View source for Health information technology

{{short description|Information technology applied to health and health care}}
{{see also|Health informatics}}
'''Health information technology''' ('''HIT''') is [[health technology]], particularly [[information technology]], applied to [[health]] and [[health care]]. It supports [[health information management]] across  computerized systems and the [[health information exchange|secure exchange of health information]] between [[consumer]]s, [[health professional|providers]], [[payment|payers]], and [[health care quality|quality]] monitors.<ref>{{Cite journal|last1=Fadahunsi|first1=Kayode Philip|last2=Akinlua|first2=James Tosin|last3=O’Connor|first3=Siobhan|last4=Wark|first4=Petra A|last5=Gallagher|first5=Joseph|last6=Carroll|first6=Christopher|last7=Majeed|first7=Azeem|last8=O’Donoghue|first8=John|date=March 2019|title=Protocol for a systematic review and qualitative synthesis of information quality frameworks in eHealth|journal=BMJ Open|volume=9|issue=3|pages=e024722|doi=10.1136/bmjopen-2018-024722|issn=2044-6055|pmid=30842114|pmc=6429947}}</ref> Based on a 2008 report on a small series of studies conducted at four sites that provide ambulatory care – three U.S. medical centers and one in the Netherlands, the use of [[electronic health record]]s (EHRs) was viewed as the most promising tool for improving the overall quality, safety and efficiency of the health delivery system.<ref>{{cite journal |vauthors=Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E, Morton SC, Shekelle PG |display-authors=3 |author-link7=Sally C. Morton|date=16 May 2006 |title=Systematic review: Impact of health information technology on quality, efficiency, and costs of medical care |journal=Annals of Internal Medicine |volume=144 |issue=10 |pages=742–52 |pmid=16702590 |doi=10.7326/0003-4819-144-10-200605160-00125 |doi-access=free }}</ref>

==Risk-based regulatory framework for health IT==
September 4, 2013  the [[Health IT Policy Committee]] (HITPC) accepted and approved recommendations from the [[Food and Drug Administration Safety and Innovation Act]] (FDASIA) working group for a risk-based regulatory framework for health information technology.<ref>{{cite web|last1=Daniel|first1=Jodi G|last2=Patel|first2=Bakul Patel|last3=Quinn|first3=Matthew|title=The path toward a risk-based regulatory framework for health IT|url=http://www.healthit.gov/buzz-blog/hit-policy-committee/path-riskbased-regulatory-framework-health/|work=Health IT Buzz|publisher=Office of the National Coordinator for Health IT (US)|date=5 September 2013}}</ref> [[Food and Drug Administration|The Food and Drug Administration]] (FDA), the [[Office of the National Coordinator for Health Information Technology|Office of the National Coordinator for Health IT]] (ONC), and [[Federal Communications Commission]] (FCC) kicked off the FDASIA workgroup of the HITPC to provide stakeholder input into a report on a risk-based regulatory framework that promotes safety and innovation and reduces regulatory duplication, consistent with section 618 of FDASIA. This provision permitted the Secretary of Health and Human Services (HHS) to form a workgroup in order to obtain broad stakeholder input from across the health care, IT, patients and innovation spectrum. The FDA, ONC, and FCC actively participated in these discussions with stakeholders from across the health care, IT, patients and innovation spectrum.

[[Healthcare Information and Management Systems Society|HIMSS]] Good Informatics Practices-GIP is aligned with FDA risk-based regulatory framework for health information technology.<ref>{{citation |date=February 2011 |publisher=Healthcare Information and Management Systems Society (HIMSS) |title=Good Informatics Practice (GIP) |chapter=Chapter 1 - Executive Summary: A framework for trusted information systems |chapter-url=http://www.himss.org/files/HIMSSorg/content/files/LSITOverviewCh1forwebsite270111.pdf |first1=Ford|last1=Winslow |first2=Anette|last2=Asher |first3=Steven|last3=Fouskarinis |first4=Gabor|last4=Fulop |first5=Damian|last5=Gomez |first6=Oscar|last6=Ghopeh |first7=Andrew|last7=Jacobson |first8=John|last8=Kim |first9=Linda|last9=Speake |first10=Mark|last10=Vilicich |first11=Howard|last11=Asher }}</ref>
GIP development began in 2004 developing risk-based IT technical guidance.<ref>{{Citation |title=LSIT Global Institute public debut |first1=Howard|last1=Asher |first2=Phil|last2=Bourne |date=19 August 2009 |publisher=SciVee |url=http://www.scivee.tv/node/12332 }}</ref> Today the GIP peer-review and published modules are widely used as a tool for educating Health IT professionals.

