title: Performing without a net: transitioning away from a health information technology-rich training environment.
abstract: OBJECTIVE
  In many academic medical centers (AMCs), health information technology (HIT) has become a foundational component of patient care. Medical training in these environments generates dependence on HIT. The authors conducted this study to determine how transitioning from an HIT-rich environment affects practitioners' self-perceptions of competence, practice efficiency, and patient safety.
  
  
  METHODS
  In 2004 and 2005, the authors performed a cross-sectional survey study involving medical students and residents who had graduated from Vanderbilt University Medical Center (VUMC), an HIT-rich AMC. The authors distributed surveys to 679 graduates from 2001 to 2003 who transferred to other institutions.
  
  
  RESULTS
  Although 128 surveys were returned undelivered because of wrong addresses, 328 (60%) were returned complete and analyzed. Among respondents, 255 (78%) reported transitioning to environments with less HIT than VUMC. The authors compared responses from this group with those of peers who transitioned to environments with the same or greater HIT penetration. After controlling for confounding effects, the authors found that graduates who transitioned to lower-HIT institutions reported feeling less able to practice safe patient care (P = .02), to utilize evidence at the point of care (P = .05), to work efficiently (P < .001), to share and communicate information (P = .03), and to work effectively within the local system (P = .007).
  
  
  CONCLUSIONS
  Providers who transition away from HIT-rich environments may perceive their care as less safe and less efficient. These results support greater adoption of HIT and underscore the need for formal education for new trainees, faculty, and staff transitioning to a new system of care.
authors.affiliation: Vanderbilt University, Nashville, Tennessee, USA. kevin.johnson@vanderbilt.edu
authors.forename: Kevin
authors.initials: K
authors.lastname: Johnson
authors.forename: Davin
authors.initials: D
authors.lastname: Chark
authors.forename: Qingxia
authors.initials: Q
authors.lastname: Chen
authors.forename: Alexis
authors.initials: A
authors.lastname: Broussard
authors.forename: S Trent
authors.initials: ST
authors.lastname: Rosenbloom
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D000328:Adult; D020811:Biomedical Technology / Q000458:organization & administration; D003430:Cross-Sectional Studies; D004501:Education, Medical / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data; D008297:Male; D008490:Medical Informatics / Q000639:trends; D010820:Physicians / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000592:standards*; D012577:Schools, Medical / Q000458:organization & administration*; D013337:Students, Medical / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013714:Tennessee