Experts consider health information technology key to improving efficiency and quality
of health care.
To systematically review evidence on the effect of health information technology on
quality, efficiency, and costs of health care.
The authors systematically searched the English-language literature indexed in MEDLINE
(1995 to January 2004), the Cochrane Central Register of Controlled Trials, the Cochrane
Database of Abstracts of Reviews of Effects, and the Periodical Abstracts Database.
We also added studies identified by experts up to April 2005.
Descriptive and comparative studies and systematic reviews of health information technology.
Two reviewers independently extracted information on system capabilities, design,
effects on quality, system acquisition, implementation context, and costs.
257 studies met the inclusion criteria. Most studies addressed decision support systems
or electronic health records. Approximately 25% of the studies were from 4 academic
institutions that implemented internally developed systems; only 9 studies evaluated
multifunctional, commercially developed systems. Three major benefits on quality were
demonstrated: increased adherence to guideline-based care, enhanced surveillance and
monitoring, and decreased medication errors. The primary domain of improvement was
preventive health. The major efficiency benefit shown was decreased utilization of
care. Data on another efficiency measure, time utilization, were mixed. Empirical
cost data were limited.
Available quantitative research was limited and was done by a small number of institutions.
Systems were heterogeneous and sometimes incompletely described. Available financial
and contextual data were limited.
Four benchmark institutions have demonstrated the efficacy of health information technologies
in improving quality and efficiency. Whether and how other institutions can achieve
similar benefits, and at what costs, are unclear.