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Health information technology (HIT) has been introduced into the health care industry since the 1960s when mainframes assisted with financial transactions, but questions remained about HIT’s contribution to medical outcomes. Several systematic reviews since the 1990s have focused on this relationship. This review updates the literature.
The purpose of this review was to analyze the current literature for the impact of HIT on medical outcomes. We hypothesized that there is a positive association between the adoption of HIT and medical outcomes.
We queried the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Medical Literature Analysis and Retrieval System Online (MEDLINE) by PubMed databases for peer-reviewed publications in the last 5 years that defined an HIT intervention and an effect on medical outcomes in terms of efficiency or effectiveness. We structured the review from the Primary Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and we conducted the review in accordance with the Assessment for Multiple Systematic Reviews (AMSTAR).
We narrowed our search from 3636 papers to 37 for final analysis. At least one improved medical outcome as a result of HIT adoption was identified in 81% (25/37) of research studies that met inclusion criteria, thus strongly supporting our hypothesis. No statistical difference in outcomes was identified as a result of HIT in 19% of included studies. Twelve categories of HIT and three categories of outcomes occurred 38 and 65 times, respectively.
A strong majority of the literature shows positive effects of HIT on the effectiveness of medical outcomes, which positively supports efforts that prepare for stage 3 of meaningful use. This aligns with previous reviews in other time frames.
Health information technology (HIT) is an umbrella term that covers a wide range of technologies that store, share, and analyze health information [
In the United States in 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act made incentive payments available to providers who adopted the
Over the last several years, many studies have examined a relationship between the use of HIT and resulting health outcomes, administrative efficiencies, and cost [
Buntin et al [
The purpose of this review was to evaluate the current literature demonstrating the impact of HIT adoption on medical outcomes. Using the same methods as Buntin et al, Chaudhry et al, and Goldzweig et al (2004, 2007, and 2011, respectively), we intended to carry this research forward into 2017 [
The conduct of our review followed a measurement tool for the “Assessment of Multiple Systematic Reviews” (AMSTAR) [
We queried two common research databases: Medical Literature Analysis and Retrieval System Online (MEDLINE) by PubMed and the Cumulative Index of Nursing and Allied Health Literature (CINAHL). We used key terms from the US National Library of medicine’s medical subject headings separated by Boolean terms. Searches were conducted from July 1, 2017 to July 4, 2017.
Searches in each database were nearly identical. Due to the differences in indexing methods between the databases, we had to slightly modify the search string and filters for each. We screened for date of publication to begin in 2007 until the end of June 2017. The filters in PubMed enabled us to screen out reviews. In CINAHL, we excluded MEDLINE because it was being collected separately from PubMed, and this eliminated most duplicates. Papers were placed into an Excel (Microsoft) spreadsheet shared among the reviewers. Remaining duplicates were removed. As a quality measure, only peer-reviewed journals were used in the selection process.
Reviewers agreed ahead of time what to look for in each abstract. We focused on papers that described a technological intervention that follows the definition of previous reviews [
The summary measure used in this analysis was the medical outcome specified in terms of either efficiency or effectiveness. When clear statistics were listed, our team recorded them for our analysis. We also identified signs of bias that could have deleterious effect on the broad application of the results. Several papers only mentioned advantages of administrative efficiency, such as a shorter length of stay (LOS) and lower readmission rates. These were kept because, we reasoned, a shorter LOS could have been due to improved outcomes, and lower readmission rates could have been enabled with improved outcomes that would have otherwise caused the patient to return.
Studies from PubMed and CINAHL that defined an HIT intervention and a corresponding effect on medical outcomes stated in terms of efficiency or effectiveness were eligible for selection. The search for this review was extensive, and the reviewers took care to be deliberate and thorough in their process.
The initial search, as illustrated in
After consensus meeting number two, the categories of HIT recorded by each reviewer were combined. We counted the number of times that a category occurred in the literature and sorted by frequency of occurrence. This data was placed into an affinity matrix for further analysis (see
Literature search with inclusion and exclusion criteria.
The specific categories of health information technology (HIT) and their frequency of occurrence.
Category of HITa | Paper in which category occurred | Frequency (n=38) |
Web-based | [ |
8 |
Telemedicine | [ |
7 |
Software | [ |
6 |
CDSSb | [ |
5 |
mHealthc | [ |
3 |
Telemonitoring | [ |
2 |
Electronic ordering | [ |
2 |
HIT | [ |
1 |
HIEd | [ |
1 |
Robot assist | [ |
1 |
Videoconferencing | [ |
1 |
Remote screening | [ |
1 |
aHIT: health information technology.
bCDSS: clinical decision support systems.
cmHealth: mobile health.
dHIE: health information exchange.
