Spencer S. Jones, PhD; Robert S. Rudin, PhD; Tanja Perry, BHM; Paul G. Shekelle, MD, PhD
Acknowledgment: The authors thank Aneesa Motala and Roberta Shanman for their research assistance and assistance with the literature searches and retrieval. They also thank the members of the Technical Expert Panel: David W. Bates, MD, MSc; George Hripsak, MD, MS; Philip J. Aponte, MD; Louise Liang, MD; and Paul Tang, MD, MS.
Grant Support: By the Office of the National Coordinator.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-1531.
Requests for Single Reprints: Spencer S. Jones, PhD, Southern California Evidence-Based Practice Center, RAND Health, 1776 Main Street, Santa Monica, CA 90401; e-mail: firstname.lastname@example.org.
Current Author Addresses: Drs. Jones and Shekelle and Ms. Perry: Southern California Evidence-Based Practice Center, RAND Health, 1776 Main Street, Santa Monica, CA 90401.
Dr. Rudin: RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA 02116.
Author Contributions: Conception and design: S.S. Jones, R.S. Rudin, P.G. Shekelle.
Analysis and interpretation of the data: S.S. Jones, R.S. Rudin, P.G. Shekelle.
Drafting of the article: S.S. Jones, R.S. Rudin, T. Perry, P.G. Shekelle.
Critical revision of the article for important intellectual content: S.S. Jones, R.S. Rudin, P.G. Shekelle.
Final approval of the article: S.S. Jones, R.S. Rudin, T. Perry, P.G. Shekelle.
Provision of study materials or patients: S.S. Jones, P.G. Shekelle.
Statistical expertise: S.S. Jones.
Obtaining of funding: S.S. Jones, P.G. Shekelle.
Administrative, technical, or logistic support: T. Perry.
Collection and assembly of data: S.S. Jones, P.G. Shekelle.
Incentives offered by the U.S. government have spurred marked increases in use of health information technology (IT).
To update previous reviews and examine recent evidence that relates health IT functionalities prescribed in meaningful use regulations to key aspects of health care.
English-language articles in PubMed from January 2010 to August 2013.
236 studies, including pre–post and time-series designs and clinical trials that related the use of health IT to quality, safety, or efficiency.
Two independent reviewers extracted data on functionality, study outcomes, and context.
Fifty-seven percent of the 236 studies evaluated clinical decision support and computerized provider order entry, whereas other meaningful use functionalities were rarely evaluated. Fifty-six percent of studies reported uniformly positive results, and an additional 21% reported mixed-positive effects. Reporting of context and implementation details was poor, and 61% of studies did not report any contextual details beyond basic information.
Potential for publication bias, and evaluated health IT systems and outcomes were heterogeneous and incompletely described.
Strong evidence supports the use of clinical decision support and computerized provider order entry. However, insufficient reporting of implementation and context of use makes it impossible to determine why some health IT implementations are successful and others are not. The most important improvement that can be made in health IT evaluations is increased reporting of the effects of implementation and context.
Office of the National Coordinator.
Evidence search and selection.
Table 1. Health IT Evaluation Studies Between 1995 and 2013, by Study Outcome Type
Table 2. Health IT Evaluation Studies Between 2007 and 2013, by Study Outcome Result
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Spencer S. Jones, Robert S. Rudin, Tanja Perry, Paul G. Shekelle. Health Information Technology: An Updated Systematic Review With a Focus on Meaningful Use. Ann Intern Med. 2014;160:48–54. doi: 10.7326/M13-1531
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Published: Ann Intern Med. 2014;160(1):48-54.
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