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IMPROVING PATIENT CARE

Improving Patient Care is a special section within Annals supported in part by the U.S. Department of Health and Human Services (HHS) Agency for Healthcare Research and Quality (AHRQ). The opinions expressed in this article are those of the authors and do not represent the position or endorsement of AHRQ or HHS.

Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care

Basit Chaudhry, MD; Jerome Wang, MD; Shinyi Wu, PhD; Margaret Maglione, MPP; Walter Mojica, MD; Elizabeth Roth, MA; Sally C. Morton, PhD; and Paul G. Shekelle, MD, PhD

16 May 2006 | Volume 144 Issue 10

Background: Experts consider health information technology key to improving efficiency and quality of health care.

Purpose: To systematically review evidence on the effect of health information technology on quality, efficiency, and costs of health care.

Data Sources: 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.

Study Selection: Descriptive and comparative studies and systematic reviews of health information technology.

Data Extraction: Two reviewers independently extracted information on system capabilities, design, effects on quality, system acquisition, implementation context, and costs.

Data Synthesis: 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.

Limitations: 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.

Conclusions: 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.

Author and Article Information

From the Southern California Evidence Based Practice Center, which includes RAND, Santa Monica, California; and University of California, Los Angeles, Cedars-Sinai Medical Center, and the Greater Los Angeles Veterans Affairs System, Los Angeles, California.

Note added in proof: Two additional studies involving benchmark institutions will be added to the analyses and evidence tables for the print version of this paper.

Disclaimer: The authors of this article are responsible for its contents. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality. Statements made in this publication do not represent the official policy or endorsement of the Agency or the U.S. government.

Acknowledgments: The authors thank the Veterans Affairs/University of California, Los Angeles, Robert Wood Johnson Clinical Scholars Program, the University of California, Los Angeles, Division of General Internal Medicine and Health Services Research, and RAND for their support during this research.

Grant Support: This work was produced under Agency for Healthcare Research and Quality contract no. 2002. In addition to the Agency for Healthcare Research and Quality, this work was also funded by the Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, and the Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Basit Chaudhry, MD, Division of General Internal Medicine, University of California, Los Angeles, 911 Broxton Avenue, 2nd Floor, Los Angeles, CA 90095; e-mail, BChaudhry{at}mednet.ucla.edu.

Current Author Addresses: Dr. Chaudhry: Division of General Internal Medicine, University of California, Los Angeles, 911 Broxton Avenue, 2nd Floor, Los Angeles, CA 90095.

Dr. Wang: Cedars-Sinai Health System, 8700 Beverly Boulevard, Los Angeles, CA 90048.

Drs. Wu, Mojica, and Shekelle, Ms. Maglione, and Ms. Roth: RAND Corporation, 1776 Main Street, Santa Monica, CA 90401.

Dr. Morton: RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709.

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