Innovative use of the integrative review to evaluate evidence of technology transformation in healthcare.

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.

Evaluating the effect of automated hand hygiene technology on compliance and C. difficile rates in a long-term acute care hospital.

BACKGROUND: Compliance with hand hygiene (HH) standards is a critical component to reducing the prevalence of Health Care Acquired Infections (HAIs). The use of HH technologies is increasing and studies examining the success of these technologies on HH compliance and HAIs are important to inform standards of care. COVID-19 has emphasized compliance HH standards. METHODS: This study evaluated HH compliance and Clostridium difficile (C difficile) rates following implementation of an HH technology at a long-term acute care hospital. The HH technology required nursing and other staff with direct patient contact to wear a "badge" that measured alcohol concentration on a health care worker's hands or time washing hands at designated sinks upon exit/entry of patient rooms. No changes were made to environmental cleaning or antibiotic stewardship standards. Compliance and infection rates were compared 12 months pre-post implementation during 2017-2019. RESULTS: There was an increase in HH compliance (89.82%-97.10%, P< .001)) and a reduction in the incidence of C. difficile (9.541-3.720, P= .0032). CONCLUSION: The HH technology significantly and quickly increased HH compliance and reduced rates of C difficile. The technology provided ancillary benefits, including data tracing of all patient and staff contacts and cross-contamination events.

Implementing health information exchange for public health reporting: a comparison of decision and risk management of three regional health information organizations in New York state.

Health information exchange (HIE) is a significant component of healthcare transformation strategies at both the state and national levels. HIE is expected to improve care coordination, and advance public health, but implementation is massively complex and involves significant risk. In New York, three regional health information organizations (RHIOs) implemented an HIE use case for public health reporting by demonstrating capability to deliver accurate responses to electronic queries via a set of services called the Universal Public Health Node. We investigated process and outcomes of the implementation with a comparative case study. Qualitative analysis was structured around a decision and risk matrix. Although each RHIO had a unique operational model, two common factors influenced risk management and implementation success: leadership capable of agile decision-making and commitment to a strong organizational vision. While all three RHIOs achieved certification for the public health reporting, only one has elected to deploy a production version.

Financial effects of health information technology: a systematic review.

BACKGROUND: Health information technology (HIT) is widely viewed as an important lever with which to improve the quality and efficiency of the healthcare system. However, there has long been debate about its financial effects. OBJECTIVES: To characterize the existing data on the financial effects of HIT and to consider the implications for the effect of HIT on healthcare spending. STUDY DESIGN: Systematic literature review. METHODS: We identified articles by (1) searching PubMed using the intersection of terms related to HIT applications and terms related to financial or economic effect; and (2) reviewing the reference lists of the included articles as well as additional policy articles and literature reviews. RESULTS: A total of 57 articles met our inclusion criteria, including 43 articles (75%) reporting financial benefits to a stakeholder associated with HIT. These included 26 articles (46%) reporting cost savings, 6 articles (11%) reporting revenue gains, and 11 articles (19%) reporting a mixture of cost savings and revenue gains. Among articles with experimental study designs, 22 of 34 (65%) reported financial benefits; and among articles explicitly measuring costs and benefits, 19 of 21 (90%) reported financial benefits. The most prevalent mechanisms were savings on administrative goods and/or personnel, savings on pharmaceuticals, and revenue gains through improved billing. Overall there is a dearth of articles on this topic, especially ones with strong study designs and financial analyses. CONCLUSIONS: HIT can have financial benefits, but more research is required, especially on HIT's effects under emerging delivery and payment reform efforts.

Applying observations from technological transformations in complex adaptive systems to inform health policy on technology adoption.

Many complex markets such as banking and manufacturing have benefited significantly from technology adoption. Each of these complex markets experienced increased efficiency, quality, security, and customer involvement as a result of technology transformation in their industry. Healthcare has not benefited to the same extent. We provide initial findings from a policy analysis of complex markets and the features of these transformations that can influence health technology adoption and acceptance.