and suspended it until 2017 via notification printed in the official weekly gazette dated February 10, 2010. This potential confliction of interest can also be noticed in hospital settings, community clinical practice and other allied health institutions. The most awful part the current scenario is the insufficient aspirations to share the clinical burden to provide the health facilities for patients presented in hospital/ clinical setting. The consultant physicians and medical practitioners are very much reluctant to involve the pharmacy professionals to perform their primary professional role. They want them to stay away from their actual scientific job and keep doing the administrative and clerical work. Therefore, the current health system and drug jurisprudence needs a serious attention to address the health problem. That will help to minimize avoidable mortalities, wrong medication, irrational prescription and development of drug resistance. Moreover, a conclusive prescribing guidelines and appropriate drug jurisprudence will expedite the achievement of MDG of WHO. © 2016, Association of Pharmaceutical Teachers of India. All rights reserved.
... Because of this admirable role of pharmacy professionals, the local population and health authorities of individual states are convinced to deploy appropriate pharmaceutical patient's care. The objectives, visions and mission statements are designed with major aspiration of improving the overall public health to achieve MDG's [12,13]. Providing the clinical and pharmaceutical care at affordable, accessible and equitable ways is also potentially desired. ...
Indian subcontinent has been ruled by different empires and dynasties throughout the past. They have brought different curative skill and knowledge. Moreover, the subcontinent surrounded by variety of believes, myths’ and religions. That obviously has significantly influenced the curative philosophy and therapeutic. Hence, we have designed this study manuscript to present a prudential review of pharmaceutical resources in sub-continent. That may potentially help to achieve the Millennium Development Goals (MDGs). Whereas, the legislative support is an important factor in health care system, and is recognized by all countries of the subcontinent. World Health Organization (WHO) is continuously
supporting to develop, strengthen and modify the existing legislation to enforce the national health policies. That will help to assign the exact professional roles to pharmacy professionals instead of irrelevant, clerical and administrative work. That will help to reduce the potential risk of irrational drug usage, therapeutical error and clinical mistakes in health care system to achieve the MDGs. Hence, in conclusion, current pharmaceutical scenario needs the legislative and strategic support to assure appropriate pharmaceutical and clinical care in Indian subcontinent. It is also enviable to assign the exact scientific and professional roles to pharmacy professional instead of irrelevant managerial and clerical tasks. That will potentially reduce the irrational drug usage and poor pharmaceutical care. Otherwise serious vulnerable health problem may potentially be posed and then harbored to other parts of the world.
... Whereas; the efforts of business community are more effective, collective and successful. 22 They have more reliable political connections, better financial resources and excellent professional commitments. Hence, the current pharmaceutical situation and drug jurisprudence need attention to establish a balanced clinical and health care system. ...
The current health practice of Punjab Province of Pakistan needs a serious attention to
control the unnecessary drug usage, improve pharmaceutical care and establish excellent
public health system. Hence, the health officials of Govt. of Pakistan have established
“Drug Regulatory Authority”, and Punjab Health Department has chalked out Punjab Drug
Rule, 2007 to deployed a revised health structure in Punjab. But, unluckily, the medical
physicians, drug store owners and bureaucracy have not put it into actual practice. Punjab
Health Department has made amendments in the Drug Rules, 2007; substituted the word
“three” by the “ten” and suspended it until 2017 via notification printed in the official
weekly gazette dated February 10, 2010. This potential confliction of interest can also be
noticed in hospital settings, community clinical practice and other allied health institutions.
The most awful part the current scenario is the insufficient aspirations to share the
clinical burden to provide the health facilities for patients presented in hospital/ clinical
setting. The consultant physicians and medical practitioners are very much reluctant to
involve the pharmacy professionals to perform their primary professional role. They want
them to stay away from their actual scientific job and keep doing the administrative
and clerical work. Therefore, the current health system and drug jurisprudence needs
a serious attention to address the health problem. That will help to minimize avoidable
mortalities, wrong medication, irrational prescription and development of drug resistance.
Moreover, a conclusive prescribing guidelines and appropriate drug jurisprudence will
expedite the achievement of MDG of WHO.
Translational bioinformatics for therapeutic discovery requires the infrastructure of clinical informatics. In this chapter, we describe the clinical informatics components needed for successful implementation of translational research at a cancer center. This chapter is meant to be an introduction to those clinical informatics concepts that are needed for translational research. For a detailed account of clinical informatics, the authors will guide the reader to comprehensive resources. We provide examples of workflows from Moffitt Cancer Center led by Drs. Perkins and Markowitz. This perspective represents an interesting collaboration as Dr. Perkins is the Chief Medical Information Officer and Dr. Markowitz is a translational researcher in Melanoma with an active informatics component to his laboratory to study the mechanisms of resistance to checkpoint blockade and an active member of the clinical informatics team.
Ambulatory surgery centers, like hospitals and other healthcare organizations, are facing common issues such as the ongoing workforce shortages and the uncertainty regarding the future of the nation’s healthcare system. Healthcare leaders should understand the interplay of factors that influence the performance of individuals employed at the ambulatory surgery center. These factors include traditional human resources management activities such as recruitment, credentialing, development and evaluation. However, the environmental aspects such as work culture and multiculturalism are also important in sustaining effective staff relationships.
