Efforts by the healthcare community. Resolution of the apparent HIT productivity paradox will require more than the isolated efforts of healthcare providers, calling for a community effort. To this end, we suggest a stronger leadership role for HIE-facilitating entities, including regional health information organizations (RHIOs). As the ONC acknowledges, RHIOs are central to data exchange across healthcare institutions. 30 Given the challenges in the healthcare industry, we propose that RHIOs should be more than mere data clearinghouses but formalized institutions that significantly improve HIT use, especially in two major roles:

Encourage learning and adaptation mechanisms in HIT practices. As with many enterprise IT systems, HIT platforms are frequently complex and rigid, requiring significant resources and enterprise-level effort to implement effectively. For such complex projects to yield tangible results, it takes time for users to adapt to new routines and practices, patients to get accustomed to new processes and functionality, and in-house IT staff to discern what system modifications would make the new system better fit with local needs. RHIOs can serve as a platform through which different parties can share resources, help others learn, and contribute back to the broader community. In addition to creating a mechanism for the development and exchange of a shared knowledgebase, these organizations represent a bridge between different types of hospitals: large/small, public/private, urban/rural. Managers can consider practices proposed in RHIO-based discourses to foster learning and adaptation in HIT adoption (such as using collaborative teams to explore HIT functionalities, rewards to enforce positive behaviors, and centers of excellence around HIT best practices).

Put users at the center of the HIT ex-
perience. Commonly found in our in-
terviews and in the HIT literature is
the concern that HIT policies have
pushed healthcare providers toward a
techno-centric perspective in which
HIT is pursued “for IT’s sake” and HIT
systems are designed without sub-
stantive input from prospective us-
ers. 10 It is critical not to lose sight of the
most important HIT stakeholders—
While each of the proposed mech-
anisms for paradoxical outcomes has
some applicability in the healthcare
context, the rich vein of research that
grew out of the productivity paradox
also offers some critical caveats for
assessing the practical effect of IT
investment and use. 12, 13, 28 First, sig-
nificant variation exists across firms
and industries with respect to the ef-
fect of IT investment on organization
performance. 9 Second, this varia-
tion and the existence of temporal
lags are tied to the fact that perfor-
mance gains are often associated not
merely with the adoption of new IT
resources but with the concomitant
redesign of business processes and
investment in complementary assets
and skills. 6, 28 Finally, the healthcare
literature reveals that measures of
productivity or business value remain
ambiguous and highly contingent on
firm or industry conditions. Apply-
ing these lessons in the context of
HIT, the evidence points to the need
for more research to understand the
complex nature of the healthcare in-
dustry and its business processes,
along with interdependence among
healthcare stakeholders in HIT devel-
opment, adoption, and use.

Beyond the Paradox

Based on our analyses of the effects of clinical HIT adoption, we find that a number of viable mechanisms are available for achieving enhanced health outcomes as a result of expanded HIT use, moving from meaningful use to meaningful results. The U.S. healthcare sector is an interdependent system. Leveraging and extending past insights from research on the productivity paradox and IT business value in general, we find it would benefit from a collective approach that brings together such diverse entities as hospitals, insurance companies, regulators, and HIT vendors to seek systemic improvements.

We found no
evidence of a
relationship
between HIT use
and such critical
health outcomes
as improved
interpersonal
care, customer
satisfaction,
customer loyalty,
patient mortality,
and reduced ER
waiting times.