Interoperable HIT will improve individual patient care, but it will also bring many public health benefits including:
*early detection of infectious [[disease outbreak]]s around the country;
*improved tracking of [[chronic disease]] management; 
*evaluation of health care based on value enabled by the collection of de-identified price and quality information that can be compared

According to an article published in the ''[[International Journal of Medical Informatics]]'', health information sharing between patients and providers helps to improve diagnosis, promotes self care, and patients also know more information about their health. The use of electronic [[medical record]]s (EMRs) is still scarce now but is increasing in Canada, American and British primary care.  Healthcare information in EMRs are important sources for clinical, research, and policy questions. Health [[information privacy]] (HIP) and security has been a big concern for patients and providers. Studies in Europe evaluating electronic health information poses a threat to electronic medical records and exchange of personal information.<ref>{{cite journal|last1=Perera|first1=Gihan|last2=Holbrook|first2=Anne|last3=Thabane|first3=Lehana|last4=Foster|first4=Gary|last5=Willison|first5=Donald J.|date=February 2011|title=Views on health information sharing and privacy from primary care practices using electronic medical records|journal=International Journal of Medical Informatics|volume=80|issue=2|pages=94–101|doi=10.1016/j.ijmedinf.2010.11.005|pmid=21167771}}<!--|access-date=2013-10-24--></ref> Moreover, software's traceability features allow the hospitals to collect detailed information about the preparations dispensed, creating a database of every treatment that can be used for research purposes.<ref>{{Cite news|url=http://clustersalud.americaeconomia.com/la-dosis-adecuada/|title=La dosis adecuada |date=23 February 2017 |work=Cluster Salud, La Industria de la vida|access-date=2017-03-02|language=es-ES}}</ref>

==Concepts and definitions==
{{dfn|Health information technology}} (HIT) is "the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, [[health data]], and knowledge for communication and decision making".<ref>Brailer, D. (2004). The decade of health information technology. HHS Report, July, 21.</ref>  [[Technology]] is a broad concept that deals with a species' usage and knowledge of tools and crafts, and how it affects a species' ability to control and adapt to its environment.  However, a strict definition is elusive; "technology" can refer to material objects of use to humanity, such as machines, hardware or utensils, but can also encompass broader themes, including systems, methods of organization, and techniques.  For HIT, technology represents computers and communications attributes that can be networked to build systems for moving health information.  Informatics is yet another integral aspect of [[MEDHOST|HIT]].

[[Informatics (academic field)|Informatics]] refers to the science of [[information]], the practice of [[Data processing|information processing]], and the engineering of [[information systems]].  Informatics underlies the academic investigation and practitioner application of computing and communications technology to healthcare, health education, and biomedical research.  [[Health informatics]] refers to the intersection of information science, computer science, and health care.  Health informatics describes the use and sharing of information within the healthcare industry with contributions from computer science, mathematics, and psychology.  It deals with the resources, devices, and methods required for optimizing the acquisition, storage, retrieval, and use of information in health and biomedicine.  [[Health informatics tools]] include not only computers but also clinical guidelines, formal medical terminologies, and information and communication systems.  [[Medical informatics]], [[nursing informatics]], [[public health informatics]], [[pharmacy informatics]], and [[translational bioinformatics]] are subdisciplines that inform health informatics from different disciplinary perspectives.<ref>{{cite web|title=When Healthcare and Computer Science Collide|url=http://healthinformatics.uic.edu/infographics/when-healthcare-and-computer-science-collide/|website=University of Illinois at Chicago|date=9 September 2014|access-date=18 September 2014}}</ref> The processes and people of concern or study are the main variables.

==Implementation==
The Institute of Medicine's (2001) call for the use of electronic prescribing systems in all healthcare organizations by 2010 heightened the urgency to accelerate United States hospitals' adoption of CPOE systems.  In 2004, President Bush signed an  Executive Order titled the President's Health Information Technology Plan, which established a ten-year plan to develop and implement electronic medical record systems across the US to improve the efficiency and safety of care.  According to a study by [[RAND Health]], the US healthcare system could save more than $81 billion annually, reduce adverse healthcare events and improve the quality of care if it were to widely adopt [[Health informatics|health information technology]].<ref>RAND Healthcare: [http://www.rand.org/pubs/research_briefs/RB9136/index1.html Health Information Technology: Can HIT Lower Costs and Improve Quality?] Retrieved on July 8, 2006</ref>

