Communications of the ACM

are generated have an awful lot of
words but communicate very little.”
— Physician, Family Practice
“The highlighted efficiency from
reducing duplicate lab tests and cut-
ting costs is just not there yet. I am not
really sure that an EHR will provide
the savings that are talked about.”
— Physician, Internal Medicine
“I have charting at home. I ended up
having to get a laptop through my work
budget to bring home so that I wasn’t
sitting at the office until ... I would
see my last person around 4: 20, and I
would be there until 6: 30 doing chart-
ing because of being slow with the
system and be more attentive to the
patient than I was to the computer.”
— Nurse Practitioner
In summary, our mixed-methods
analyses suggest strong evidence of
increased adoption and use of EHR
While the majority of New York hos-
pitals have implemented and used EHR
and HIEs in their practice, the evidence
is inconclusive with respect to how
these initiatives have affected quality of
care and broad health outcomes across
the state. We found no evidence of a re-
lationship between HIT use and such
critical health outcomes as improved
interpersonal care, customer satisfac-
tion, customer loyalty, patient mortal-
ity, and reduced ER waiting times (see
Figure 3). These results are in line with
previous studies suggesting unclear
evidence of HIT effects. 15

While HIE participation and EHR use levels reveal no significant relationships with most outcome measures, we were surprised to find EHR use also does have a significant adverse relationship with patient readmission rates and complication rates. To further explore this counterintuitive result, we looked at the social-capital index in each county where the hospitals operate. The social-capital index27 reflects the socioeconomic growth of a community.f The post-analyses suggest areas with low social capital often see higher readmission rates and complication rates. This low score is due to such factors as rural market, low social support, and low educational rate. One possible explanation for our counterintuitive finding is that hospitals in areas with low social capital encounter inherent difficulties that in turn increase patient readmission and complication rates regardless of their use of HIT. We encourage future research into this relationship.

Augmenting our quantitative
analysis, our conversations with
healthcare providers suggest mixed
feelings and skepticism toward the
expected values of HIT. In particu-
lar, many clinicians were concerned
that HIT initiatives were too often
not motivated by patient-oriented
objectives and might undermine
f The social capital index was developed by
the Northeast Regional Center for Rural
Development ( http://aese.psu.edu/nercrd)
and uses an array of individual and commu-
nity factors to measure the socioeconomic
growth of a community.
rather than enhance the quality of
care providers render. Prominent
concerns include the perception
that HIT adoption results in extra
workload, ineffective communica-
tion, poor information quality, and
ineffectiveness addressing opera-
tional needs. The following illustra-
tive statements highlight the con-
cerns shared by our respondents:
“This whole business about elec-
tronic medical records helping with
communication I think is a total falla-
cy. I think it really hinders communica-
tion, unless you freehand-type or you
dictate, which defeats the main pur-
pose of electronic medical records.”
— Physician, Pediatrics
“I hear complaints from patients say-
ing, ‘They’re looking at the computer
and not at me.’” — Physician, Pediatrics

“This is my issue with all electronic medical records: The notes that

Explaining the IT productivity paradox in HIT contexts.

Causes Description

HI T mismeasurement Most HI T measures focus on efficiency rather than effectiveness. Recent efforts like “meaningful use” level 2 are useful but far from satisfactory.

Delay delivering HIT benefits HITs are complex systems that require an average of two
to four years to deliver significant benefits to healthcare
providers.
Redistribution of HIT benefits HIT gains are offset by unintended consequences in health-
care processes and procedures, including extra work and
lack of human-doctor interaction.