Using a field experiment in the United Arab Emirates, we compared the impacts of directive and empowering leadership on customer-rated core task proficiency and proactive behaviors. Results of tests for main effects demonstrated that both directive and empowering leadership increased work unit core task proficiency, but only empowering leadership increased proactive behaviors. Examination of boundary conditions revealed that directive leadership enhanced proactive behaviors for work units that were highly satisfied with their leaders, whereas empowering leadership had stronger effects on both core task proficiency and proactive behaviors for work units that were less satisfied with their leaders. We discuss implications for both theory and practice.
Healthcare technology and quality improvement programs have been identified as a means to influence healthcare costs and healthcare quality in Canada. This study seeks to identify whether the ability to implement healthcare technology by a hospital was related to usage of quality improvement programs within the hospital and whether the culture within a hospital plays a role in the adoption of quality improvement programs.
A cross-sectional study of Canadian hospitals was conducted in 2010. The sample consisted of hospital administrators that were selected by provincial review boards. The questionnaire consisted of 3 sections: 20 healthcare technology items, 16 quality improvement program items and 63 culture items.
Rasch model analysis revealed that a hierarchy existed among the healthcare technologies based upon the difficulty of implementation. The results also showed a significant relationship existed between the ability to implement healthcare technologies and the number of quality improvement programs adopted. In addition, culture within a hospital served a mediating role in quality improvement programs adoption.
Healthcare technologies each have different levels of difficulty. As a consequence, hospitals need to understand their current level of capability before selecting a particular technology in order to assess the level of resources needed. Further the usage of quality improvement programs is related to the ability to implement technology and the culture within a hospital.
In this article, we provide guidance for substantive researchers on the use of structural equation modeling in practice for theory testing and development. We present a comprehensive, two-step modeling approach that employs a series of nested models and sequential chi-square difference tests. We discuss the comparative advantages of this approach over a one-step approach. Considerations in specification, assessment of fit, and respecification of measurement models using confirmatory factor analysis are reviewed. As background to the two-step approach, the distinction between exploratory and confirmatory analysis, the distinction between complementary approaches for theory testing versus predictive application, and some developments in estimation methods also are discussed.
The components of human resource (HR) flexibility and their potential relationship to firm performance have not been empirically examined. The authors hypothesize that flexibility of employee skills, employee behaviors, and HR practices represent critical subdimensions of HR flexibility and are related to superior firm performance. Results based on perceptual measures of HR flexibility and accounting measures of firm performance support this prediction. Whereas skill, behavior, and HR practice flexibility are significantly associated with an index of firm financial performance, the authors find that only skill flexibility contributes to cost-efficiency.
Effective information technology management is just one critical competency required for the successful implementation of strategic business processes. As communications and information become more important business tools, the ability to support new strategies with fast, cost-effective information technology will become increasingly-important for anticipating and reacting to changing market conditions. Firms with valuable assets that do not face immediate competitive threats should focus on organizational learning as a means to continuously strengthen their assets and ward off competition.
Health care organizations are facing the dual challenge of providing high-quality patient care at an affordable price. In this article, we argue that the role of people, or human resource management (HRM), and information, or health information technologies (HIT), is crucial in surmounting the above challenge. Specifically, we contend that HRM and HIT in health care are fundamental rather than support functions, and health care organizations need to build internal capabilities in both HRM and HIT to manage these resources effectively. Health care organizations vary in their levels of HRM and HIT capabilities. A few exceptional health care organizations have built both of these capabilities and have derived significant complementarities between HRM and HIT that, in turn, have allowed them to be leaders in value-based health care delivery. Several health care organizations have developed capabilities in either HRM or HIT but not in both, and still others have developed capabilities in neither function. Outsourcing of HRM and HIT by health care organizations is likely to hamper the integration and embedding of these functions in organizational operations. Although HIT has attracted significant attention from policy makers and health care organizations alike, it is not so with HRM. Most large-scale HIT initiatives that proceed without strong HRM capabilities are likely to result in disappointing outcomes. This occurs because the organizational change and development embodied in major HIT initiatives often cannot be sustained without strong HRM capabilities.
PurposeThis study expands upon existing knowledge of response rates by conducting a large-scale quantitative review of published
response rates. This allowed a fine-grained comparison of response rates across respondent groups. Other unique features of
this study are the analysis of response enhancing techniques across respondent groups and response rate trends over time.
In order to aid researchers in designing surveys, we provide expected response rate percentiles for different survey modalities.
DesignWe analyzed 2,037 surveys, covering 1,251,651 individual respondents, published in 12 journals in I/O Psychology, Management,
and Marketing during the period 1995–2008. Expected response rate levels were summarized for different types of respondents
and use of response enhancing techniques was coded for each study.
FindingsFirst, differences in mean response rate were found across respondent types with the lowest response rates reported for executive
respondents and the highest for non-working respondents and non-managerial employees. Second, moderator analyses suggested
that the effectiveness of response enhancing techniques was dependent on type of respondents. Evidence for differential prediction
across respondent type was found for incentives, salience, identification numbers, sponsorship, and administration mode. When
controlling for increased use of response enhancing techniques, a small decline in response rates over time was found.
ImplicationsOur findings suggest that existing guidelines for designing effective survey research may not always offer the most accurate
information available. Survey researchers should be aware that they may obtain lower/higher response rates depending on the
respondent type surveyed and that some response enhancing techniques may be less/more effective in specific samples.
Originality/valueThis study, analyzing the largest set of published response rates to date, offers the first evidence for different response
rates and differential functioning of response enhancing techniques across respondent types.
KeywordsResponse rate-Response enhancing technique-Survey-Respondent type-Sample-Meta-analysis
Debate is ongoing about the wisdom of the $27 billion federal investment driving the adoption of health information technology (IT). Debate about IT's productivity yield echoes earlier debates from other sectors of the economy, which carry important lessons.
