東華大學圖書館 |

Implementation and Management of Information Technology in Health Care Delivery.

紀錄類型:	書目-電子資源 : Monograph/item
正題名/作者:	Implementation and Management of Information Technology in Health Care Delivery./
作者:	Holmgren, A. Jay.
出版者:	Ann Arbor : ProQuest Dissertations & Theses, : 2021,
面頁冊數:	123 p.
附註:	Source: Dissertations Abstracts International, Volume: 83-02, Section: B.
Contained By:	Dissertations Abstracts International83-02B.
標題:	Health care management. -
電子資源:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=28415850
ISBN:	9798534674064

Implementation and Management of Information Technology in Health Care Delivery.
Holmgren, A. Jay.

Implementation and Management of Information Technology in Health Care Delivery. - Ann Arbor : ProQuest Dissertations & Theses, 2021 - 123 p.

Source: Dissertations Abstracts International, Volume: 83-02, Section: B.

Thesis (Ph.D.)--Harvard University, 2021.

This item must not be sold to any third party vendors.

Since the passage of the HITECH Act in 2009, the federal government has spent over $30 billion dollars in an effort to digitize the US health care delivery system. While electronic health records (EHRs) are now ubiquitous in acute care hospitals and primary care physician offices, many of the theorized benefits of EHRs in reducing costs and improving quality have not materialized. Moving beyond digitizing clinical data towards using data and information technology to improve care requires a set of complementary changes in both policy and organizational management. This dissertation adds to our understanding of how information technology use impacts health care delivery organizations and how policymakers and health system leaders can work towards using EHRs to improve care. Chapter one examines organizational practices of the adoption and use of electronic health records using a novel national hospital survey and describes variation in organizational practices such as level of senior leadership engagement in EHR-related decision-making and level of clinician involvement in IT implementation. This study also finds specific organizational strategies, such as human capital investment and integration across technical systems, may complement EHR investments to help hospitals achieve more advanced adoption. Chapter two focuses on the use of electronic health records and how they have changed clinician work. Using a unique dataset of EHR metadata from ambulatory care organizations with Epic Systems EHRs, this study compares differences between US and international clinicians, finding large differences in EHR work time. These results suggest that US-specific socio-technical factors may be driving a significant amount of EHR-related clinician work and associated burnout. Chapter three focuses on the evaluation of electronic health records. Using data from a national assessment of hospital inpatient medication EHR safety, this chapter describes the current state of EHR safety performance to prevent adverse drug events. The study then uses a regression discontinuity design to determine the causal impact of providing hospitals with publicly reported negative feedback on their EHR safety, finding that hospitals who received the negative qualitative feedback improved significantly more in the subsequent year compared to hospitals who received positive feedback. These results have important implications regarding the value of quality assessment in health care. This study finds a small but significant "nudge" effect of providing hospitals with feedback on improvement in the next year, and provides evidence that measurement and feedback can improve quality.Taken together, these three studies add to our knowledge of how organizations can more effectively use electronic health records, how technology and socio-technical demands contribute to clinician workload, and the value of EHR-based quality assessment and feedback programs in improving patient safety.

ISBN: 9798534674064Subjects--Topical Terms:

2122906
Health care management.
Subjects--Index Terms:

Health care delivery

Implementation and Management of Information Technology in Health Care Delivery.
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300 $a 123 p.
500 $a Source: Dissertations Abstracts International, Volume: 83-02, Section: B.
500 $a Advisor: Huckman, Robert S.
502 $a Thesis (Ph.D.)--Harvard University, 2021.
506 $a This item must not be sold to any third party vendors.
520 $a Since the passage of the HITECH Act in 2009, the federal government has spent over $30 billion dollars in an effort to digitize the US health care delivery system. While electronic health records (EHRs) are now ubiquitous in acute care hospitals and primary care physician offices, many of the theorized benefits of EHRs in reducing costs and improving quality have not materialized. Moving beyond digitizing clinical data towards using data and information technology to improve care requires a set of complementary changes in both policy and organizational management. This dissertation adds to our understanding of how information technology use impacts health care delivery organizations and how policymakers and health system leaders can work towards using EHRs to improve care. Chapter one examines organizational practices of the adoption and use of electronic health records using a novel national hospital survey and describes variation in organizational practices such as level of senior leadership engagement in EHR-related decision-making and level of clinician involvement in IT implementation. This study also finds specific organizational strategies, such as human capital investment and integration across technical systems, may complement EHR investments to help hospitals achieve more advanced adoption. Chapter two focuses on the use of electronic health records and how they have changed clinician work. Using a unique dataset of EHR metadata from ambulatory care organizations with Epic Systems EHRs, this study compares differences between US and international clinicians, finding large differences in EHR work time. These results suggest that US-specific socio-technical factors may be driving a significant amount of EHR-related clinician work and associated burnout. Chapter three focuses on the evaluation of electronic health records. Using data from a national assessment of hospital inpatient medication EHR safety, this chapter describes the current state of EHR safety performance to prevent adverse drug events. The study then uses a regression discontinuity design to determine the causal impact of providing hospitals with publicly reported negative feedback on their EHR safety, finding that hospitals who received the negative qualitative feedback improved significantly more in the subsequent year compared to hospitals who received positive feedback. These results have important implications regarding the value of quality assessment in health care. This study finds a small but significant "nudge" effect of providing hospitals with feedback on improvement in the next year, and provides evidence that measurement and feedback can improve quality.Taken together, these three studies add to our knowledge of how organizations can more effectively use electronic health records, how technology and socio-technical demands contribute to clinician workload, and the value of EHR-based quality assessment and feedback programs in improving patient safety.
590 $a School code: 0084.
650 4 $a Health care management. $3 2122906
650 4 $a Information technology. $3 532993
650 4 $a Ambulatory care. $3 3685727
650 4 $a Polls & surveys. $3 3546576
650 4 $a Patient safety. $3 2074800
650 4 $a Electronic health records. $3 3433800
650 4 $a Censuses. $3 3564174
650 4 $a Technology adoption. $3 3681799
650 4 $a Optimization. $3 891104
650 4 $a Variables. $3 3548259
650 4 $a Data collection. $3 3561708
650 4 $a Data analysis. $2 bisacsh $3 3515250
650 4 $a Data entry. $3 3685728
650 4 $a Confidence intervals. $3 566017
650 4 $a Hospital systems. $3 3685729
650 4 $a Nonprofit organizations. $3 540326
650 4 $a Case studies. $2 itrt $3 996239
650 4 $a Statistical analysis. $3 3543751
653 $a Health care delivery
653 $a Electronic health records
653 $a Health system leaders
690 $a 0769
690 $a 0489
710 2 $a Harvard University. $b Health Policy. $3 2093139
773 0 $t Dissertations Abstracts International $g 83-02B.
790 $a 0084
791 $a Ph.D.
792 $a 2021
793 $a English
856 4 0 $u http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=28415850