Health Information Technology and its Impact on Health Services Use and Quality Open Access

Bae, Jaeyong (2014)

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Health information technology, including electronic health records, has the potential to improve healthcare quality and outcomes by innovating healthcare delivery processes. This dissertation is comprised of three essays investigating the impact of Electronic Health Records (EHRs) on health services utilization and quality of healthcare both in ambulatory and hospital care settings. The first essay examines the impact of eight EHR components that map four core EHR functionalities on the frequency of health behavior counseling provided during primary care visits. This essay finds that two functionalities, order entry and health information and data, were independently associated with increases in the probability of health behavior counseling service delivery. On the other hand, decision support and results management were associated with decreases in the provision of health behavior counseling services when these components were used alone. However, using these two functionalities with relevant complementary components increases health counseling services. The second essay examines differential impacts of EHRs on hospital-acquired adverse patient safety events depending on intra-operability of an EHR system and the degree of physician resistance. The main conclusion of this essay is that a single source EHR system is associated with a reduction in patient safety events. The third essay examines whether EHRs enhance adherence to 3 core Surgical Care Improvement Project (SCIP) infection-prevention process of care measures and reduce postoperative infections. The results show that hospitals with basic EHRs are more likely to adhere to SCIP infection-prevention measures, and an increase in adherence rates of one of the 3 core SCIP measures, timely start of antibiotics, are associated with lower postoperative infection rates. However, the results finds no significant mediation effect of SCIP process of care measures on the association between EHRs and postoperative infections, and no significant EHR effects on postoperative infections.

Table of Contents

Chapter 1: Introduction 1.1 Background 2 1.2 Definitions 5 1.2.1 Electronic Health Record 5 1.2.2 Inter-operability and Intra-operability of Health Information System 5 1.2.3 Health Information Technology for Economic and Clinical Health Act 5 1.2.4 Patient Safety 5 1.3 Key Functionalities of an EHR System 6 1.4 Conceptual Framework 8 1.5 Aim and Scope 10 1.6 References 11 Chapter 2: Impact of Electronic Health Records on Delivery of Health Behavior Counseling Services: The Role of Complementary Functionalities 2.1 Background 16 2.2 Conceptual Framework 18 2.3 Literature Review 20 2.4 Methods 2.4.1 Data 22 2.4.2 Health Behavior Counseling Services 23 2.4.3 EHR Adoption 23 2.4.4 Statistical Models 24 2.4.5 Confounding of EHR Adoption and Health Behavior Counseling Services 25 2.5 Results 2.5.1 Descriptive Statistics 26 2.5.2 Propsensity Score Matching 27 2.5.3 Adjusted EHR Impact on Health Behavior Counseling Services 28 2.5.4 Sensitivity Analyses 29 2.6 Discussion 30 2.7 Conclusion 34 2.8 References 34 Chapter 3: The Impact of Electronic Health Records on Hospital-Acquired Adverse Safety Events: Do Intra-operability and Physician Support Matter? 3.1 Introduction 62 3.2 Background 3.2.1 Barriers to EHR Use 63 3.2.2 EHR Use and Patient Safety 64 3.3 Theoretical Framework 65 3.4 Literature 67 3.4.1 Compatibility of EHR System and Staff Support 67 3.4.2 EHRs and Patient Safety 68 3.4.3 Contrubution of This Study 72 3.5 Methods 3.5.1 Data 73 3.5.2 Hospital-Acquired Adverse Patient Safety Events 74 3.5.3 Key Explanatory Variables 74 3.5.3 Empirical Models 75 3.6 Results 77 3.6 Discussion and Conclusion 79 3.7 References 82 Chapter 4: The Impact of Electronic Health Records on Adherence to Infection-Prevention Process of Care Measures and Surgical Infections 4.1 Background 100 4.2 Conceptual Framework 101 4.3 Literature Review 104 4.4 Methods 4.4.1 Data 106 4.4.2 Postoperative Infections 107 4.4.3 Core Surgical Care Improvement Project (SCIP) Measures 108 4.4.4 Basic EHR Use 108 4.4.5 Empirical Models 108 4.5 Results 108 4.6 Discussion and Conclusion 110 4.7 References 112 Chapter 5: Conclusion 5.1 Summary of Principal Findings 125 5.1 Implication of Findings 126

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