The specific categories of outcomes and their frequency of occurrence.
Category of outcome | Paper in which category occurreda | Frequency |
Physical | [ |
39 |
Psychological | [ |
13 |
Continuity of care | [ |
13 |
Total | Multiple occurrences in same paper | 65 |
aMore than one occurrence was observed in the following papers in the categories of outcome; physical: 15-17, 23, 28, 37, 39, 41, 42; psychological: 18, 21, 27, 40; continuity of care: 23.
Twelve different categories of HIT were identified in our analysis with a total of 38 occurrences. Web-based interventions were analyzed most frequently at 8 of 38 occurrences (21%) [
The asterisks note that more than one occurrence was observed within the same paper. Evidence of efficiency or effectiveness that were grouped under physical outcomes included body mass index, blood pressure, hypertension, pain, infection, activities of daily living, mortality, vaccines nutrition, physical activity, cardiovascular disease, wound healing, diabetes distress, quality of life, A1C level, low-density lipoprotein, vaccination rate, sedation interruptions, spontaneous breathing trials, mechanical ventilations, asthma control, cholesterol, and cluster of differentiation 4 count. Occurrences grouped as psychological included depression, insomnia, self-efficacy, emotional stability, maintenance of motivation, upset, negative mood states, social outcomes, and eating disorder symptomatology. Continuity of care included medication administration, medication adherence, service utilization, readmission, length of stay, unmet needs, and reduced office visits. Although readmission, length of stay, and reduced utilization are qualities most often associated with administrative efficiencies, we chose to keep these in the review because these efficiencies could have been enabled because of improved medical outcomes. The most common outcome category was physical, which appeared 39 of 65 occurrences (60%) [
Outcome results and their frequency of occurrence.
Result of outcome | Paper in which result occurred | Frequency (n=37) |
Improved | [ |
30 |
No statistical difference | [ |
7 |
Of the 37 papers included, 30 (81%) reported an improvement in efficiency or effectiveness related to a medical outcome. No statistical difference in outcomes was reported in 7 of 37 occurrences (19%) studies. These results strongly support our hypothesis; therefore, we accept our hypothesis and reject the null. There is a positive association between the adoption of HIT and medical outcomes.
We made 15 comments related to bias in the original research, the majority of which were related to the lack of heterogeneity in characteristics of participants. Characteristics that were noted include socioeconomic status, gender, age, ethnicity, and geographical area. Small sample size was noted as a potential concern in 4 studies, and participation refusal or dropout was noted in 2 studies. In one study, participants received payment for participation, and in another study, two of the authors had invented the technology being evaluated. Other sources of bias identified included outcomes reported based on a quality manager’s response to survey, seasonal influences not controlled for, and technical challenges experienced that resulted in delays.
Health care providers will continue to be incentivized to adopt HIT as policy makers respond to quality, and safety concerns and reimbursement methods transition toward value-based purchasing [
First, Buntin et al reported that less than 10% of the studies included in their work demonstrated negative findings related to the adoption of HIT [
Second, the literature review conducted by Chaudhry et al in 2004 noted that the improved outcomes demonstrated were reported by a limited set of large benchmark organizations and cautioned on the ability to generalize positive findings to other institutions [
One common theme in all four literature reviews is the limited amount of research associated with HIE specifically [
Our literature review did not identify any studies demonstrating a negative impact on medical outcomes as the result of HIT adoption. The absence of negative findings may be because of publication bias [
HIT has the potential to improve the quality and safety of health care services. Providers who leverage HIT to improve medical outcomes can position themselves for sustainability in the future. Further research is needed to continue to reveal and define the relationship between the adoption of HIT and medical outcomes. This will be especially true as the industry establishes new and innovative ways to integrate technological advances and works toward greater interoperability as the United States prepares for stage 3 of meaningful use, as all providers seek a link between the application of HIT in health care and its effect on outcomes, and as other nations such as Switzerland, Denmark, and Germany reconcile national medical programs such as a nationwide EHR, regional electronic patient record system, and national medical chip cards, respectively, against outcomes.
Summary of analysis.
Assessment for Multiple Systematic Reviews
Cumulative Index of Nursing and Allied Health Literature
electronic health record
health information exchange
health information technology
Health Information Technology for Economic and Clinical Health
length of stay
Medical Literature Analysis and Retrieval System Online
mobile health
Primary Reporting Items for Systematic Reviews and Meta-Analysis
None declared.