Researchers at the Center for Health Information and Decision Systems (CHIDS) are delving into the importance of information technology (IT) in health care, and just how new IT can be successfully implemented. Two recent studies examine these areas.
IT and Quality Disclosures
Quality is something consumers are very concerned about when it comes to health care. But they are often at a loss when it comes to comparing quality among hospitals and doctors because of a lack of information. Information technology can change that, according to Ritu Agarwal and Guodon “Gordon” Gao of CHIDS. Their research (conducted with Corey Angst, Smith PhD now at the University of Notre Dame) is the first to demonstrate the value of IT in the domain of quality reporting. They found that hospitals with better IT infrastructure are more likely to disclose quality information.
“Consumers need quality information to make wise choices,” said Gao, associate professor and CHIDS co-director. “Unfortunately in health care, it’s very hard to get that information. In recent years, there has been an increasing emphasis from government and practitioners to improve the transparency of quality of providers.”
Making that quality information available to consumers and easily digestible is a big part of the recently enacted Affordable Care Act, said Agarwal, CHIDS founder and director and professor and dean’s chair of information systems. The researchers’ findings provide support for the federal subsidies for health IT adoption in the HITECH Act of 2009.
The researchers looked at voluntary hospital disclosures, which are often run by associations or nonprofits and are more comprehensive and up-to-date than mandatory disclosures.
“In health care, there are some laws that require disclosure, but overall the general culture has not been towards collecting a lot of information to be able to report on quality,” says Agarwal. "One of the key takeaways from this research is that IT can play a pivotal role in reducing the costs for collecting, distributing and sharing information for hospitals.”
Hospitals want to disclose their quality information to stay competitive in the marketplace, and having good IT systems in place makes it much easier and cheaper for them to collect the necessary data. As everything moves to digital records, it should be much easier to push for quality transparency, says Gao. And as hospitals reveal more about their quality and can do so at a lower cost, they should be able to improve performance and increase competition to attract more patients.
“Information technology and voluntary quality disclosure by hospitals,” is accepted for publication in the journal Decision Support Systems.
Routinize Health IT
In a second study, Agarwal and Gao researched how to successfully introduce technology in the complex health care setting, where doctors have long followed set routines in the way they practice medicine – in some cases, for centuries. The researchers’ goal was to figure out how doctors can successfully incorporate new technology into their work routines. This study has important applications for the management of IT in health care.
“This was really the first study to take an in-depth look at how clinical routines are affected by technology and what to do to overcome the barriers and challenges to make the adoption successful,” Agarwal said.
Smith School doctoral student Jie Mein Goh (now faculty at IE Business School in Spain) spent a year shadowing doctors at a hospital before and after new technology was introduced. She followed doctors on their daily rounds to observe their routines firsthand.
“We are trying to open the black box of IT adaptation in health care,” says Gao. “Many times when you introduce new technology – especially IT – into a hospital setting, there is strong resistance from physicians because they feel they already have their way of conducting their work and they don’t like to be disrupted. This often results in a lot of resistance and even abandonments of health IT initiatives.”
The researchers found that how a new IT initiative is framed to doctors plays a big role in determining successful implementation. For example, doctors might shun new IT if they feel it didn’t deliver on promises to improve patient safety and hospital efficiency. Agarwal and Gao suggest hospital administrators should carefully develop messaging and framing around new IT to help physicians successfully incorporate it into their routines. The study also finds the importance of modifying and customizing IT to meet the specific needs of a hospital and its doctors in order for it become part of the daily routine.
“Work routines and technology must be allowed to change in response to each other in an iterative fashion until the technology and the routine become inseparable and integral,” says Agarwal. “This aspect of health IT implementation has largely been overlooked.”
“Evolving Work Routines: Adaptive Routinization of Information Technology in Healthcare,” was published in Information Systems Research in September 2011.
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