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“True genius resides in the capacity for evaluation of uncertain, hazardous, and conflicting information.”

-Winston Churchill

OBJECTIVES

  • Discuss challenges in conducting outcome evaluations for healthcare IT.

  • Describe methods to prioritize evaluation projects.

  • Discuss the importance of developing a research question.

  • Identify appropriate data types for various types of evaluation studies.

  • Understand components of a quality publication for an outcome evaluation study.

INTRODUCTION

Clinical information systems are a major investment for healthcare organizations, not just in terms of dollars but human resources as well. Millions of dollars are being spent on electronic health records (EHRs), and the U.S. federal government is contributing billions to advance the adoption of healthcare technology. With more than 80% of U.S. hospitals and 72% of U.S. office-based physicians now using at least a basic EHR, the need to address some fundamental questions becomes essential (ONC, 2013):

  • Are EHRs improving patient care and reducing healthcare costs?

  • Are EHRs reducing duplication of services?

  • Are EHRs reducing time spent documenting patient care?

  • Are EHRs reducing medication errors and improving the safety of care delivery?

These questions and others are becoming more and more important to answer. Many organizations are looking to their informatics specialists to help lead the way and provide the expertise in determining the outcomes of their major investment. One might think that organizations have invested significant time and resources to answer these questions throughout their EHR implementation journey, yet that is not currently the case. Relatively few healthcare organizations have developed formal health information technology (IT) outcome evaluation programs.

Although the literature is growing and evolving in the area of healthcare IT outcomes research, these studies are typically conducted in academic medical centers with ample resources, money, and the right skill sets. With EHRs representing a significant portion of an organization's bottom line, it is surprising that formal evaluation programs are not more prominent. This chapter will provide guidelines and the steps that your organization can use to develop and carry out healthcare IT outcome evaluations. It includes examples, ideas, and tools for informatics specialists to use to determine whether their EHR is truly helping.

THE HEALTHCARE IT CLIMATE

The adoption rate for clinical information systems is on the rise, with the primary driver being the Centers for Medicare and Medicaid Services (CMS) Meaningful Use incentive program through the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009. The pace has been fast and furious to implement these systems and capture the incentive dollars. Now that they are in place, it is time to determine their effectiveness.

For an explanation of Meaningful Use, see Chapter 1.

Taking on the task of improving how healthcare IT systems are evaluated is the next phase of technology adoption in healthcare. Between 2000 and 2010, hospitals and ambulatory ...

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