Many family physicians and other health care professionals and organizations have heartily embraced health information technology in recent years. The increased interest in implementation of electronic health records (EHRs) is due, at least to some extent, to federal incentive dollars paid to health care professionals who can prove meaningful use of their EHRs.
As the number of users has grown, so too has the body of research on health IT, a situation that prompted the Office of the National Coordinator (ONC) for Health IT to fund research for a "systematic update" of existing literature on the topic.
Specifically, reviewers were charged with updating previous literature reviews and combing through recent evidence to see how well EHR functionalities, as called for in meaningful use regulations, relate to the quality, safety and efficiency of health care provided to patients.
The ONC health IT review was published in the January Annals of Internal Medicine in an article titled "Health Information Technology: An Updated Systematic Review With a Focus on Meaningful Use."(annals.org)
- The Office of the National Coordinator for Health Information Technology funded research to provide a "systematic update" of existing literature on health IT.
- Reviewers discovered an overabundance of studies focused on clinical decision support and computerized provider order entry to the detriment of other topics.
- Authors suggested that future research focus on how health IT can be used to realize value in health care.
Literature Review Findings
Two independent reviewers extracted data from 236 studies published between January 2010 and August 2013. Reviewers found that the number of published health IT evaluation studies rose by about 13 percent per year before 2007 and by roughly 25 percent each year from 2008 to 2012. They also discovered that a limited number of topic areas garnered most of the research attention.
"The summary data show that CDS (clinical decision support) and CPOE (computerized provider order entry) have been studied extensively, and other functionalities, such as health information exchange and functionalities that allow patients to access their own electronic records, are not as well-studied," wrote the authors.
Furthermore, wrote the authors, "Evaluations of the effect of health IT on health care quality predominate and make up more than one-half of all studies included in all four systematic reviews." Specifically, a summary of two health IT evaluation studies done between 2007 and 2013 showed that 142 studies focused on CDS and 91 centered on CPOE; a majority of those studies reported positive results.
During the same time period, reviewers found far fewer studies focused on other EHR functions important to patient care. For example,
- health information exchange was the focus of 33 studies,
- patient lists by condition (30 studies),
- electronic prescribing (25 studies),
- patient access to EHRs (20 studies) and
- patient care reminders (10 studies).
Furthermore, only 11 evaluation studies were performed on other meaningful use functionalities, such as patient education, medication lists, problem lists, lab test results and immunization registries.
Although the researchers noted that there were fewer of these types of studies and the studies that were done often found mixed results, the studies "reported positive findings more often than not."
However, the lack of extensive study in so many categories clearly concerned the reviewers.
"Although the health IT evaluation literature base is expanding rapidly, we are concerned that there has not been a commensurate increase in our understanding of the effect of health IT or how it can be used to improve health and health care," they wrote.
Furthermore, "Study questions, research methods and reporting of study details have not sufficiently adapted to meet the needs of clinicians, health care administrators, and health policymakers and are falling short of addressing the future needs of the health care system."
Authors also drew some broad conclusions regarding results of studies on clinical decision support. "We conclude that CDS generally results in improvements in the processes targeted by the decision support," they said.
Ditto for results of evaluations and systematic reviews completed on CPOE EHR functions. "We can conclude that CPOE effectively decreases medication errors," said the authors. They encouraged physicians and other health care professionals to adopt CDS and CPOE systems.
Contemplating Future Research
The reviewers agreed that some changes were necessary moving forward. "The health IT literature is expanding rapidly but failing to produce a commensurate amount of useful knowledge," said the authors.
They discouraged further single-site studies focused on CDS and CPOE entry that produce basic information. Rather, "The most important improvement that can be made in health IT evaluations is increased measurement of and reporting of context, implementation and context-sensitivity of effectiveness," they concluded.