Health Information Technology and Patient Outcomes

[By] increasing communication and coordination among providers, who must manage clinical information coming from a number of different sourcesÂ… health IT improve(s) outcomes for patients with complex and severe diagnosesÂ… [but not for] average patients.

Some healthcare policymakers have argued that increased adoption of health information-technology (IT) systems within hospitals would lead to improved quality of care for patients. In Health Information Technology and Patient Outcomes: the Role of Organizational and Informational Complementarities (NBER Working Paper No. 18684), co-authors Jeffery McCullough, Stephen Parente, and Robert Town review and analyze the IT systems at thousands of U.S. hospitals, along with millions of Medicare discharge records, and conclude that IT adoption in general does not affect outcomes for the average patient. However, they find that IT solutions do have an impact on the mortality rates for patients with complex conditions that require cross-specialty coordination of care. Their results also suggest that the main benefits from IT adoption tend to flow toward larger health institutions that handle a wide variety of severe and complex caseloads.

As previous studies have shown, adoption of new IT solutions in general can lead to cost, communication, and productivity gains at many organizational levels within many types of institutions. These authors want to determine whether those general IT benefits ultimately extend to the care of patients, not simply to the benefit of the health institutions themselves. They focus primarily, although not exclusively, on the adoption of "electronic medical records" (EMR) and "computerized provider order entry" (CPOE) systems at hospitals to measure the impact of IT adoption on patient-care outcomes.

For this study, the authors use detailed, hospital-level IT adoption-rate information from the U.S. Health Information Management System Society for the years 2002 through 2007 and information about IT adoption at specific hospitals across the country from the American Hospital Association. During 2002-7, the number of hospitals adopting EMR and CPOE information technologies was increasing rapidly. In addition, the authors merge the hospital IT adoption data to millions of inpatient discharge records on every Medicare, fee-for-service patient admitted for one of four high-mortality conditions: acute myocardial infarction; congestive heart failure; coronary atherosclerosis; and pneumonia.

In the end, the authors find that health IT generally improves patient care by increasing communication and coordination among providers, who must manage clinical information coming from a number of different sources. Such IT innovations improve outcomes for patients with complex and severe diagnoses. The authors estimate that health IT adoption averted 200 deaths per 100,000 admissions across the IT-sensitive conditions examined. However, they find no relationship between IT and the quality of care for the average patients, or any relationship between health IT and either readmissions or length of stay at hospitals.

--Jay Fitzgerald

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