Friday, January 24, 2014

This Is A Very Useful Update On What Works (Or Not) With E-Health. Must Read Material.

This popped up a little while ago:

Health Information Technology: An Updated Systematic Review With a Focus on Meaningful Use

Spencer S. Jones, PhD; Robert S. Rudin, PhD; Tanja Perry, BHM; and Paul G. Shekelle, MD, PhD


Background: Incentives offered by the U.S. government have spurred marked increases in use of health information technology (IT).
Purpose: To update previous reviews and examine recent evidence that relates health IT functionalities prescribed in meaningful use regulations to key aspects of health care.
Data Sources: English-language articles in PubMed from January 2010 to August 2013.
Study Selection: 236 studies, including pre–post and time-series designs and clinical trials that related the use of health IT to quality, safety, or efficiency.
Data Extraction: Two independent reviewers extracted data on functionality, study outcomes, and context.
Data Synthesis: Fifty-seven percent of the 236 studies evaluated clinical decision support and computerized provider order entry, whereas other meaningful use functionalities were rarely evaluated. Fifty-six percent of studies reported uniformly positive results, and an additional 21% reported mixed-positive effects. Reporting of context and implementation details was poor, and 61% of studies did not report any contextual details beyond basic information.
Limitation: Potential for publication bias, and evaluated health IT systems and outcomes were heterogeneous and incompletely described.
Conclusion: Strong evidence supports the use of clinical decision support and computerized provider order entry. However, insufficient reporting of implementation and context of use makes it impossible to determine why some health IT implementations are successful and others are not. The most important improvement that can be made in health IT evaluations is increased reporting of the effects of implementation and context.
Primary Funding Source: Office of the National Coordinator.
The full free text is available from here:
These two paragraphs summarise where we would seem to be with the bold making it clear there is much more to do!
“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. 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.
Nevertheless, some broad conclusions can be drawn. Most studies of CDS report positive or mixed-positive results, and existing systematic reviews of specific CDS systems are mostly positive with respect to changes in processes of care (2833). We conclude that CDS generally results in improvements in the processes targeted by the decision support. If neutral or negative results are reported in new studies of CDS, these results are more likely to be because of specifics of the particular intervention, context, or implementation than an indication that the general construct of computerized decision support is not a beneficial IT functionality for improving health care quality. The same is true for CPOE: Most evaluations have reported positive or mixed-positive effects, and most existing systematic reviews likewise conclude that CPOE reduces medication errors (3435). We can conclude that CPOE effectively decreases medication errors. Health care providers should be encouraged to adopt CDS and CPOE, and future studies of CDS and CPOE should concentrate on how to make them work better rather than testing the hypothesis of whether they work at all. In contrast to this, the evidence base on other functionalities, such as patient care reminders or patient specific education, have small numbers of studies, and any new studies add proportionately much more to our existing knowledge, both about the general construct of the functionality plus the potential for context and implementation sensitivity of the effects. The lack of reporting about key elements of context and implementation of health IT was noted in the review by Chaudhry and colleagues, and despite calls then and more recently for better reporting on context and implementation—and even suggestions for specific items to report on (3637)—we still find that crucial elements of context and implementation are missing from most published health IT studies.”
Well worth a read.

1 comment:

Bernard Robertson-Dunn said...

re: "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."

That's because IT does not, of itself, achieve anything. It's the applications and data that support the processes and information that assist health professionals.

As long as people only think in terms of health IT, they will not achieve anything significant.

Health Information Systems can enable a better way of working - and it's that better way of working will deliver better health outcomes.

On the one hand you have health professionals who:

1. are suspicious of change - after all they can do serious harm if they get things wrong.


2. don't think in terms of new processes and information - after all, they have no training in these areas.

On the other hand you have IT (and health IT) specialists who

1. only understand technology solutions


2. who don't understand how to come up with new processes and information - after all, they have no training in these areas.

And on the third hand you have policy makers who don't understand either, and who think that you can throw money at consultants and technology vendors who will, magically, make it all happen. That way lies madness.

Have a happy Australia Day long weekend.