Policy-based incentives for health care providers to adopt health information technology are predicated on the assumption that, among other things, electronic access to patient test results and medical records will reduce diagnostic testing and save money. To test the generalizability of findings that support this assumption, we analyzed the records of 28,741 patient visits to a nationally representative sample of 1,187 office-based physicians in 2008. Physicians' access to computerized imaging results (sometimes, but not necessarily, through an electronic health record) was associated with a 40-70 percent greater likelihood of an imaging test being ordered. The electronic availability of lab test results was also associated with ordering of additional blood tests. The availability of an electronic health record in itself had no apparent impact on ordering; the electronic access to test results appears to have been the key. These findings raise the possibility that, as currently implemented, electronic access does not decrease test ordering in the office setting and may even increase it, possibly because of system features that are enticements to ordering. We conclude that use of these health information technologies, whatever their other benefits, remains unproven as an effective cost-control strategy with respect to reducing the ordering of unnecessary tests.
How do information technology (IT) capabilities contribute to firm performance? This study develops a conceptual model linking IT-enabled information management capability with three important organizational capabilities (customer management capability, process management capability, and performance management capability). We argue that these three capabilities mediate the relationship between information management capability and firm performance. To test our conceptual model, we use a rare archival data set that contains actual scores from multidimensional and high-quality assessments of firms and intraorganizational units of a conglomerate business group that had adopted a model of performance excellence for organizational transformation based on the Baldrige criteria. This research design provides unobtrusive measures of the key constructs to validate our conceptual model. We find that information management capability plays an important role in developing other firm capabilities for customer management, process management, and performance management. In turn, these capabilities favorably influence customer, financial, human resources, and organizational effectiveness measures of firm performance. We discuss the implications of these findings for research and practice. Among key managerial implications, senior leaders must focus on creating necessary conditions for developing IT infrastructure and information management capability because they play a foundational role in building other capabilities for improved firm performance. The Baldrige model also needs some changes to more explicitly acknowledge the role and importance of information management capability so that senior leaders know where to begin in their journey toward business excellence.
Many practitioner-oriented publications argue that managers should be more proactive on the job, and that proactive behavior is an increasingly important component of job performance. Organizational research on the antecedents and consequences of proactive behavior has appeared in several different literatures and has taken different approaches toward defining, measuring, and understanding proactivity. In this article, I review a diverse set of literatures that directly address proactive behavior in organizational contexts. I describe four constructs related to proactive behavior: proactive personality, personal initiative, role breadth self-efficacy, and taking charge. Next, I review six research domains that have explicitly addressed proactive behaviors: socialization, feedback seeking, issue selling, innovation, career management, and certain kinds of stress management. After considering findings from these research streams, I offer an analysis of the different approaches to the study of proactive behavior and provide a set of suggestions for future research.
To report the frequency, types, and causes of errors associated with outpatient computer-generated prescriptions, and to develop a framework to classify these errors to determine which strategies have greatest potential for preventing them.
This is a retrospective cohort study of 3850 computer-generated prescriptions received by a commercial outpatient pharmacy chain across three states over 4 weeks in 2008. A clinician panel reviewed the prescriptions using a previously described method to identify and classify medication errors. Primary outcomes were the incidence of medication errors; potential adverse drug events, defined as errors with potential for harm; and rate of prescribing errors by error type and by prescribing system.
Of 3850 prescriptions, 452 (11.7%) contained 466 total errors, of which 163 (35.0%) were considered potential adverse drug events. Error rates varied by computerized prescribing system, from 5.1% to 37.5%. The most common error was omitted information (60.7% of all errors).
About one in 10 computer-generated prescriptions included at least one error, of which a third had potential for harm. This is consistent with the literature on manual handwritten prescription error rates. The number, type, and severity of errors varied by computerized prescribing system, suggesting that some systems may be better at preventing errors than others.
Implementing a computerized prescribing system without comprehensive functionality and processes in place to ensure meaningful system use does not decrease medication errors. The authors offer targeted recommendations on improving computerized prescribing systems to prevent errors.
Background:
There is considerable international interest in exploiting the potential of digital solutions to enhance the quality and safety of health care. Implementations of transformative eHealth technologies are underway globally, often at very considerable cost. In order to assess the impact of eHealth solutions on the quality and safety of health care, and to inform policy decisions on eHealth deployments, we undertook a systematic review of systematic reviews assessing the effectiveness and consequences of various eHealth technologies on the quality and safety of care.
Methods and findings:
We developed novel search strategies, conceptual maps of health care quality, safety, and eHealth interventions, and then systematically identified, scrutinised, and synthesised the systematic review literature. Major biomedical databases were searched to identify systematic reviews published between 1997 and 2010. Related theoretical, methodological, and technical material was also reviewed. We identified 53 systematic reviews that focused on assessing the impact of eHealth interventions on the quality and/or safety of health care and 55 supplementary systematic reviews providing relevant supportive information. This systematic review literature was found to be generally of substandard quality with regards to methodology, reporting, and utility. We thematically categorised eHealth technologies into three main areas: (1) storing, managing, and transmission of data; (2) clinical decision support; and (3) facilitating care from a distance. We found that despite support from policymakers, there was relatively little empirical evidence to substantiate many of the claims made in relation to these technologies. Whether the success of those relatively few solutions identified to improve quality and safety would continue if these were deployed beyond the contexts in which they were originally developed, has yet to be established. Importantly, best practice guidelines in effective development and deployment strategies are lacking.
