Effect of Health Information Technology on Quality Health Care

Abstract

 In the health-care administration field, the mission is to improve the health of patients through research and scientific discovery. Normally the tools and costs for quality healthcare is very expensive and if a patient seeks proper care, information technology in health care can be an innovative way in both preventing and solving health care issues. Thus, adding high reliability in the safety of patient-centric quality medical care in a healthcare environment. Among the health information systems that are commonly used by physicians include electronic health records, e-prescription, clinical decision support (CDS) system, and virtual clinics and doctors. The health information technology modelled on patients include personal health records, patient portal, and mobile home healthcare. The adoption of health information technology in healthcare leads to lower mortality rates. The adoption of HIT in healthcare facilities leads to an increase in some expenditure. Health information technology impacts on hospital care by supporting the provision of primary care through enhancing access and continuity, managing patients’ population and management of patient records. The aspects of health information technology that influence hospital quality include providing immunization alerts, drug alerts, and improved documentation. The health quality aspects influenced by HIT include the general health wellness of children, child immunization administration, medication prescription errors, and hospital acquired pressure ulcer. 

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Introduction

Health Information Technology (HIT) is designed to facilitate the storage of patient’s records in a safe and careful manner, minimize the input errors, missing records, and improve the process of communication (Sun, 2016). Over last few years, there have been several health care policies and incentives that have sought to add weight to the adoption of an effective application of health IT in an attempt to enhance quality in the primary care settings. Among these policies include the Federal Health Information Technology of Economic and Clinical Health (HITECH) Act, enacted in 2009 under the American Recovery and Reinvestment Act. These acts sought to offers incentives for the adoption of meaningful use of Electronic Health Records (EHRs) (Higgins et al., 2015). The meaningful use highlighted the requirements for using EHR data to improve healthcare processes and outcomes by tracking and reporting the quality measures, e-prescribing, implementing decision support, and engaging in the health information exchange. The progress of meaningful use of EHRs can be noted in the event of 2014 where the Centers for Medicare and Medicaid Services reported that it had issued $19.2 billion in incentives for encourage adherence to minimum government standards in the use of electronic health records to over 441,000 registered providers that were engaged in the Federal EHR meaningful use program (Higgins et al., 2015). 

The adoption of health information technology was further cemented through the enactment of the Patient Protection and Affordable Care Act of 2010. The Act insisted on the importance of quality improvement and made proposals on the use of health information technology as a tool to improve patient safety, reduce medical errors, and enhance the delivery of patient-centered care (Higgins et al., 2015). To achieve this, the Office of the National Coordinator (ONC) for Health Information Technology opened up about 62 regional extension centers with an objective of offering EHR technical assistance to private practice facilities and federal facility centers that were qualified (Higgins et al., 2015). This enhanced access to health care for the communities that have been placed as medically undeserving. The effort to improve the adoption of health information technology can be seen through the works of the Agency for Healthcare Research & Quality (AHRQ). The agency had engaged in contracts and grants valued at more than $300 million to over 200 communities, hospital, providers, and healthcare systems in more than 48 states, with an aim of enhancing the understanding of health IT to improve the quality healthcare (Higgins et al., 2015). The purpose of the paper will be to highlight the impact of health information technology in the healthcare sector. The paper discusses the different forms of HIT that used by physicians and those modelled on patients. The paper is also organized into sections that discusses the impact of health information technology on mortality and expenditure, hospital care, quality of services in healthcare facilities. 

Research Question

What effects does health information technology have on quality health care? 

Research Methodology

I examined several different and complex elements of quality management, quality health care and the effects of health information technology on quality health care while the research consists of various literature reviews and scholarly journal publications. 

Modeling the Physician’s on Patient Health

The main health information technology systems that are available for use by healthcare practitioners in healthcare facilities include the “Electronic Physician’s Order (CPOE) and Clinical Decision Support (CDS). Other HIT systems include E-prescribing, electronic sign-out and hand-off tools, Barcode Medication Administration (BCMA), smart pumps, Automated Medication Dispensing reporting (ADC), and retained surgical items detectors” (Alotaibi & Federico, 2017).  Additionally, Electronic Medication Administration Record (eMar), Patient Data Management System (PDMS), patient electronic, telemedicine, electronic incident reporting, and Electronic Health Records (EHR) are also part of the HIT systems available for use by care providers (Alotaibi & Federico, 2017). 

