Full Title: Enabling Patient-Centered Care through Health Information Technology (Health IT)
This report focuses on the development of a comprehensive understanding of the impact of health information technology (IT) applications developed and implemented to enhance the provision of patient-centered care (PCC).
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Objectives: The main objective of the report is to review the evidence on the impact of health
IT that supports patient-centered care (PCC) on:
- Health care processes.
- Clinical outcomes.
- Intermediate outcomes (patient or provider satisfaction, health knowledge and behavior, and cost).
- Responsiveness to needs and preferences of patients.
- Shared decisionmaking and patient–clinician communication.
- Access to information.
Additional objectives were to
identify barriers and facilitators for using health IT to deliver PCC, and to identify gaps in
evidence and information needed by patients, providers, payers, and policymakers.
Data Sources: MEDLINE®, Embase®, Cochrane Library, Scopus, Cumulative Index to Nursing
and Allied Health Literature, PsycINFO, INSPEC, and Compendex databases through July 31,
Methods: Paired members of our team reviewed citations to identify randomized controlled
trials of PCC-related health IT interventions and studies that addressed barriers and facilitators
for health IT for delivery of PCC. Independent assessors rated studies for quality. Paired
reviewers abstracted data.
Results: The search identified 327 eligible articles, including 184 articles on the impact of health
IT applications implemented to support PCC and 206 articles addressing barriers or facilitators
for such health IT applications. Sixty-three articles addressed both questions. The study results
suggested positive effects of PCC-related health IT interventions on health care process
outcomes, disease-specific clinical outcomes (for diabetes mellitus, heart disease, cancer, and
other health conditions), intermediate outcomes, responsiveness to the needs and preferences of
patients, shared decisionmaking, patient-clinician communication, and access to medical
Studies reported a number of barriers and facilitators for using health IT applications to enable
PCC. Barriers included:
- Lack of usability.
- Problems with access to the health IT application due to older age, low income, education, cognitive impairment, and other factors.
- Low computer literacy in patients and clinicians.
- Insufficient basic formal training in health IT applications.
- Physicians' concerns about more work.
- Workflow issues. Problems related to new system implementation, including concerns about confidentiality of patient information.
- Incompatibility with current health care practices.
- Lack of standardization.
- Problems with reimbursement.
Facilitators for the utilization of health IT included ease of use,
perceived usefulness, efficiency of use, availability of support, comfort in use, and site location.
Conclusions: Despite marked heterogeneity in study characteristics and quality, substantial
evidence exists confirming that health IT applications with PCC-related components have a
positive effect on health care outcomes.
Enabling Patient-Centered Care through Health IT
Evidence-based Practice Center: The Johns Hopkins University EPC
Current as of June 2012
Enabling Patient-Centered Care through Health IT, Structured Abstract. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/tp/pcchittp.htm