Conclusions:
There is a large gap between the postulated and empirically demonstrated benefits of eHealth technologies. In addition, there is a lack of robust research on the risks of implementing these technologies and their cost-effectiveness has yet to be demonstrated, despite being frequently promoted by policymakers and "techno-enthusiasts" as if this was a given. In the light of the paucity of evidence in relation to improvements in patient outcomes, as well as the lack of evidence on their cost-effectiveness, it is vital that future eHealth technologies are evaluated against a comprehensive set of measures, ideally throughout all stages of the technology's life cycle. Such evaluation should be characterised by careful attention to socio-technical factors to maximise the likelihood of successful implementation and adoption.
Experts consider health information technology key to improving efficiency and quality of health care.
To systematically review evidence on the effect of health information technology on quality, efficiency, and costs of health care.
The authors systematically searched the English-language literature indexed in MEDLINE (1995 to January 2004), the Cochrane Central Register of Controlled Trials, the Cochrane Database of Abstracts of Reviews of Effects, and the Periodical Abstracts Database. We also added studies identified by experts up to April 2005.
Descriptive and comparative studies and systematic reviews of health information technology.
Two reviewers independently extracted information on system capabilities, design, effects on quality, system acquisition, implementation context, and costs.
257 studies met the inclusion criteria. Most studies addressed decision support systems or electronic health records. Approximately 25% of the studies were from 4 academic institutions that implemented internally developed systems; only 9 studies evaluated multifunctional, commercially developed systems. Three major benefits on quality were demonstrated: increased adherence to guideline-based care, enhanced surveillance and monitoring, and decreased medication errors. The primary domain of improvement was preventive health. The major efficiency benefit shown was decreased utilization of care. Data on another efficiency measure, time utilization, were mixed. Empirical cost data were limited.
Available quantitative research was limited and was done by a small number of institutions. Systems were heterogeneous and sometimes incompletely described. Available financial and contextual data were limited.
Four benchmark institutions have demonstrated the efficacy of health information technologies in improving quality and efficiency. Whether and how other institutions can achieve similar benefits, and at what costs, are unclear.
In this paper we explore the relationship between computers and productivity growth at the firm level. We apply standard productivity and growth accounting techniques to data from 600 large US firms over 1987-1994. While we find that computer make a positive and significant contribution to output growth in the short term (using 1 year differences), the implied returns to computers are two to five times greater when differences are taken over seven years instead of one year. Our results challenge the conclusions drawn from aggregate data on computers and productivity, but are consistent with case evidence that the combination of computers and organizational co-investments make a substantial contribution to growth. JEL Categories: O3 Technological Change; D24 Capital and Total Factor Productivity Computers and Productivity Growth Page 1 1.
The statistical tests used in the analysis of structural equation models with unobservable variables and measurement error are examined. A drawback of the commonly applied chi square test, in addition to the known problems related to sample size and power, is that it may indicate an increasing correspondence between the hypothesized model and the observed data as both the measurement properties and the relationship between constructs decline. Further, and contrary to common assertion, the risk of making a Type II error can be substantial even when the sample size is large. Moreover, the present testing methods are unable to assess a model's explanatory power. To overcome these problems, the authors develop and apply a testing system based on measures of shared variance within the structural model, measurement model, and overall model.
Current competitive environments have created a growing interest in employee flexibility in firms. Recently researchers have differentiated between two facets of employee flexibility: behavior flexibility and skill flexibility. This study proposes a model of relationships between these two facets of employee flexibility and the extent to which HR practices influence them. This model is tested by estimating structural equation models on a sample of 226 commercial departments in Spanish companies. The results of the study show that the two facets of employee flexibility are interrelated, in that skill flexibility influences behavior flexibility. Furthermore, findings confirm the influence of job enrichment on employee flexibility and the significant effect of the internal fit among HR practices on employee flexibility. © 2013 Wiley Periodicals, Inc.
In 2009, as part of the so-called Stimulus Act, the federal government made a large investment in health information technology (health IT), designating up to $30 billion in incentive payments to providers to adopt and “meaningfully use” certified electronic health record (EHR) systems. The EHR Incentive Program’s inclusion in this legislation—also known as the American Recovery and Reinvestment Act (ARRA)—was apt (111th Congress of the United States 2009). Not only could health IT funding stimulate economic activity but it could also help modernize the health care system, lay the foundation for new health care delivery and payment models, and promote a learning health care environment.
This article reports on the development of a concept of personal initiative (PI). Personal initiative is a work behavior defined as self-starting and proactive that overcomes barriers to achieve a goal. It is argued that future workplaces will require people to show more PI than before, and that current concepts of performance and organizational behavior are more reactive than desirable. The facets of PI are developed along the lines of goals, information collection, plans, and feedback. Personal initiative enables people to deal with job difficulties more actively, for example, with stressors, unemployment, career changes, or becoming an entrepreneur. High PI changes the work situation of employees and relates to success as an entrepreneur. Personal initiative is seen to sharpen and partly modify the concepts of reciprocal determinism, organizational citizenship behavior, innovation, entrepreneurship, work performance, intrinsic motivation, and self-regulation.
Purpose
The primary purpose of this study is to examine the effect that information system capability had on e‐business information technology (IT) implementation strategy; and to understand how the quality of the implementation process for IT strategy could affect e‐business performance.
Design/methodology/approach
This study performed a survey of chief information officers from 1,000 major firms in Taiwan. Structural equation modelling (SEM) was used to test for the validity of research hypotheses.