Electronic health records (EHR)

According to the Centers for Medicare and Medicaid Service, electronic health record is an electronic version of the patient’s medical history that is maintained by a healthcare facility over a period. The systems cover data such as relevant administrative data for the particular patient including demographics, progress notes, issues, medications, vital signs, medical history, immunization, laboratory information, and radiology report (Bajwa, 2014). Where the health records are maintained strictly within the facility, these are referred to as the electronic medical records (EMRs). However, in a situation where the health records are interconnected between the different healthcare facilities and can be accessed from outside, there are referred to as electronic health records (EHRs). The EHR allows the physicians to access and view the patient medical records on their devices. The physicians are also to enter data directly in the system making it part of the digital medical record. The physician further makes prescriptions by selecting the drugs from a list thereby, avoiding the difficulties posed by illegible handwriting, which was a major source of medical errors. 

E-prescription 

The adoption of health information technology has made it possible for the prescribers to relay the prescriptions to the pharmacies electronically. This has ended the era of handwritten prescription notes, faxes, and calling to deliver the prescriptions. The adoption of this technology has been effective in the reduction of prescription errors due to the breakdown of communication between the physician and the pharmacy (Bajwa, 2014). 

The clinical decision support (CDS) system 

The adoption of EHR has led to the development of data repositories that stores large amounts of information about diagnostics and treatment of different illnesses and disorders. This is effective in assisting the physicians to carry out a diagnosis and make a decision on the most suitable treatment and method of healthcare delivery. In this case, the physician makes the decision while being informed by evidence rather than mere opinion. The CDS helps the physician gain access to reference material and information upon which they base their decision. The adoption of the EHR has made it possible for the physician to identify the adverse events and errors (Bajwa, 2014). This reliance on this system assists in encouraging the physicians to adhere to the standards and evaluate the clinical performance. 

Virtual clinics and doctors

Virtual clinics are online clinics that offer 24-hour online access for patients to healthcare physicians who assist in making a diagnosis and prescribe treatment. Under this setup, the patients have indicated improvement in the experience of care by patients and have had an effect on the reduction of per capita health care costs. Among the application allowing this includes virtual clinic, which enables the physicians within a healthcare network to provide answers to the patients in the real time, and the virtual doctor that offers valuable information on ways to enhance their health (Bajwa, 2014).

Modeling of Healthcare Information Technology on Patients

Personal Health Record (PHR)

This is a technological development with a web of EHR and HIT, that seeks to enhance the active participation of the patients in their healthcare decision-making. The electronic version of the Personal Health Record (PHR) enables the patients to enter data on their health status and this is linked to the physicians EHR to allow the healthcare provider to review the information that the patient has assembled. This system is essential in encouraging the patient’s participation in making decisions affecting their care plans (Bajwa, 2014). The patients are thereby motivated to keep track of their health maintenance. 

Patient portal

Patient portals are healthcare applications that enable the interaction between the patients and the physicians. These portals are accessible anytime through the internet. Majority of the patient’s portals are integrated into the websites of the providers and may be run as different modules connected to these websites. These portals allow the patients to access their medical details and to interact directly with the physicians over the internet (Bajwa, 2014). 

Mobile Home Healthcare

The technology on mobile home health care allows patients to communicate about the status of their disease to the physicians while still at home. This is an effective approach in the management of chronic illnesses, especially among the elderly population. This has been utilized through linkages with blood pressure monitors, glucose monitors, weight scales, and pulse oximeters. The current devices require data to be transferred to the Electronic Medical Records EMR/EHR (Bajwa, 2014). 

Research Data and Statistics

Data Sources 

The Office of the National Coordinator for Health Information Technology is an important source of data to better understand the adoption of health information technology in healthcare facilities and by physicians. The source of data will be a report to Congress that highlights the Health IT progress by examining the HITECH Era as well as the future of Health IT. The report was a submission pursuant to the section 3001(c) of the Public Health Service Act and a section of the Hitech Act which describes the specific actions that the federal government and private facilities have taken to enable the adoption of a nationwide system for the electronic use and exchange of health information. The report highlights the barriers to the adoption of a nationwide system and offers recommendations on the achievement of the full implementation of the nationwide system.  

