Documente Academic
Documente Profesional
Documente Cultură
2, JUNE 2005
283
I. INTRODUCTION
of systems-based medical decision-making, disease management, and public health assessment. The potential opportunities,
while promising, present significant challenges [3]. Greater
demands will likely be made on current information systems
for more reliable and timely data quality assessment, affecting
clinical and administrative implementation of evidence-based
medicine practice [4]. Greater reliance on data likewise will
promote the adoption and diffusion of enterprise-wide decision-making methods. While automated information systems
are well adapted to such methods, paper medical records may
not be as compatible with high-speed multisite information
environments.
At the administrative level, the pressure to implement more
timely and comprehensive measures of system-based data has
never been greater. Recent U.S. regulatory actions, such as The
Health Insurance Portability and Accountability Act of 1996,
known as HIPAA, mandates major paperwork reduction and
data standardization practices in patient record documentation
[5], [6]. Strong financial, regulatory, and quality incentives exist
for health information managers to replace paper-based record
systems with automated computer-based technologies [7], [8].
Given this mandate, we surveyed a national group of health information managers regarding their adoption of CPR systems.
Our study sought to determine: 1) the prevalence of CPR adoption level by health-care organizations and 2) the extent of any
significant regional and practice variation in adoption patterns.
II. METHODS
Data from a nationwide survey of 8700 health-care information managers were used to examine the organizational
and environmental characteristics of CPR adoption in a variety of health-care settings. Selected adoption characteristics
were compared across practice settings, geographic areas, and
selected health-care demographic characteristics. The survey
data included measures of the accuracy via automated systems,
and organizational characteristics relevant to data acquisition.
The sample population targeted was selected from a database
of health information managers, certified as Registered Health
Information Administrators or Registered Health Information
Technicians, as of March 30, 2002. Location and demographic
information was provided by the Foundation for Record Education, and contained current and historical information on all
credentialed health information professionals in the U.S. The
survey was designed to provide the health-care industry with
more timely and frequent practice information about health
284
TABLE I
OVERALL PERCENTAGE OF TOTAL PATIENT RECORD
INFORMATION CAPTURED BY COMPUTER
TABLE II
PERCENTAGE OF TOTAL PATIENT RECORD INFORMATION
CAPTURED BY COMPUTER, BY PRACTICE SETTING
dependent variables across computerization levels by comparison with the variation observed during pretest and with like
variation between adopters and nonadopters. We examined
these differences using covariate-adjusted average probabilities, including computerized record adopters and nonadopters,
using raw reported incremental computerization levels as well
as quartile computerization categories. Logistic coefficients
and levels of covariance were then subjected to a Wald test and
examined for significance of observed differences.
III. RESULTS AND DISCUSSION
The survey obtained data from 7151 health information managers, for an 82.2% response rate. Respondents were from a variety of practice settings and job titles and excluded students.
285
TABLE III
PERCENTAGE OF PATIENT RECORD INFORMATION CAPTURED BY COMPUTER, BY REGION
TABLE IV
PERCENTAGE OF PATIENT RECORD INFORMATION
CAPTURED BY COMPUTER, BY MERGER STATUS
286
TABLE V
PERCENTAGE OF COMPUTERIZED RECORDS ALSO MAINTAINED ON PAPER
TABLE VI
PERCENTAGE OF COMPUTERIZED RECORDS ALSO
MAINTAINED ON PAPER, BY PRACTICE SETTING
paper records may still be preferred as a fail-safe in healthcare organizations. Regardless of the motivation, the approach
taken by providers to adopt electronic evidence-based medicine
is likely to be an important factor in ensuring that developments
are met with an appropriate response.
Of note here was the lack of any strong consensus regarding
quality of information within the CPR. Only 51% of respondents
who use computerized records indicate that the overall accuracy
of their patient data is better or much better than data maintained
on paper records. 37% reported accuracy to be the same as with
paper records. This may explain the prevalence of backup, redundant paper-based systems reported in this study. Adoption
of the CPR likewise appeared to have little positive effect on
file space requirements. Among more advanced adopters of the
CPR (those with 50% or greater of their record data computerized), about 70% indicate an anticipated increase in file space
requirements in the next two years. Overall, about 17% of the
high adopters predicted their file space needs would increase by
31% or greater. In contrast, about 81% of all respondents indicated an increase in file space needs in the near future.
Regional variation in the adoption of system-based patient
records, and shortages of trained health information professionals, suggests an urgent need for new training programs
within the health-care professions. If there is insufficient specialist staff to cope with an increased demand, then this may
have to be met from other sources. The need for more focused
areas of information management expertise in the field of data
quality remains one of the greatest challenges faced by the
health-care industry today. Involving health-care professionals
already familiar with paper-based information management
would be a likely first step, serving to develop increased
knowledge of data processes and problems among health-care
professionals. The environment now provides far greater opportunities for electronic migration, with the challenge at the
primary care level being the identification of low-cost scalable
solutions to assess and improve the quality and accessibility of
medical data.
Many health professionals are likely to experience challenges
in implementing evidence-based medicine in their respective organizations, both as a consequence of unfamiliarity with datadriven medical decision-making, and because of the influence
that data will have on specialized fields of medicine. Professionals may have to adapt by acquiring new knowledge and by
adopting new roles, anticipated at several levels of service. Information systems developers will, thus, need to adopt a more
flexible approach to teamwork and incorporate evidence-based
medicine into practice. Traditional resistance to a data-driven
model of care may persist due to its reliance on impersonal authority, but the evolution of health care toward evidence-based
models suggest that medical decisionmaking will grow beyond
the experience and judgment of any given provider.
A. Action Needed
A number of studies to date have recommended potential
areas for further research related to computerization of medical
records. A landmark Institute of Medicine report, for example,
outlined a number of technological barriers to adoption, citing
a need for further maturation of a few emerging technologies,
287
TABLE VII
PERCENTAGE OF COMPUTERIZED RECORDS ALSO MAINTAINED ON PAPER, BY REGION
TABLE VIII
PERCENTAGE OF COMPUTERIZED RECORDS ALSO MAINTAINED ON PAPER
288
Daniel P. Lorence is an Assistant Professor at Pennsylvania State University, University Park, PA, with
appointments in Health Policy and Administration
and in Information Science and Technology.