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.