Chaudhry B et al. 2006 "Systematic review: impact of health information technology on quality, efficiency, and costs of medical care."

Reference
Chaudhry B, Wang J, Wu SY, et al. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Ann Intern Med 2006;144(10):742-752.
Abstract
"Background: Experts consider health information technology key to improving efficiency and quality of health care.
Purpose: To systematically review evidence on the effect of health information technology on quality, efficiency, and costs of health care.
Data Sources: 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.
Study Selection: Descriptive and comparative studies and systematic reviews of health information technology.
Data Extraction: Two reviewers independently extracted information on system capabilities, design, effects on quality, system acquisition, implementation context, and costs.
Data Synthesis: 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.
Limitations: 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.
Conclusions: 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."
Objective
"To systematically review evidence on the effect of health information technology on quality, efficiency, and costs of health care."
Size
not applicable
Type of Health IT
Decision support system
Computerized provider order entry (CPOE)
Electronic health records (EHR)
Type of Health IT Functions
The functions varied across the articles reviewed.
Workflow-Related Findings
Decision support, usually in the form of computerized reminders, had a "role in increasing adherence to guideline or protocol-based care."
Another "theme showed the capacity of health information technology to improve quality of care through clinical monitoring based on large-scale screening and aggregation of data. These studies demonstrated how health information technology can support new ways of delivering care that are not feasible with paper-based information management."
"Ten studies examined the effect of health information technology systems on utilization of care," such as diagnostic testing, and most found decreased rates of test ordering. The primary technology in these studies was point-of-care decision support.
"The effect of health information technology on provider time was mixed." Some studies showed providers spending more time by using information technology; others showed decreases in the time required for tasks.
Study Design
Systematic literature review
Study Participants
Two English-language searches were conducted in MEDLINE. The authors also searched the Cochrane Central Register of Controlled Trials, the Cochrane Database of Abstracts of Reviews of Effects, and the Periodical Abstracts Database, "hand-searched personal libraries kept by content experts and project staff; and mined bibliographies of articles and systematic reviews for citations." They "asked content experts to identify unpublished literature. Finally, [they] asked content experts and peer reviewers to identify newly published articles up to April 2005." A total of 257 articles were selected, but this review focuses on 74 articles that were "conducted in the United States, that had empirically measured data on multifunctional systems, and that included health information and data storage in the form of electronic documentation or order-entry capabilities. Predictive analyses were excluded."