Question

You have developed a HIT implementation strategy, determined a way to quantify and communicate your strategy, found a way to implement your strategy, and identified ways to improve upon the strategy you implemented all focused on optimal:

• Patient care
• HIT user satisfaction
• HIT use efficiency and effectiveness

Answer 1

Health information technology (HIT) is defined as the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making. Implementation of electronic health record (EHR) systems have led to accelerated HIT adoption and implementation in health care settings.Hospitals have been rapidly responding to these new policies and incentives with large-scale implementations of EHRs during the past few years. Adopting new technology requires the redesign of individual and collective workflows and results in changes in both organizational structure and process.  To facilitate appropriate adoption and use, upgrades, redesign, and optimization are needed, including both minor and major changes in EHR infrastructures, functions, interfaces, and workflows. unsuccessful implementation of HIT systems could be due to poorly designed HIT, poor use of HIT by clinicians, or socioorganizational factors such as goal conflicts, lack of time, or lack of support from colleagues.

MU requirements have commonly been used as a means to assess HIT implementation success in order to promote essential HIT functionalities. MU stage 2 requires providers to have certain HIT functionalities (eg: computerized provider order entry, personal health record, medication reconciliation) in order to continue to participate in the EHR incentive programs. By focusing on achieving MU, there is risk of missing the big picture of health care system changes. Therefore, there is a need to improve the understanding of how to appropriately assess the performance and success of HIT implementation over time to allow for generalize to other HIT implementation contexts.

Successful HIT implementation is commonly evaluated using measures such as HIT adoption, technology acceptance, and clinical quality. Yet this disparate array of measures fails to account for complex sociotechnical interactions, variability across contexts, and the different trajectories within organizations that exist because of different implementation plans and timelines. Appropriate measurement of HIT implementation thus needs to take into account this variability across organizations and over time but at the same time enable us to generalize the variation across HIT implementation studies in order to inform practice. As a result, the issue of consistent measurement becomes increasingly significant. The measures that exist include HIT adoption, HIT acceptance, and clinical quality measures (CQMs). The first common measure, HIT adoption, is defined by the EHR MU stages outlined by the Office of the National Coordinator and measures the rate of health care systems having chosen to invest resources toward EHR implementation. It is commonly reported as an adoption rate to reflect the percentage of health care organizations with specific EHR functionalities or capabilities that are meaningful for patient care. The second approach to measuring implementation success involves HIT acceptance, the extent of individual commitment to use the technology.

When assessing individual user acceptance, the technology acceptance model (TAM) is a commonly applied and useful model, albeit with limitations. TAM’s predictive power in health care is lower than what has been found in other domains, and some recommend that the TAM should be integrated with other adoption theories, particularly those that include variables related to both human and social change processes. CQMs are another common metric used to assess the success of HIT. However, HIT implementation appears to have little impact on care quality whether measured by patient mortality, adverse drug events, or readmission rates. Although CQMs are helpful for assessing the extent to which HIT can be used to monitor the quality of health care services provided, this approach to measurement does not take into account organizational or human factors that could impact HIT implementation.

HIT implementation is a process, not an outcome, understanding implementation success requires consideration of the sociotechnical environment in which it takes place. The advantages of health information technology (IT) include facilitating communication between health care providers; improving medication safety, tracking, and reporting; and promoting quality of care through optimized access to and adherence to guidelines. Health IT systems permit the collection of data for use for quality management, outcome reporting, and public health disease surveillance and reporting. However, improvement is needed with all health IT, especially regarding design, implementation, and integration between platforms within the work environment. Robust interoperability is critical for safe care, but this goal has proved elusive. Significant patient safety concerns already have been recognized; it is important to keep patient safety and quality as the primary focus. Most obstetrician–gynecologists are now using electronic health records. They have rapidly moved into use because of the recognition of their potential benefits and government programs that incentivize their use. The benefits of health information technology (IT) include its ability to store and retrieve data; the ability to rapidly communicate patient information in a legible format; improved medication safety through increased legibility, which potentially decreases the risk of medication errors; and the ease of retrieval of patient information.

The potential to improve patient safety exists through the use of medication alerts, clinical flags and reminders, better tracking and reporting of consultations and diagnostic testing, clinical decision support, and the availability of complete patient data. Data gathered through the use of health IT can be used to evaluate the efficacy of therapeutic interventions and have been demonstrated to lead to improvements in the practice of medicine. Alerts can optimize adherence to guidelines and evidence-based care. Record uniformity can be designed to reduce practice variations, conduct systematic audits for quality assurance, and optimize evidenced-based care for common conditions. Health IT is increasing patient engagement as consumers of health care. It allows patients access to their medical records, which helps them to feel more knowledgeable about their conditions and encourages them to actively participate in shared decision making.

Developing systems to manage alerts, establish levels of importance, and make them unambiguous is a critical patient safety priority. Computerized Physician Order Entry has improved legibility and order processing times, and lowered the risk of medical errors; however, safety concerns have been raised. The time needed to place an order has increased, the ordering process may disrupt the work flow of the health care provider, and some formatting can create new opportunities for errors. These errors may be caused by fragmented displays, inflexible ordering formats, incompatible orders, and separations in functions that prevent full comprehension of a patient’s health care needs. Patient engagement tools, while improving patient involvement, also introduce reliability concerns regarding data. Use of portable devices that are not password protected makes the patient record vulnerable to invasion of privacy. Automated and self-populating templates designed to save time can inadvertently cause inaccuracy in the medical record. Health care providers must review and edit these templates to ensure that they accurately reflect the encounter. Copying and pasting patient notes from prior visits also can compromise a patient’s record if not appropriately reviewed and edited.

During implementation of any major change, such as implementing HIT components, electronic health records (EHR), or other clinical information systems, and accompanying quality improvement initiatives, significant attention must be made to communicating with all users and stakeholders. Most organizations hold both formal and informal meetings with end users at every shift during go live, daily or weekly for a few weeks thereafter, then monthly. They also provide feedback cards and host a special help desk hotline for staff. Those conducting the implementation need to be aware of user concerns—expressed or implied. Conduct a formal user satisfaction survey within a month to three months following go live. A user survey demonstrates that ongoing input from users is important and helps motivate them to continue to work with the new HIT systems. This is not scientific but may be the best way to spot problems early, reinforce HIT goals, and recognize staff members for their efforts. Ensure that all of the organization’s leaders are visible during and after implementation and have them use the HIT Assessment tool to identify the strategy implementation result.

Health Information Technology improves patient safety by reducing medication errors, reducing adverse drug reactions and improving compliance to practice guidelines. There should be no doubt that health information technology is an important tool for improving healthcare quality and safety. The purpose of Health IT is to provide better care for patients and help achieve health equity. Health IT supports recording of patient data to improve healthcare delivery and allow for analysis of this information for the hospital. This data is used for the implementation of policies in order to better treat and prevent the spread of diseases for government also. Patients that suffer from disease and ailments directly benefit from Health IT because of the improved level of care. The benefits of electronic health records include: Better health care by improving all aspects of patient care, including safety, effectiveness, patient-centeredness, communication, education, timeliness, efficiency, and equity.