title: Innovative use of the integrative review to evaluate evidence of technology transformation in healthcare.
abstract: Healthcare is in a period significant transformational activity through the accelerated adoption of healthcare technologies, new reimbursement systems that emphasize shared savings and care coordination, and the common place use of mobile technologies by patients, providers, and others. The complexity of healthcare creates barriers to transformational activity and has the potential to inhibit the desired paths toward change envisioned by policymakers. Methods for understanding how change is occurring within this complex environment are important to the evaluation of delivery system reform and the role of technology in healthcare transformation. This study examines the use on an integrative review methodology to evaluate the healthcare literature for evidence of technology transformation in healthcare. The methodology integrates the evaluation of a broad set of literature with an established evaluative framework to develop a more complete understanding of a particular topic. We applied this methodology and the framework of punctuated equilibrium (PEq) to the analysis of the healthcare literature from 2004 to 2012 for evidence of technology transformation, a time during which technology was at the forefront of healthcare policy. The analysis demonstrated that the established PEq framework applied to the literature showed considerable potential for evaluating the progress of policies that encourage healthcare transformation. Significant inhibitors to change were identified through the integrative review and categorized into ten themes that describe the resistant structure of healthcare delivery: variations in the environment; market complexity; regulations; flawed risks and rewards; change theories; barriers; ethical considerations; competition and sustainability; environmental elements, and internal elements. We hypothesize that the resistant nature of the healthcare system described by this study creates barriers to the direct consumer involvement and engagement necessary for transformational change. Future policies should be directed at removing these barriers by demanding and emphasizing open technologies and unrestricted access to data versus as currently prescribed by technology vendors, practitioners, and policies that perpetuate market equilibrium.
authors.affiliation: Columbia University, School of Nursing, 617 West 168th Street, New York, NY 10032, USA. Electronic address: aphillips@mghihp.edu.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Phillips
authors.affiliation: Columbia University, School of Nursing, 617 West 168th Street, New York, NY 10032, USA; Columbia University, Department of Biomedical Informatics, 617 West 168th Street, New York, NY 10032, USA.
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Merrill
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration*; D007255:Information Services
keywords: Complex adaptive systems; Health reform; Information technology; Integrative review; Technology transformation