Systematic Review of Electronic Health Records Value Since HITECH Act (Preprint)

Abstract

Electronic health records are the electronic record of patient health information created during one or more encounters in any healthcare setting. The Health Information Technology Act of 2009 has been a major driver of the adoption and implementation of electronic health records in the United States. Given that the adoption of electronic health records is a complex and expensive investment, a return on this investment is expected.

This literature review focuses on how the value of electronic health records, as an intervention is defined in relation to the elaboration of value into two different value outcome categories: financial and clinical outcomes, and to understand how electronic health records contribute to these two value outcome categories.

This literature review was conducted using the preferred reporting items for systematic reviews and meta-analysis. The initial search of key terms electronic health records, value, financial outcomes, and clinical outcomes in three different databases yielded 971 articles. After removing 410 duplicates, 561 articles were incorporated in the title and abstract screening. During the title and abstract screening phase, articles were excluded from any further review phases if they met any of the following criteria: 1) not relevant to the outcomes of interest, 2) not relevant to electronic health records, 3) non-empirical, and 4) non-peer reviewed. After the application of exclusion criteria, 80 studies remained for a full-text review. After evaluating the full text of the residual 80 studies, 26 studies were excluded seeing that they did not address the impact of EHR adoption on the outcomes of interest. Four additional studies were discovered through manual reference searches, and added to the total, resulting in 58 studies for analysis. A qualitative analysis tool, ATLAS.ti.8.2 was used to categorize and code the final 58 studies.

The findings from the literature review indicated a combination of positive and negative impact of electronic health records on financial and clinical outcomes. Five out of 58 studies surveyed for this review of literature report on the intersection of financial and clinical outcomes. To investigate this intersection further, the category “Value – Intersection of Financial and Clinical Outcomes” was generated. Four out of five of these studies specified a positive association between EHR adoption and financial and clinical outcomes.

This review of literature reports on the individual and collective value of EHRs from a financial and clinical outcomes perspective. The collective perspective examined the intersection of financial and clinical outcomes suggesting a reversal of the current understanding of how IT investments could generate improvements in productivity and prompts a new question to be asked of whether an increase in productivity could potentially lead to more IT investments.