The [[American Recovery and Reinvestment Act]], signed into law in 2009 under the Obama administration, has provided approximately $19 billion in incentives for hospitals to shift from paper to electronic medical records.  Meaningful Use, as a part of the 2009 [[Health Information Technology for Economic and Clinical Health Act]] (HITECH) was the incentive that included over $20 billion for the implementation of HIT alone, and provided further indication of the growing consensus regarding the potential salutary effect of HIT. The American Recovery and Reinvestment Act has set aside $2 billion which will go towards programs developed by the National Coordinator and Secretary to help healthcare providers implement HIT and provide technical assistance through various regional centers.  The other $17 billion in incentives comes from [[Medicare (United States)|Medicare]] and [[Medicaid]] funding for those who adopt HIT before 2015.  Healthcare providers who implement electronic records can receive up to $44,000 over four years in Medicare funding and $63,750 over six years in Medicaid funding.  The sooner that healthcare providers adopt the system, the more funding they receive.  Those who do not adopt electronic health record systems before 2015 do not receive any federal funding.<ref>{{cite web|title=Centers for Medicare and Medicaid Services|url=https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/EHRIncentivePrograms/}}</ref>

While electronic health records have potentially many advantages in terms of providing efficient and safe care, recent reports have brought to light some challenges with implementing electronic health records.  The most immediate barriers for widespread adoption of this technology have been the high initial cost of implementing the new technology and the time required for doctors to train and adapt to the new system.  There have also been suspected cases of [[Medicare fraud|fraudulent billing]], where hospitals inflate their billings to Medicare.  Given that healthcare providers have not reached the deadline (2015) for adopting electronic health records, it is unclear what effects this policy will have long term.<ref>{{cite news|last=Freudenheim|first=Milt|title=The Ups and Downs of Electronic Medical Records|url=https://www.nytimes.com/2012/10/09/health/the-ups-and-downs-of-electronic-medical-records-the-digital-doctor.html?pagewanted=all&_r=0|newspaper=New York Times|date=2012-10-08}}</ref>

One approach to reducing the costs and promoting wider use is to develop open standards related to EHRs.  In 2014 there was widespread interest in a new [[HL7]] draft standard, [[Fast Healthcare Interoperability Resources]] (FHIR), which is designed to be open, extensible, and easier to implement, benefiting from modern web technologies.<ref name=forbes>{{cite news
 | url=https://www.forbes.com/sites/danmunro/2014/03/30/setting-healthcare-interop-on-fire/
 | title=Setting Healthcare Interop On Fire
 | work=[[Forbes]]
 | author=Dan Munro
 | date=2014-03-30
 | access-date=2014-11-22 }}
</ref>

==Types of technology==
In a 2008 study about the adoption of technology in the United States, Furukawa, and colleagues classified applications for prescribing to include [[Electronic health record|electronic medical records]] (EMR), [[Clinical decision support system|clinical decision support]] (CDS), and [[computerized physician order entry]] (CPOE).<ref>{{cite journal | author = Furukawa M. F., Raghu T. S., Spaulding T. J., Vinze A. | year = 2008 | title =  Adoption Of Health Information Technology For Medication Safety In U.S. Hospitals, 2006| journal = Health Affairs | volume = 27 | issue = 3| pages = 865–875 | doi = 10.1377/hlthaff.27.3.865 | pmid = 18474981 }}</ref> They further defined applications for dispensing to include bar-coding at medication dispensing (BarD), robot for medication dispensing (ROBOT), and [[Automated dispensing cabinet|automated dispensing machines]] (ADM). They defined applications for administration to include electronic [[medication administration record]]s (eMAR) and [[Bar code medication administration|bar-coding at medication administration]] (BarA or BCMA). Other types include [[Health information exchange]].

