Health Information Technology in Ambulatory Care Settings: Effects on Quality and Disparities

There is currently a research gap on the effects of health information technology (IT) on healthcare quality and disparities in the ambulatory care setting. Previous research has focused on the inpatient hospital setting, though most healthcare services are provided in the ambulatory setting, overlooking an area of large potential cost savings from hospitalization preventions.

The goal of this project was to use existing data to study the effects of electronic medical records (EMRs), picture archiving, and practice management systems on healthcare quality and racial disparities in the ambulatory care setting. The results may inform policymaking in the area of health IT, where Federal resources are being devoted to promoting adoption to reduce costs and improve quality.

The specific aims of the project were as follows:

• Develop a national panel database that measures the degree of ambulatory health IT in local areas. 
• Combine the data on ambulatory IT with local-area panel measures of ambulatory care quality and controls for population and healthcare factors. 
• Estimate the effects of health IT on the quality of ambulatory care. 
• Estimate differential effects of health IT on different racial and ethnic sub-populations. 

Researchers constructed measures of county-level ambulatory care quality and county-level health IT adoption using data from Medicare, the Nationwide Inpatient Sample, and the Healthcare Information and Management Systems Society (HIMSS) Analytics Database. The study team explored associations between the IT measures and ambulatory care quality as measured by local rates of hospitalizations, and also analyzed gender, age, racial, and ethnic disparities.

Study outcomes indicated that greater adoption of county-level ambulatory health IT, including EMRs, picture archiving, and practice management, significantly lowered rates of Medicare hospitalizations of conditions that may be prevented by vaccines or effective healthcare management, suggesting improved quality of care. Outcomes also indicated that the largest gains from ambulatory IT adoption, in the form of fewer hospital admissions, were for patients over the age of 65. Younger patients also had a lower admission rate with greater health IT adoption, though the results were not statistically significant. Finally, the study did not find any consistent differential effects of ambulatory IT with regard to sex, race, or ethnicity demographic groups. The measures and models developed in this study may be applied by other researchers for future large-scale evaluations of IT implementation in ambulatory settings.