Findings
Results showed that the capability of information systems could have a direct and significant effect on the quality of IT strategy implementation, and how the quality of this process could affect e‐business performance.
Research limitations/implications
Every organization hopes to improve corporate competitiveness and transform its enterprise through the effective implementation of IT strategy. This study examined how information systems capability could affect the implementation of enterprise IT strategy. However, since large firms in Taiwan are the primary research subjects of this study, the conclusions may not be applicable to enterprises in different countries or cultures. Future studies could examine the subject from the three aspects of technology, organization, and environment to understand the effect that each of these aspects has on e‐business information systems capability.
Practical implications
With the rapid development of information technology, the introduction of innovative strategy dealing with IT has become an important topic of research, and has become a focus in the era of e‐business. As a result, organizations feel it is important to discover the shortcomings in information system capability factors that must be improved from the individual, group, or organization levels, and develop appropriate implementation frameworks for IT strategy based on this foundation.
Originality/value
This study uses empirical analysis to examine the effect that the capability of information systems has on the quality of implementation of IT strategy. A compilation of relevant literature showed that most studies have focused on conceptual frameworks or have examined the question of IT strategy from the level of technology. Few studies have examined the effect that information system capability has on IT implementation strategy. Therefore, the results and findings of this study could provide an important reference for IT strategy implementation, in the era of e‐business.
Service organizations need to consider in depth the human resource management (HRM) strategies that will enable them to achieve sustained competitive advantage in the e-commerce era. This paper analyzes the HRM strategies developed to accommodate the changing customer service practices associated with B2C e-commerce in the retail banking sector. Based on case study data, it describes how two banks in Australia, one large, the other small, have linked their e-commerce strategies with their overall business strategy, and the extent to which their HRM strategies have helped them to utilize their e-commerce capability to achieve sustained competitive advantage
A team of RAND Corporation researchers projected in 2005 that rapid adoption of health information technology (IT) could save the United States more than 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.
To create a coordinated, consistent, national strategy that will address the safety issues posed by EHRs, we propose that a concerted effort be made to improve health care safety in the context of technology use. This effort should address preventable risks that may hamper endeavors to create a safer EHR-enabled health care system. Further discussion and consensus among national agencies (e.g., the Office of the National Coordinator for Health Information Technology [ONC], the AHRQ, the Joint Commission, the Centers for Medicare and Medicaid Services) is clearly necessary for the adoption of future national patient-safety goals specific to EHR use. However, this approach must be given immediate priority considering the rapid pace of EHR adoption and the resulting changes in our nation's health care system. National EHR-related patient-safety goals are needed to address current problems with existing EHR implementations and failures to leverage current EHR capabilities. For instance, the ONC has recently taken several important steps in this direction with release of the revised 2014 EHR certification criteria (e.g., emphasis on user-centered design and application of quality management systems in the EHR design and development process58). Such efforts should be expanded in the future. Goals must be technically feasible, financially prudent, and practically achievable within current constraints and be accompanied by specific guidance on achieving them. Input on these goals must be sought not only from EHR developers and clinical end users but also from cognitive scientists, human-factors engineers, graphic designers, and informaticians with expertise in patient safety in complex health care environments. Creating unique EHR-related national patient-safety goals will provide new momentum for patient-safety initiatives in an EHR-enabled health system.
A. Satorra and P. Bentler . . . developed an approach to the asymptotic behavior of covariance structure statistics that rather naturally yields corrections to the goodness-of-fit statistic of the scaling and Satterthwaite types / present these results and . . . illustrate how they improve upon the uncorrected statistics that are now implemented in the field of covariance structure analysis / [show] that the proposed corrections not only encompass the ones advocated by A. Shapiro and M. Browne (1987) in case of elliptical data but do not suffer from the drawback of Browne-Shapiro's corrections of lack of robustness against deviations from the assumption of an elliptical distribution / provides a theory for correcting the standard covariance matrix of the vector of parameter estimates (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In this study, the authors examine the relationship between high-commitment HR practices and firm performance in professional services firms through the mediator of employee effort. In addition, they contribute to the debate in the field of strategic HRM on whether high-commitment HR practices should be used across all employee groups within a firm. Their study's results show that high-commitment HR practices positively relate to firm performance through employee effort for two employee groups within professional services firms. Further, they found that the relationship between effort and performance is contingent on the value of the employee group to firm competitive advantage, suggesting that companies may only want to expend the effort and resources on building a high-commitment HR system for employee groups that are clearly tied to creating firm competitive advantage. © 2011 Wiley Periodicals, Inc.
Given the role that IT plays in businesses today, the chief information officer (CIO) is seen as having a significant responsibility in ensuring that its value is optimized. However, the history of IT investments has not been glowing and as a consequence blame for this situation is usually placed at the feet of the CIO. To explore further the role of the CIO and its link with organizational performance, interviews were conducted with CIOs, CxOs, and commentators. From the analysis of the data, a model linking the CIO role with organizational performance enabled by IT was developed. This model highlights the critical factors contributing to CIO and, ultimately, IT success. Of central importance is the environment within which the CIO operates. In particular, the research highlights the pivotal role of the IT savviness of the CEO and the leadership team. It reveals some uncomfortable lessons for CEOs and other c-suite members.
