Health Information Technology

An Updated Systematic Review with a Focus on Meaningful Use

Published in: Annals of Internal Medicine, v. 160, no. 1, Jan. 2014, p. 48-54

by Spencer S. Jones, Robert S. Rudin, Tanja Perry, Paul G. Shekelle

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Research Question

  1. How do health IT functionalities as prescribed in meaningful use regulations affect quality, safety, and efficiency?

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.

Key Finding

It is impossible to know why some health IT implementations are successful but others are not, because evaluations do not focus adequately on contextual and implementation factors.

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