Systematic review: impact of health information technology on quality, efficiency, and costs of medical care.
BACKGROUND
Experts consider health information technology key to improving efficiency and quality of health care.


OBJECTIVE
To systematically review evidence on the effect of health information technology on quality, efficiency, and costs of health care.


METHODS
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.


METHODS
Descriptive and comparative studies and systematic reviews of health information technology.


METHODS
Two reviewers independently extracted information on system capabilities, design, effects on quality, system acquisition, implementation context, and costs.


RESULTS
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.


CONCLUSIONS
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.
Chaudhry
Basit
B
Southern California Evidence Based Practice Center, RAND, Santa Monica, California 90401, USA. BChaudhry@mednet.ucla.edu
Wang
Jerome
J
Wu
Shinyi
S
Maglione
Margaret
M
Mojica
Walter
W
Roth
Elizabeth
E
Morton
Sally C
SC
Shekelle
Paul G
PG
D020811:Biomedical Technology; D017598:Efficiency, Organizational; D019983:Guideline Adherence; D017048:Health Care Costs; D006296:Health Services / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D019300:Medical Errors / Q000517:prevention & control; D008491:Medical Informatics Applications; D011159:Population Surveillance; D011787:Quality of Health Care / Q000191:economics / Q000592:standards*; D014481:United States