Adherence to Clinical Guidelines, Electronic Health Record Use, and Online Reviews

Abstract

To increase transparency of healthcare quality, the Centers for Medicare and Medicaid Services (CMS) initiated the Physician Quality Reporting System (PQRS). However, the impact of PQRS on physicians is unclear, particularly as related to their online reputation. Is there an association between a physician’s online reputation and her adherence to clinical guidelines stipulated in the PQRS? Is online reputation associated with use of electronic health records (EHR)? To investigate these questions, we combine data on online physician reviews with the PQRS data on clinical guideline adherence and EHR use. Unlike prior research, which primarily uses clinical outcomes as proxies for care quality, our study uses adherence to clinical guidelines, a process measure that reflects physician conformance with evidence-based clinical practices. In addition, we focus on EHR use at the physician level, in contrast to the usual approach of examining it at the aggregate institutional level. Consistent with the economic theory of credence goods, we observe no significant relationship between physicians’ adherence to clinical guidelines and their online reviews. Although there is some evidence of association between EHR use and their overall rating, similar relationships are not consistently observed for individual dimensional ratings. Overall, the online reputation of a physician exhibits minimal association with her actual clinical activities — and is mostly driven by latent topics in the textual reviews — implying that the ability of online reviews to inform prospective patients of care quality might be quite limited. Therefore, patients should be cautious when using online physician reviews, and policymakers should increase the accessibility of PQRS and other similar data to help patients make informed physician choices.

Key words and phrases:

• clinical guidelines
• physician quality reporting
• online physician reviews
• electronic health record
• credence goods
• online eWoM

Acknowledgements

We gratefully acknowledge the guidance received from the Editor-in-Chief, Guest Editors and reviewers of this journal. We are also grateful to the reviewers, track chairs, and attendees of the Fifty-second Hawaii International Conference on Information Systems, Hawaii, 2019. We thank the participants of the INFORMS Conference on Information Systems and Technology, Phoenix, 2018, International Conference on Information Systems, San Francisco, 2018, and the 2018 Conference on Health IT and Analytics, Washington, DC, for their feedback on early versions of this research. Finally, financial support received from the University of Texas at Dallas, University of Texas at Austin, and University of Alabama is gratefully acknowledged.

Notes

1. The Office of the National Coordinator (ONC) for the Health Information Technology Certification Process has established standards and other criteria for structured data that an EHR must use.

2. See https://datausa.io/profile/geo/dallas-fort-worth-arlington-tx-metro-area for more details.

3. The physician’s name has been removed to conceal the physician’s identity.

4. For details, please refer to https://cran.r-project.org/web/packages/sentimentr/sentimentr.pdf as well as https://rdrr.io/cran/sentimentr/man/sentiment.html.

5. We standardized ClinicalAdherenceRate in our estimation models to avoid multi-collinearity with the interaction term.

6. We used textual comments with nine or more words. Short comments are difficult to analyze using such an algorithm.

Additional information

Notes on contributors

Danish H. Saifee

Danish H. Saifee ([email protected]) is an assistant professor of Management Information Systems at the Culverhouse College of Business, University of Alabama. He received his Ph.D. from the Jindal School of Management, University of Texas at Dallas. Dr. Saifee’s primary research interests are at the intersection of healthcare and information technology. He has presented his recent research at various conferences and workshops, including the Conference on Health IT and Analytics, International Conference on Information Systems, and Hawaii International Conference on System Sciences.

Indranil R. Bardhan

Indranil R. Bardhan ([email protected]) is the Foster Parker Centennial Professor of Management in the McCombs School of Business, University of Texas at Austin. He holds a Ph.D. in Management Science and Information Systems from the McCombs School of Business, University of Texas. His research focuses on healthcare analytics and information technology, and has been funded by the National Science Foundation and the UT Health System. He serves as a senior editor at MIS Quarterly and an associate editor at Management Science, and is a co-editor of a special issue of MIS Quarterly on healthcare IT and analytics.

Atanu Lahiri

Atanu Lahiri([email protected]) is an associate professor of information systems at the Jindal School of Management, University of Texas at Dallas. He received his P.h.D from the Simon School of Business, University of Rochester. His research interests are primarily in the area of economics of information systems. His papers have appeared in Information Systems Research, Journal of Management Information Systems, Management Science, and MIS Quarterly, among other journals.

Zhiqiang (Eric) Zheng

Zhiqiang (Eric) Zheng ([email protected]) is the Ashbel Smith Professor of Information Systems at the Jindal School of Management, University of Texas at Dallas. He received his Ph.D. from the Wharton School of Business, University of Pennsylvania. His research interests focus on financial technology, healthcare analytics, and social media analytics. His papers have appeared in such journals as Information Systems Research, Management Science, MIS Quarterly, and Production and Operations Management. He serves as a senior editor for Information Systems Research.