This paper draws on the social and behavioral sciences in an endeavor to specify the nature and microfoundations of the capabilities necessary to sustain superior enterprise performance in an open economy with rapid innovation and globally dispersed sources of invention, innovation, and manufacturing capability. Dynamic capabilities enable business enterprises to create, deploy, and protect the intangible assets that support superior long- run business performance. The microfoundations of dynamic capabilities—the distinct skills, processes, procedures, organizational structures, decision rules, and disciplines—which undergird enterprise-level sensing, seizing, and reconfiguring capacities are difficult to develop and deploy. Enterprises with strong dynamic capabilities are intensely entrepreneurial. They not only adapt to business ecosystems, but also shape them through innovation and through collaboration with other enterprises, entities, and institutions. The framework advanced can help scholars understand the foundations of long-run enterprise success while helping managers delineate relevant strategic considerations and the priorities they must adopt to enhance enterprise performance and escape the zero profit tendency associated with operating in markets open to global competition. Copyright © 2007 John Wiley & Sons, Ltd.
Integrating the strategic human resource management research with the multiple-stakeholder view of organizational climate, in this study we propose that the human resource management practices of a high-performance work system enhance a business unit's market performance in the service context by facilitating 2 types of strategically targeted organizational climate: concern for customers and concern for employees, which further encourage employees to engage in cooperative behaviors with customers (service performance) and coworkers (helping behavior) that are essential in achieving superior market performance. The results based on the data collected from multiple sources of 133 stores in Taiwan in 2 phases largely supported the proposed theoretical framework and shed light on the influence mechanism of high-performance work system on organizational effectiveness in the service context.
Purpose:
The purpose of this article is to describe perspectives on information availability and information use among users of a management information system in one specialized health care organization. The management information system (MIS) is defined as the information system that provides management with information about financial and operational aspects of hospital management.
Methods:
The material for this qualitative case study was gathered by semi-structured interviews. The interviewees were purposefully selected from one specialized health care organization. The organization has developed its management information system in recent years. Altogether 13 front-line, middle and top-level managers were interviewed. The two themes discussed were information availability and information use. The data were analyzed using inductive content analysis using ATLAS.ti computer program.
Results:
The main category "usage of management information system" consisted of four sub-categories: (1) system quality, (2) information quality, (3) use and user satisfaction and (4) development of information culture.
Conclusions:
There were many organizational and cultural aspects which influence the use of MIS in addition to factors concerning system usability and users. The connection between information culture and information use was recognized and the managers proposed numerous ways to increase the use of information in management work. The implementation and use of management information system did not seem to be planned as an essential tool in strategic information management in the health care organization studied.
The myth that medicine requires complex, highly specialized information-technology (IT) systems continues to justify soaring costs, burdensome physician workloads, and stagnation in innovation. But there's a clear path toward better tools for health care's complex tasks.
The potential for improving response rates by changing from one mode of data collection to another mode and the consequences for measurement and nonresponse errors are examined. Data collection from 8999 households was done in two phases. Phase 1 data collection was conducted by telephone interview, mail, interactive voice response, or the Internet, while Phase 2 focused on nonrespondents to Phase 1, and was conducted by a different mode, either telephone or mail. Results from our study suggest that switching to a second mode is an effective means of improving response. We also find that for the satisfaction–dissatisfaction questions asked in this survey, respondents to the aural modes (telephone and IVR) are significantly more likely than are respondents to the visual modes (mail and web) to give extreme positive responses, a difference that cannot be accounted for by a tendency towards recency effects with telephone. In general, switching to a second mode of data collection was not an effective means of reducing nonresponse error based on demographics.
This study develops a research model of how the technical, behavioral, and business capabilities of IT personnel are associated with IT infrastructure capabilities, and how the latter are associated with IT-dependent organizational agility, which is conceptualized as comprising IT-dependent system, information, and strategic agility. Analysis of cross-sectional data collected from 293 IT managers generally corroborates the hypothesized relationships, showing that the technical and behavioral capabilities of IT personnel have a positive effect on infrastructure capabilities. The analysis also provides evidence that the effect of infrastructure capabilities on IT-dependent strategic agility is direct, as well as mediated by IT-dependent system and information agility. The validity of the findings is strengthened by demonstrating that the hypothesized research model fits the data better than two alternative theoretically-anchored models describing different relationships between the same constructs. This study advances understanding of the interrelationships between two major subsets of IT capabilities, and their relationships with the agility afforded by IT.
Information technology is generally considered an enabler of a firm's agility. A typical premise is that greater IT investment enables a firm to be more agile. However, it is not uncommon that IT can also hinder and sometimes even impede organizational agility. We propose and theorize this frequently observed but understudied IT-agility contradiction by which IT may enable or impede agility. We develop the premise that organizations need to develop superior firm-wide IT capability to successfully manage their IT resources to realize agility. We refine the conceptualization and measurement of IT capability as a latent construct reflected in its three dimensions: IT infrastructure capability, IT business spanning capability, and IT proactive stance. We also conceptualize two types of organizational agility: market capitalizing agility and operational adjustment agility. We then conduct a matched-pair field survey of business and information systems executives in 128 organizations to empirically examine the link between a firm's IT capability and agility. Business executives responded to measurement scales of the two types of agility and organizational context variables, and IS executives responded to measurement scales of IT capabilities and IS context variables. The results show a significant positive relationship between IT capability and the two types of organizational agility. We also find a significant positive joint effect of IT capability and IT spending on operational adjustment agility but not on market capitalizing agility. The findings suggest a possible resolution to the contradictory effect of IT on agility: while more IT spending does not lead to greater agility, spending it in such a way as to enhance and foster IT capabilities does. Our study provides initial empirical evidence to better understand essential IT capabilities and their relationship with organizational agility. Our findings provide a number of useful implications for research and managerial practices.