Data Statistics

  1. Factors influencing the adoption of HIT
Factor Rate of adoption 
Size of practice Small (< 10 physicians)25.9%
Large (> 10 physicians54.6%
Specialization Primary care physiciansPrimary care physicians had an 8.6% higher than non-primary physicians.
Non-primary care physicians
Age of providers< 45 years physiciansPhysicians aged below 45 years adopted HIT 20.4% less than those aged 55 years and above

It has been established that among the physicians, 78% possesses certification for EHR while 96% of hospitals are certified (The Office of the National Coordinator for Health Information Technology, 2016). This is an indication that there has been a rapid digitization within the health systems, which could be linked to extensive collaboration and the effect of incentives provided by the Medicare and Medicaid EHR Incentives programs. The Regional Extension Center has also offered technical support to more than 120,000 health care providers. The HITECH funding programs have expanded the HIT-related infrastructure in terms of technical, legal, and policy structures to support the digitization of the healthcare system.  

Notably, evidence indicates that the health care system is experiencing an increased flow of health information. In 2008, it has been reported that only 41% of healthcare facilities shared health information electronically with outside providers. By 2015, this rate had doubled by more than 82% of the non-federal acute care facilities reportedly transmitting electronically laboratory results, radiology results, clinical summaries, and medication lists (The Office of the National Coordinator for Health Information Technology, 2016). 

  1. Abilities of HIT systems
Factor PeriodRate 
Ability to electronically view medical information201225%
201695%
Ability of downloads patients’ health information201214%
201587%
Capacity to transmit medical information201312%
201571%
Use of HIT to collect quality data200217%
201342%
Ability of e-prescribing200225%
200770%

There has also been increased access to health information with the adoption of health information technology. Evidence shows that the increased access to electronic health information makes patients develop a deeper sense of trust in how their information is being managed. The digitizing of the U.S. health systems has empowered the individuals to take greater control of decision about their health and wellbeing. 

  1. Impact of HIT on Mortality 
FactorReduction on mortality rate
Basic functionality of HIT0.99%
Increase in a single functionality in the HIT system0.21%
Impact on general patients (across the population, age, and insurance)0.3%
Impact on Medicare patients0.5%
  1. Impact of HIT on Hospital Quality 
HIT Element Impact on a Health Quality aspect 
Immunization alerts12% increase in general wellness of the child
22% increase in sick child immunization administration 
Drug alerts22% decrease in medication prescription errors
Improved documentation 13% decrease in Hospital acquired pressure ulcer

Discussion of the Impact of Health Information Technology in Healthcare

  1. Impact of Health Information Technology on Mortality and Expenditure 

In their study, Lin et al. revealed that a number of base-line EHR functionalities were connected to a higher 30-day mortality rate (2018). The inclusion of new EHR functionality was connected with lower mortality rates. While considering the patient population across all ages and insurance types, results revealed that adoption of health information technology led to a reduction in the hospital severity-adjusted mortality by 0.3% (McKenna, Dwyer, & Rizzo, 2018). The severity-adjusted mortality takes is a mortality rate that have been adjusted for predicted risk of death. When the effect was checked for Medicare patient, the HIT adoption led to a reduction in the hospital’s severity-adjusted mortality rate by 0.5% which is not statistically significant (McKenna, Dwyer, & Rizzo, 2018). 

The adoption of HIT leads to an increase medical expenditure. The medical expenditure factors, in this case, include that screening and diagnostic tests, hospital visits, increased spending on treatment interventions, and outpatient physician services. It was noted that after the adoption of the HIT, the expenditure on diagnostic testing and imaging increased by 1.6% equivalent to about $160 per patient (Agha, 2014). A trend break model indicated that a rise in expenditure is slower amongst adopters after HIT adoption, although the coefficient is smaller. Under this sector, it has been noted that expenditure has the highest estimated 3-year effect of 1.3% (Agha, 2014). This approximate rise in the diagnostic testing reveals that HIT may reduce the effort costs of ordering and following additional tests, which may thereby; enhance a physician’s propensity to order for more intensive work-up. 

