Dearth of data evaluating IT in doctor practices

Looking at 274 studies examining the impact of health information technologies, a government-financed report concludes they show one thing: More studies are needed.

That's because many studies focused on large, early-adopting organizations rather than smaller entities such as physician practices, according to the study conducted by the RAND Corp., a Santa Monica, Calif.-based think tank. The study was funded by the Agency for Healthcare Research and Quality and the U.S. Dept. of Health and Human Services.

The researchers' findings are based on a systematic review of 274 studies evaluating the impact of health information technologies, including electronic medical records and computerized physician order-entry, on health care delivery. Most of those studies were published between 1995 and January 2004, but some were published up to April 2005.

The studies showed that clinical health information technologies can significantly improve quality of care. But that conclusion is based on the fact that 25% of the studies researchers reviewed came from just four large organizations that have been early adopters of clinical information technology -- the Regenstrief Institute, Indianapolis; the Dept. of Veterans Affairs, Washington D.C.; Brigham and Women's Hospital/Partners HealthCare, Boston; and LDS Hospital/Intermountain Healthcare, Salt Lake City.

"The key finding of the study is that health information technology systems have been shown [to have] significant impact on the quality and efficiency [of care delivery], but those facts have been demonstrated at a small number of institutions, all of which have internally developed their own health information technology systems over the span of several years and have an academic orientation," said Basit Chaudhry, MD, a consultant at RAND Corp.

Throw in the paucity of available research evaluating the use of multifunctional commercial systems and their financial impact at smaller organizations -- physician practices and nonacademic hospitals or health systems -- and researchers could not generalize or draw a broader conclusion regarding the clinical and financial impacts of technology at those organizations, which are more likely to use commercial systems, said Dr. Chaudhry, who is also a clinical instructor at the division of general internal medicine at the University of California, Los Angeles.

The researchers were able to find only nine studies evaluating the use of multifunctional clinical systems at nonacademic medical centers. These sites reaped some quality and efficiency benefits from technology but not as many as the four academic organizations that had developed their own systems, said Dr. Chaudhry. He is the lead author of an article published in the May 16 issue of Annals of Internal Medicine summarizing the findings of the report commissioned by AHRQ.

Still, the study's findings shouldn't be interpreted to mean that large organizations are more likely to benefit from information technology than physician practices or small hospitals, said Scott Young, MD, director for health information technology at AHRQ.

There is anecdotal evidence that information technology has benefited "smaller, more typical providers of care" but there is no solid scientific evidence supporting that, Dr. Young said. Aware of that, AHRQ in 2004 launched a $166-million initiative under which it awarded grants to health care organizations of various sizes to implement and evaluate information technology.

To date, AHRQ has funded 122 programs in 41 states, and research from some programs that could help give physicians and others the data they need to adopt technology could start coming online later this year, Dr. Young said.