This research aims at improving our understanding of the concept of the business competence of information technology professionals and at exploring the contribution of this competence to the development of partnerships between IT professionals and their business clients. Business competence focuses on the areas of knowledge that are not specifically IT-related. At a broad level, it comprises the organization-specific knowledge and the interpersonal and management knowledge possessed by IT professionals. Each of these categories is in turn inclusive of more specific areas of knowledge. Organizational overview, organizational unit, organizational responsibility, and IT-business integration form the organization-specific knowledge, while interpersonal communication, leadership, and knowledge networking form the interpersonal and management knowledge. Such competence is hypothesized to be instrumental in increasing the intentions of IT professionals to develop and strengthen the relationship with their clients. The first step in the study was to develop a scale to measure business competence of IT professionals. The scale was validated and then used to test the model that relates competence to intentions to form IT-business partnerships. The results support the suggested structure for business competence and indicate that business competence significantly influences the intentions of IT professionals to develop partnerships with their business clients.
Investments in certain technologies do confer a competitive edge - one that has to be constantly renewed, as rivals don't merely match your moves but use technology to develop more potent ones and leapfrog over you. That's the conclusion of a comprehensive analysis that Harvard Business School professor McAfee and MIT professor Brynjolfsson conducted of all publicly traded U.S. companies in all industries over the past few decades. They found a clear correlation between levels of IT spending and a new competitive dynamic: Since the mid-1990s, when the rate of spending on IT began to rise sharply, the spread between the leaders and laggards in an industry has widened. There are more winner-take-all markets. But the increased concentration has ramped up, rather than dampened, churn among the remaining players. And these dynamics are greatest in those industries that are more IT intensive. This pattern is already familiar to the makers of digital products, but it has now spread to traditional industries, the authors contend, not because more products are becoming digital but because more processes are. Enterprise software like ERP and CRM systems, coupled with cheap networks, is allowing companies to replicate their unique business processes quickly, widely, and faithfully, in the same way that a digital photo can be endlessly reproduced. In this new environment, top managers must pay careful attention to which processes to make consistent and which to vary locally. And while standardizing some ways of working, they must also encourage employees to come up with creative process improvements to outdo competitors' innovations. Competing at such high speeds isn't easy, and not everyone will be able to keep up - but the companies that do may realize vastly improved business processes as well as higher market share and increased market value.
In 2009, the U.S. government passed the HITECH Act, which allocated up to $29 billion to support the adoption and meaningful use of electronic health records and other forms of health information technology. This article discusses the origins and provisions of the act.
This paper explores the distinctive culture that existed within a knowledge-intensive firm (KIF) and also attempts to explain the emergence and effects of this culture. The findings are based on a detailed case study that was conducted over two years within a consultancy firm that created and applied scientific knowledge and expertise to the invention of solutions for clients. The firm employed highly educated scientists, considered 'leading' in their respective disciplines and project work was inherently fluid, complex, and uncertain. These kinds of 'knowledge workers', and this kind of work, are expected to demand high levels of autonomy. This creates complex managerial dilemmas around how to balance autonomy with control and uncertainty and flexibility with efficiency. The analysis shows how a strong culture based on an acceptance of ambiguity (e.g. in roles, power relations, organizational routines and practices) promoted the development of a loyal, committed, effective workforce and sustained a fluid and flexible form of project working over time. Critically, ambiguity allowed individuals to sustain multiple identities as both 'expert' and 'consultant'. This, coupled with a corporate identity premised on 'élitism', helped to maximize commitment to the work and minimize tensions between control and autonomy. Thus the culture that embraced ambiguity (a consensus that there would be no consensus) engendered a form of normative control whereby consultants operated freely and at the same time willingly participated in the regulation of their own autonomy. Copyright Blackwell Publishers Ltd 2003.
To estimate the effects of electronic medical records (EMR) implementation on medical-surgical acute unit costs, length of stay, nurse staffing levels, nursing skill mix, nurse cost per hour, and nurse-sensitive patient outcomes.
Data on EMR implementation came from the 1998-2007 HIMSS Analytics Databases. Data on nurse staffing and patient outcomes came from the 1998-2007 Annual Financial Disclosure Reports and Patient Discharge Databases of the California Office of Statewide Health Planning and Development (OSHPD).
Longitudinal analysis of an unbalanced panel of 326 short-term, general acute care hospitals in California. Marginal effects estimated using fixed effects (within-hospital) OLS regression.
EMR implementation was associated with 6-10 percent higher cost per discharge in medical-surgical acute units. EMR stage 2 increased registered nurse hours per patient day by 15-26 percent and reduced licensed vocational nurse cost per hour by 2-4 percent. EMR stage 3 was associated with 3-4 percent lower rates of in-hospital mortality for conditions.
Our results suggest that advanced EMR applications may increase hospital costs and nurse staffing levels, as well as increase complications and decrease mortality for some conditions. Contrary to expectation, we found no support for the proposition that EMR reduced length of stay or decreased the demand for nurses.
Many believe that computerization will improve health care quality, reduce costs, and increase administrative efficiency. However, no previous studies have examined computerization's cost and quality impacts at a diverse national sample of hospitals.
We linked data from an annual survey of computerization at approximately 4000 hospitals for the period from 2003 to 2007 with administrative cost data from Medicare Cost Reports and cost and quality data from the 2008 Dartmouth Health Atlas. We calculated an overall computerization score and 3 subscores based on 24 individual computer applications, including the use of computerized practitioner order entry and electronic medical records. We analyzed whether more computerized hospitals had lower costs of care or administration, or better quality. We also compared hospitals included on a list of the "100 Most Wired" with others.