The adoption of health information technology leads to an increase in expenditures related to hospital stays. On this note, it was observed that there was an increasing initial bump in the expenditure on inpatient care, later followed by a gradual settling to the baseline trend. The initial rise in expenditure was noted to be about 1.1%, which is lower than the estimated effect on diagnostic imaging (Agha, 2010). However, over a period of three years, the inpatient expenditures have been approximated to be 0.7% higher, which is not statistically significant (Agha, 2014). 

Patterns of increase in expenditures have been observed on medications, durable medical equipment, operating room staffing, and blood transfusions. In this case, there is an observed initial increase before stabilization of the expenditures (Agha, 2014). Overall, evidence has indicated increased spending linked with intensive diagnostic work-ups and interventions. Inpatient hospital expenses and outpatient physician services do not change significantly. It has been noted that they are higher scope for a rise in expenditures with testing, imaging, operations, and inpatient pharmacy (Agha, 2014).  

  1. Impact of Health Information Technology on Hospital Care 

Among the health information technology that has had an impact on hospital care include the application of health information technology to enhance Patient-Centered Medical Home (PCMH). This has led to the revolutionization of the primary care to ensure that it is more respectful and responsive to a patient’s needs, preference, and values. Health information technology has played a vital role in supporting functions of primary care such as enhancing access and continuity, identifying and managing patient populations, planning and managing healthcare, supporting self-care and community support, tracking and coordinating care, and measuring and improving performance. Health information technologies provide meaningful opportunities for primary care practices to achieve a patient-centered care status (Kraschnewski & Gabbay, 2013). The federal government offers incentives to healthcare facilities to adopt the meaningful use of certified EHRs to healthcare. 

In enhancing access and continuity of care, the healthcare information technology is applied using a web-based personal health record or patient portal. The use of personal health records provides an opportunity to increase patient engagement and self-efficacy. The use of portable records provides an opportunity for real-time information exchange of clinical results such laboratory. This may be connected to the EHR to serve as a patient web portal. Patient web portal enhances the efficiency and productivity of care that is beneficial to both patient and health care providers. It is, thereby, clear that the application of healthcare information technology enhances care access, continuity and enhances medication adherence (Kraschnewski & Gabbay, 2013).

Health information technology enables the identification and management of patient populations. These technologies facilitate the process of collection of patient information, which includes demographics and clinical data. This information is useful in population management, assessment, and documentation of patient risk factors, as well as identifying patients for proactive and point-of-care reminders (Kraschnewski & Gabbay, 2013). An example of health information technology is a web-based data collection that is adopted by the University of Pittsburgh primary care clinics and is used to screen patients in the waiting room. The inclusion of this system within the EHR of the healthcare facility allows it to get access to individual patient results. Such a system allows maintenance of a registry for health conditions of the diseases that they normally encounter. In the management of the population, a patient registry is very essential. A patient registry is an electronic organization of patients depicting their condition and their disease-specific clinical and laboratory quality measures (Kraschnewski & Gabbay, 2013). The patient registry enables the tracking of the patient and outcome allows the improvements in clinical efficiency and spotting of high-risk patients. 

The use of health information technology in healthcare facilities facilitates the planning and management of care. This includes the identification of patients suffering from different health conditions and highlights the appropriate care management. The use of EHRs in providing point-of-care reminders enhances the ability to use team-based care. Team-based care is noted to be more effective when using the tools of EHR to allow different team members to offer ideal care throughout the clinical encounter. Pre-visit planning is another example of health information technology that facilitates the provision of care. This offers a summary of essential information about the patient as he/she enters the clinic room and generates an automated physician order depending on the patient’s health status (Kraschnewski & Gabbay, 2013). 

  1. Impact of Health Information Technology on Hospital Quality

A study carried out revealed an inverse relationship between EHR adoption in healthcare facilities and patient outcomes of prolonged length of stay (PLOS) and admission. Further analysis based on the relationship between nursing work environment, missed nursing care, and patient satisfaction indicated confounding effect of EHR on patient satisfaction (Hessels, Flynn, Cimiotti, Bakken, & Gershon, 2015). It has been indicated that there is a positive association between the adoption of the clinical information system, patient scheduling application, and adherence to best practices in the treatment of heart attacks, heart failures, and pneumonia (Bardhan & Thouin, 2013)

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