Integrated Health Information Technology and the Quality of Patient Care: A Natural Experiment

Abstract

Fragmentation of care delivery remains one of the main challenges of healthcare systems. In this study, we examine health information technology (HIT) that is electronically integrated across care physicians, specialists, hospitals, and pharmacists and its impact on quality of care. Drawing on the structure–process–outcome framework, we hypothesize that integrated HIT will have both a direct and an indirect effect on quality of care. By providing more complete information to physicians and allowing them to detect and manage health problems early in the care cycle, integrated HIT is expected to directly improve quality of care. Integrated HIT is also hypothesized to improve quality of care indirectly by increasing continuity of care and reducing the odds of therapeutic errors. We test these hypotheses through a contemporaneous natural experiment of a matched set of 15,626 outpatients receiving ambulatory care through an integrated HIT system and 15,626 outpatients in a control group. The results show that the patients treated with the integrated system had better quality of care in the follow-up period than patients of the control group. Integrated HIT also had an indirect effect on quality of care through an increase in continuity of care. Our study contributes to research by examining how an integrated HIT system—rather than specific HIT components—influences patient-related outcomes, and how this effect is mediated by two key processes: continuity of care and therapeutic duplication errors. Our work also helps decision makers to better understand the impact of HIT in a complex and highly decentralized and fragmented care delivery system.

Key words and phrases:

• continuity of care
• health information technology
• I-HIT
• information technology impact
• integrated HIT
• IT and healthcare
• quality of care

Supplemental File

Supplemental data for this article can be found on the publisher’s website at 10.1080/07421222.2017.1334477

Notes

1. Appendix 5 in the Online Appendix lists the most common types of HIT used by providers. While HIT can also include technologies used by patients (e.g., personal health records; health applications; online health sites), we focus on provider-based HIT.

2. Henceforth, when we use the term quality of care we are referring to the outcome component, unless stated otherwise.

3. One study looked at interpersonal care, which is conceptually related to continuity of care in that it assesses interactions between patients and providers, communication, understanding, empathy, responsiveness, and personalized care [4]. The study found a positive relationship between cardiology IT and interpersonal care.

4. While therapeutic duplication errors and QoC are described in the arguments leading to the hypotheses and measured in terms of odds, we omitted the term odds from the wording of the hypotheses for simplicity and efficiency of writing.

5. The original name of the HIT system was modified to preserve anonymity and confidentiality.

6. The equations, which are available upon request, are in the following format, with the independent variables taking place of X₁ and the corresponding covariates taking place of X₂ to X_k. P is the probability of the outcome given the covariates:

$Ln\left(\frac{P}{1-P}\right)={\beta }_0+{\beta }_1{X}_1+{\beta }_2{X}_2+\mathrm{...}+{\beta }_k{X}_k$

Additional information

Notes on contributors

Alain Pinsonneault

Alain Pinsonneault ([email protected]; corresponding author) is James McGill Professor and the Imasco Chair of Information Systems in the Desautels Faculty of Management at McGill University. He has been appointed to the Order of Québec and is Fellow of the Royal Society of Canada and the Association for Information Systems. His research interests include the organizational and individual impacts of information technology (IT), user adaptation, social networks, business model in the digital economy, e-health, e-integration, strategic alignment of IT, and the business value of IT. His research has appeared in numerous journals, including Management Science, Information Systems Research, Journal of Management Information Systems, MIS Quarterly, and Organization Science. He has served on the editorial boards of the four latter journals.

Shamel Addas

Shamel Addas ([email protected]) is an assistant professor of information systems (IS) at the Smith School of Business, Queen’s University, Canada. Prior to that, he was an assistant professor at IESEG School of Management in France. He holds a Ph.D. in management from McGill University. His research centers on the intended and unintended impact of IS on organizational work, including communication technology interruptions, the dark side of IS, and health IT. His work has been published or is forthcoming in leading journals, such as MIS Quarterly, Information Systems Journal, Knowledge Management Research & Practice, and others.

Christina Qian

Christina Qian ([email protected]) is a research assistant at McGill University’s Clinical and Health Informatics Research Laboratory. She received her master’s degree in epidemiology with a focus on pharmacoepidemiology from McGill University.

Vijay Dakshinamoorthy

Vijay Dakshinamoorthy ([email protected]) is a data scientist in Technology Strategy with TELUS Communications. He holds an MSE in computer engineering and an MA in business administration from the University of Michigan. His research interests include organizational and healthcare impacts of IT, complex systems, data science, machine learning, and artificial intelligence. He has authored or coauthored research that has been presented at numerous conferences.

Robyn Tamblyn

Robyn Tamblyn ([email protected]) is a professor of medicine, a James McGill Chair, and a medical scientist at McGill University. She is scientific director of the McGill Clinical and Health Informatics Research Group and scientific director of the CIHR Institute of Health Services and Policy Research. Her work has been published in the Journal of the American Medical Association, Annals of Internal Medicine, British Medical Journal, Medical Care, and others. She received the CHSRF KT award for research in improving medication use, the ACFAS Bombardier award for innovation in the development of a drug management system, and the John P. Hubbard Award for outstanding achievement in the assessment of professional competency in healthcare and medical education. She has been appointed to the Order of Canada and she received the annual Outstanding Achievement Award from the Medical Council of Canada.