lingering questions about potential
mismeasurement in assessing the
long-term impact of HIT. As we have
noted in reference to the observed adverse effect of EHR use on patient readmission and complication rates in
the New York State context, a range of
factors (such as urban/rural setting,
social capital within a region, and
academic vs. non-academic hospital
adoption) can influence the contribution of HIT use on health outcomes.
Clarifying the most relevant factors
would thus aid the healthcare field
in untangling the causal dynamics around HIT adoption and use.
In addition, another important improvement regarding HIT evaluation
would be increased use of evidence-based and clinical HIT research. 24
Using rich data generated through
clinical HIT systems, future studies
could examine how HIT as “
infor-matic intervention” can significantly
improve patients’ health outcomes.
Other initiatives (such as the Precision Medicine Initiative launched in
2016 by the U.S. National Institutes of
Health) also underscore the need for
more evidence-based HIT research in
the future.g
Learn how to realize value from HIT.
Early studies of HIT adoption and
use focused largely on determining
whether a particular HIT functional-
ity created value and to what extent.
With increasing adoption of EHRs
and other forms of HIT, it is no lon-
ger sufficient for researchers to ask
whether HIT creates value in terms
of health outcomes. 16 As researchers,
we need to help healthcare provid-
ers and policymakers learn how to
realize value from HIT. That is, while
HIT is being adopted, researchers
should focus on exploring the causal
mechanisms underlying its use to
deliver health value to patients. Such
theory-building research could help
clarify the antecedents of the produc-
tive application of HIT resources. In
particular, such research could le-
verage recent research shifting from
consideration of simple IT use to ef-
g The Precision Medicine Initiative was
launched in 2016 by the U.S. National In-
stitutes of Health as a national, large-scale
research participation group for the testing
and study of evidence-based interventions;
https://allofus.nih.gov/
the patients whose wellness is directly
affected by HIT use and the healthcare
providers who guide the patients
through the treatment process. Health-
care providers thus need to encourage
both policymakers and technology de-
velopers to emphasize inclusion of pa-
tients and healthcare providers in the
design processes of HIT systems. To en-
able a coherent and seamless experi-
ences across HIT systems, RHIOs can
act as a forum for users’ experiences to
be heard, providers’ suggestions to be
noted, and community members’ opin-
ions to be constructively formed. Such
a collaborative approach is essential to
HIT success, because, despite the exis-
tence of competitive forces among
healthcare providers, patient wellness
should be regarded as the ultimate
goal for all parties.
Academic research. Although the
literature on HIT evaluation is expanding rapidly, there has not been
a parallel increase in academic understanding of how HIT contributes
to patient outcomes or how it can be
used to improve health and healthcare. The related research should be
adapted to meet the needs of clinicians, healthcare administrators,
and health policymakers. We thus
suggest the following actions for academic researchers:
Develop enhanced measurements
for clinical HIT impact. As noted,
the healthcare system today lacks
adequate outcome-oriented measurements of the efficiency and effectiveness of HIT. For example, the
U.S. Department of Health and Human Services released final criteria
of “meaningful use” in 2010, aiming
to improve quality and efficiency of
care by encouraging clinicians and
hospitals to use EHRs. However, as
of 2017, the existing measurement
of “meaningful use” focused exclusively on input metrics. Accordingly,
researchers are well positioned to
develop appropriate means of outcome measurement to connect HIT
investment with productivity and
clinical relevance. One important improvement that can be made in HIT
evaluation is increased measurement
of context, implementation, and
context-sensitivity of effectiveness. 18
Exploring contextual and/or organizational factors would help address
Many clinicians
were concerned
that HIT initiatives
were too often
not motivated by
patient-oriented
objectives and
might undermine
rather than enhance
the quality of care
providers render.
