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Enabling Patient-Centered Care Through Health Information Technology
Evidence Reports/Technology Assessments, No. 206
Investigators: Joseph Finkelstein, MD, PhD, Amy Knight, MD, Spyridon Marinopoulos, MD, MBA, M Christopher Gibbons, MD, MPH, Zackary Berger, MD, PhD, Hanan Aboumatar, MD, Renee F Wilson, MS, Brandyn D Lau, MPH, Ritu Sharma, BS, and Eric B Bass, MD, MPH.
Author Information and AffiliationsStructured Abstract
Objectives:
The main objective of the report is to review the evidence on the impact of health information technology (IT) that supports patient-centered care (PCC) on: health care processes; clinical outcomes; intermediate outcomes (patient or provider satisfaction, health knowledge and behavior, and cost); responsiveness to needs and preferences of patients; shared decisionmaking and patient–clinician communication; and access to information. Additional objectives were to identify barriers and facilitators for using health IT to deliver PCC, and to identify gaps in evidence and information needed by patients, providers, payers, and policymakers.
Data Sources:
MEDLINE®, Embase®, Cochrane Library, Scopus, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, INSPEC, and Compendex databases through July 31, 2010.
Methods:
Paired members of our team reviewed citations to identify randomized controlled trials of PCC-related health IT interventions and studies that addressed barriers and facilitators for health IT for delivery of PCC. Independent assessors rated studies for quality. Paired reviewers abstracted data.
Results:
The search identified 327 eligible articles, including 184 articles on the impact of health IT applications implemented to support PCC and 206 articles addressing barriers or facilitators for such health IT applications. Sixty-three articles addressed both questions. The study results suggested positive effects of PCC-related health IT interventions on health care process outcomes, disease-specific clinical outcomes (for diabetes mellitus, heart disease, cancer, and other health conditions), intermediate outcomes, responsiveness to the needs and preferences of patients, shared decisionmaking, patient-clinician communication, and access to medical information.
Studies reported a number of barriers and facilitators for using health IT applications to enable PCC. Barriers included: lack of usability; problems with access to the health IT application due to older age, low income, education, cognitive impairment, and other factors; low computer literacy in patients and clinicians; insufficient basic formal training in health IT applications; physicians’ concerns about more work; workflow issues; problems related to new system implementation, including concerns about confidentiality of patient information; depersonalization; incompatibility with current health care practices; lack of standardization; and problems with reimbursement. Facilitators for the utilization of health IT included ease of use, perceived usefulness, efficiency of use, availability of support, comfort in use, and site location.
Conclusions:
Despite marked heterogeneity in study characteristics and quality, substantial evidence exists confirming that health IT applications with PCC-related components have a positive effect on health care outcomes.
Contents
- Preface
- Acknowledgments
- Technical Expert Panel
- Peer Reviewers
- Executive Summary
- Introduction
- Methods
- Results
- Results of the Literature Search
- Description of the Types of Studies Retrieved
- Key Question 1a Are health IT applications that address one or more components of PCC effective in improving health care process outcomes, and how do these improvements vary by type of health IT application?
- Key Question 1b Are health IT applications that address one or more components of PCC effective in improving clinical outcomes for patients, and how do these improvements vary by type of health IT application?
- Key Question 1c Are health IT applications that address one or more components of PCC effective in improving intermediate outcomes for patients, and how do these improvements vary by type of health IT application?
- Key Question 1d Are health IT applications that address one or more components of PCC effective in improving responsiveness to the needs and preferences of individual patients, and how do these improvements vary by type of health IT application?
- Key Question 1e Are health IT applications that address one or more components of PCC effective in improving shared decisionmaking between patients, their families, and providers; patient-clinician communication; and access to medical information; and how do these improvements vary by type of health IT application?
- Key Question 2 What are barriers and facilitators that clinicians, developers, patients and their families or caregivers encounter that may impact implementation and use of health IT applications that address patient-centered care, and how do these barriers and facilitators vary by type of health IT application?
- Key Question 3 What knowledge or evidence deficits exist regarding needed information to support estimates of cost, benefit, impact, sustainability, and net value with regard to enabling PCC through health IT?
- Key Question 4 What critical information regarding the impact of health IT applications implemented to enable PCC is needed to give consumers, their families, clinicians, and developers a clear understanding of the value proposition particular to them?
- Discussion
- Process Outcomes
- Clinical Outcomes
- Intermediate Outcomes
- Improved Responsiveness to the Needs, Preferences, and Values of Individual Patients
- Improved Shared Decisionmaking Between Patients, Their Families, and Providers; Patient-Clinician Communication; and Access to Medical Information
- Additional Observations
- Barriers and Facilitators
- Limitations
- Future Research Needs
- Implications and Conclusions
- References
- Appendix A List of Acronyms
- Appendix B Glossary of Terms
- Appendix C Detailed Search Strategies
- Appendix D Summary of Health IT Applications
- Appendix E Screen and Data Abstraction Forms
- Appendix F Excluded Articles
- Appendix G Evidence Tables
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. 290-2007-10061-I, Prepared by: The Johns Hopkins University Evidence-based Practice Center, Baltimore, MD
Suggested citation:
Finkelstein J, Knight A, Marinopoulos S, Gibbons MC, Berger Z, Aboumatar H, Wilson RF, Lau BD, Sharma R, Bass EB. Enabling Patient-Centered Care Through Health Information Technology. Evidence Report/Technology Assessment No. 206. (Prepared by Johns Hopkins University Evidence-based Practice Center under Contract No. 290-2007-10061-I.) AHRQ Publication No. 12-E005-EF. Rockville, MD: Agency for Healthcare Research and Quality; June 2012. www.effectivehealthcare.ahrq.gov/reports/final.cfm.
This report is based on research conducted by the Johns Hopkins University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2007-10061-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
This report may be used, in whole or in part, as the basis for the development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
None of the investigators have an affiliations or financial involvement that conflicts with the material presented in this report.
- 1
540 Gaither Road, Rockville, MD 20850; www
.ahrq.gov
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