More computerized hospitals had higher total costs in bivariate analyses (r=0.06, P=.001) but not multivariate analyses (P=.69). Neither overall computerization scores nor subscores were consistently related to administrative costs, but hospitals that increased computerization faster had more rapid administrative cost increases (P=.0001). Higher overall computerization scores correlated weakly with better quality scores for acute myocardial infarction (r=0.07, P=.003), but not for heart failure, pneumonia, or the 3 conditions combined. In multivariate analyses, more computerized hospitals had slightly better quality. Hospitals on the "Most Wired" list performed no better than others on quality, costs, or administrative costs.
As currently implemented, hospital computing might modestly improve process measures of quality but does not reduce administrative or overall costs.
This paper uses data gathered from a case NHS Trust in Scotland to demonstrate progress in terms of operational and strategic information management and to highlight some of the problems currently experienced in the health-care environment in striving to comply with governmental policies relating to information sharing.
Progress has certainly been made and there is recognition of the potential to be achieved from more efficient and effective information management in health care. Problems exist, however, and there is still a considerable gap to be filled between the policy objectives and what is actually achievable in reality on a day-to-day basis. Data have been gathered from a hospital and a health centre to illustrate information flow between two of the Trust entities and a benchmark has been provided, showing that best practice can be achieved and how it can be achieved.
Modern information technology started four decades ago, yet in most major corporations, IT remains an expensive mess. This is partly because the relatively young and rapidly evolving practice of IT continues to be either grossly misunderstood or blindly ignored by top management. Senior managers know how to talk about finances because they all speak or understand the language of profit and loss and balance sheets. But when they allow themselves to be befuddled by IT discussions or bedazzled by three-letter acronyms, they shirk a critical responsibility. In this article, the authors say a systematic approach to understanding and executing IT can and should be implemented, and it should be organized along three interconnected principles: A Long-Term IT Renewal Plan Linked to Corporate Strategy. Such a plan focuses the entire IT group on the company's over-arching goals during a multiyear period, makes appropriate investments directed toward cutting costs in the near term, and generates a detailed blueprint for long-term systems rejuvenation and value creation. A Simplified, Unifying Corporate Technology Platform. Instead of relying on vertically oriented data silos that serve individual corporate units (HR, accounting, and so on), companies adopt a clean, horizontally oriented architecture designed to serve the whole organization. A Highly Functional, Performance-Oriented IT Organization. Instead of functioning as if it were different from the rest of the firm or as a loose confederation of tribes, the IT department works as a team and operates according to corporate performance standards. Getting IT right demands the same inspired leadership and superb execution that other parts of the business require. By sticking to the three central principles outlined in this article, companies can turn IT from a quagmire into a powerful weapon.
While computer technology has revolutionized industries such as banking and airlines, it has done little for health care so far. Most of the health-care organizations continue the early-computer-era practice of buying the latest technology without knowing how it might effectively be employed in achieving business goals. By investing merely in information technology (IT) rather than in IT capabilities they acquire IT components--primarily hardware, software, and vendor-provided services--which they do not understand and, as a result, are not capable of fully utilizing for achieving organizational objectives. In the absence of internal IT capabilities, health-care organizations have relied heavily on the fragmented IT vendor market in which vendors do not offer an open architecture, and are unwilling to offer electronic interfaces that would make their 'closed' systems compatible with those of other vendors. They are hamstrung as a result because they have implemented so many different technologies and databases that information stays in silos. Health systems can meet this challenge by developing internal IT capabilities that would allow them to seamlessly integrate clinical and business IT systems and develop innovative uses of IT. This paper develops a comprehensive conception of IT capability grounded in the resource-based theory of the firm as a remedy to the woes of IT investments in health care.
This Health Policy Report explores the risks and benefits of health information technology, how policymakers are encouraging and managing its dissemination, and what the future holds for health information technology in U.S. medicine.
This study examined whether information technology (IT) governance, a term describing the decision authority and reporting structures of the chief information officer (CIO), is related to the financial performance of hospitals. The study was conducted using a combination of primary survey data regarding health care IT adoption and reporting structures of Florida acute care hospitals, with secondary data on hospital financial performance. Multiple regression models were used to evaluate the relationship of the 3 most commonly identified reporting structures. Outcome variables included measures of operating revenue and operating expense. All models controlled for overall IT adoption, ownership, membership in a hospital system, case mix, and hospital bed size. The results suggest that IT governance matters when it comes to hospital financial performance. Reporting to the chief financial officer brings positive outcomes; reporting to the chief executive officer has a mixed financial result; and reporting to the chief operating officer was not associated with discernible financial impact.
The future of resource-based theory: Revitalization or decline
- J B Barney
- D J Ketchen
- P M Wright
Barney, J. B., Ketchen, D. J. Jr., & Wright, P. M. (2011). The
future of resource-based theory: Revitalization or decline?
Journal of Management, 37(5), 1299Y1315.
How the electronic health record did not measure up to the demands of our medical home practice
- R Fernandopuule
- N Patel
Fernandopuule, R., & Patel, N. (2010). How the electronic health
record did not measure up to the demands of our medical home
practice. Health Affairs, 29(4), 622Y628.
Meaningful useVPropping up the EHR market without improving quality
- K Klauer
Klauer, K. (2013). Meaningful useVPropping up the EHR market
without improving quality. Emergency Physicians Monthly, 20(3), 22.