Research Builds Case for Hospital IT Adoption To Boost Safety

by Kate Ackerman, iHealthBeat Associate Editor

Despite mounting evidence that IT can help boost patient safety, many hospitals have been reluctant to invest in technology like electronic health records and computerized physician order entry systems.

Only about 11% of hospitals that responded to an American Hospital Association survey released in February reported having a fully implemented EHR system. This reluctance is likely tied to financial, cultural and workflow barriers. In addition, there are several well-publicized instances in which IT actually added to problems at hospitals -- information that clearly supports hospital officials' resistance.

Experts believe that as the volume of research supporting the benefits of health IT increases and as the results of those studies are able to be generalized to hospitals nationwide, health care leaders' resistance to investing in IT will dwindle.

Jon White, director of Health IT at the Agency for Healthcare Research and Quality, said, "There is a good amount [of research] under our belt, but we also have a good amount more to go." He added that as research continues, "providers -- at least those [who] understand the literature and the evidence -- will kind of say you know, 'I deliver better care when I use these tools in this way; therefore, I have kind of a moral responsibility to do that.'"

Mounting Evidence

A study in the current issue of the Journal of Healthcare Management builds on existing research on IT and patient safety at hospitals.

"The evidence that IT when properly implemented can yield positive organizational benefits is beginning to be well known," but most studies on the topic "are conducted in very limited settings -- academic medical centers or other specialized institutions where information generated there may not necessarily translate to the average community hospital," Nir Menachemi, author of the study and associate professor at Florida State University's College of Medicine, said. He added, "So trying to begin filling in more pieces of the puzzle in terms of how IT affects care, we looked at this project so that the information could be generalized to the typical hospital."

The study, called "Hospital Adoption of Information Technologies and Improved Patient Safety," examined the relationship between IT adoption and AHRQ's patient safety indicators at 98 hospitals in Florida. The study found that eight patient safety indicators were related to at least one measure of IT adoption -- a finding the study's authors say hospital leaders should consider when making decisions about IT adoption.

Menachemi noted that "the more mature a given hospital's IT infrastructure is, the more benefit we saw. But simple things like just having some administrative IT applications in place ... still had a benefit because those types of systems just increase general communication ... and make things more efficient, and that ultimately does translate into better care."

While the study only looked at hospitals in Florida, Menachemi said, "I do believe that if we did this nationally, we'd get very similar results."

"Healthy Dose of Skepticism"

White, a former family physician, said that while he is "a true believer" and knows that "health IT can improve health care," he thinks "as a country we ought to have a healthy dose of skepticism about health IT."

"It's really not as simple as just buying a system and you know flipping the on switch," White said, adding, "Health IT, like a lot of medical interventions, is a fairly complex tool."

He recounted that during an AHRQ project, someone explained that "health IT implementation is one part technology and two parts culture and two parts workflow." White said that statement "just reflects that the technology is important, but if it's not integrated into the system and if you don't take health IT implementation as an opportunity to examine your health care system and how you deliver health care, then that's a lost opportunity."

For example, a study published in the December 2005 issue of the journal Pediatrics found that patient mortality unexpectedly increased after the implementation of a computerized physician order entry system at Children's Hospital of Pittsburgh.

Meanwhile, Los Angeles' Cedars-Sinai Medical Center halted use of its CPOE system in January 2003 after 400 physicians complained that it was difficult, time-consuming and posed risks to patient safety.

In both of these examples, "there were warning signs before the IT came around," White said, explaining, "There were inter-staff tensions, there were flaws in the communication channels and the handoffs that happened in both those places. And frankly, at Cedars-Sinai, they didn't get the buy-in from the folks who are going to be using the system beforehand."

"Just assuming that 'Oh, we implemented such and such system so we should be fine' is definitely the wrong attitude," Menachemi said, adding, "IT is not a magic bullet that just improves safety and care automatically, it's really just another tool in the arsenal."

White noted that "any time you do any sort of an intervention, you'll have unintended consequences," but there are ways to ensure that IT does not exacerbate any problems.

He said the key to avoiding mistakes similar to those made at Children's Hospital of Pittsburgh and Cedar-Sinai is to take a "thoughtful and holistic approach" to IT implementation.

Rather than focusing on whether the system has been turned on and is functioning, hospital officials need to ask themselves, "Are people using it? Are the things happening that we want to happen as a result in this health care system?" White said.

He added that AHRQ is conducting research not only on the benefits of health IT, but also on the barriers. That research, along with lessons learned from early adopters, will help alleviate some of the risk involved in hospital IT adoption.

The IT Factor in Hospital Selection

With CMS' Hospital Compare Web site, state hospital comparison sites and other online resources, consumers have a plethora of information available to them when it comes to choosing a hospital.

Could IT be a deciding factor when it comes to selecting a hospital?

As consumers become more aware of research pointing to the benefits of health IT, they might become a driving force in hospitals' IT adoption.

White said that assuming it's not an emergency, "well-implemented IT is something consumers should look at when they're choosing a hospital." He added, "I certainly would look at it for my family."

Menachemi said health IT "should certainly be something that they're aware about and interested in, but frankly, I think most patients are under the impression that physicians and hospitals are farther along on IT adoption than they really are." He added that because consumers perform many activities online, like banking and purchasing airline tickets, they "think we're farther along in health care than we are, and some of them may be shocked to find out that we're not."

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