===Electronic health record (EHR)===
[[Image:EHRadoption.gif|thumb|250px|US medical groups' adoption of EHR (2005)]]
{{main|Electronic health record}}
Although the electronic health record (EHR), previously known as the electronic medical record (EMR), is frequently cited in the literature, there is no consensus about the definition.<ref>Jha, A. K., Doolan, D., Grandt, D., Scott, T. & Bates, D. W. (2008).  The use of health information technology in seven nations.  International Journal of Medical Informatics, corrected proof in-press.</ref>  However, there is consensus that EMRs can reduce several types of errors, including those related to prescription drugs, to preventive care, and to tests and procedures.<ref>American College of Physicians Observer: [http://www.acponline.org/journals/news/sep04/emr.htm How EMR software can help prevent medical mistakes] {{webarchive|url=https://web.archive.org/web/20080830042002/http://www.acponline.org/journals/news/sep04/emr.htm |date=2008-08-30 }} by Jerome H. Carter (September 2004)</ref>  Recurring alerts remind clinicians of intervals for preventive care and track referrals and test results. Clinical guidelines for disease management have a demonstrated benefit when accessible within the electronic record during the process of treating the patient.<ref>{{cite journal | first1 = Kensaku | last1= Kawamoto | first2 = Caitlin A | last2 = Houlihan | first3 = E Andrew | last3 = Balas | first4 = David F | last4 = Lobach | date = 2 Apr 2005 | title = Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success | journal = British Medical Journal | volume = 330 | pages = 765–774 | url = http://bmj.bmjjournals.com/cgi/content/full/330/7494/765 | access-date = 2006-06-29 | doi = 10.1136/bmj.38398.500764.8F | pmid = 15767266 | issue = 7494 | pmc = 555881}}</ref>  Advances in [[health informatics]] and widespread adoption of interoperable electronic health records promise access to a patient's records at any health care site. A 2005 report noted that medical practices in the United States are encountering barriers to adopting an EHR system, such as training, costs and complexity, but the adoption rate continues to rise (see chart to right).<ref>{{cite journal |vauthors=Gans D, Kralewski J, Hammons T, Dowd B | year = 2005 | title = Medical groups' adoption of electronic health records and information systems | journal = Health Affairs | volume = 24 | issue = 5 | pages = 1323–1333 | url = http://content.healthaffairs.org/cgi/content/abstract/24/5/1323 | access-date = 2006-07-04 | doi = 10.1377/hlthaff.24.5.1323 | pmid = 16162580 }}</ref> Since 2002, the [[National Health Service]] of the United Kingdom has placed emphasis on introducing computers into healthcare. As of 2005, one of the largest projects for a national EHR is by the National Health Service (NHS) in the [[United Kingdom]].  The goal of the NHS is to have 60,000,000 patients with a centralized electronic health record by 2010. The plan involves a gradual roll-out commencing May 2006, providing  [[general practice]]s in England access to the [[National Programme for IT]] (NPfIT), the NHS component of which is known as the "Connecting for Health Programme".<ref>NHS Connecting for Health: [http://www.connectingforhealth.nhs.uk/delivery/ Delivering the National Programme for IT] {{webarchive|url=https://web.archive.org/web/20060810215938/http://www.connectingforhealth.nhs.uk/delivery |date=2006-08-10 }} Retrieved August 4, 2006</ref> However, recent surveys have shown physicians' deficiencies in understanding the patient safety features of the NPfIT-approved software.<ref>{{cite journal |author1=C J Morris |author2=B S P Savelyich |author3=A J Avery |author4=J A Cantrill |author5=A Sheikh | year = 2005 | title = Patient safety features of clinical computer systems: questionnaire survey of GP views | journal = Quality and Safety in Health Care | volume = 14 | pages = 164–168 | url = http://qhc.bmjjournals.com/cgi/content/full/14/3/164 | access-date = 2006-07-08 | doi = 10.1136/qshc.2004.011866 | pmid = 15933310 | issue = 3 | pmc = 1744017 }}</ref>

A main problem in HIT adoption is mainly seen by physicians, an important stakeholder to the process of EHR. The Thorn et al. article, elicited that emergency physicians noticed that [[health information exchange]] disrupted workflow and was less desirable to use, even though the main goal of EHR is improving coordination of care. The problem was seen that exchanges did not address the needs of end users, e.g. simplicity, user-friendly interface, and speed of systems.<ref>{{cite journal|last1=Thorn|first1=S.|last2=Carter|first2=M.|last3=Bailey|first3=J.|title=Emergency Physicians' Perspectives on Their Use of Health Information Exchange|url=http://www.annemergmed.com/article/S0196-0644(13)01449-2/abstract|journal=Annals of Emergency Medicine|year=2014|volume=63|issue=3|pages=329–337|doi=10.1016/j.annemergmed.2013.09.024|pmid=24161840}}</ref> The same finding was seen in an earlier article with the focus on [[Computerized physician order entry|CPOE]] and physician resistance to its use, Bhattacherjee et al.<ref>{{cite CiteSeerX|last=Hikmet|first=N.|title=Physicians' Resistance toward Healthcare Information Technologies: A Dual-Factor Model|citeseerx=10.1.1.101.9714}}</ref>

One opportunity for EHRs is to utilize [[natural language processing]] for searches. One systematic review of the literature found that searching and analyzing notes and text that would otherwise be inaccessible for review could be accessed through increasing collaboration between software developers and end-users of natural language processing tools within EHRs.<ref>{{Cite journal|last1=Turchin|first1=Alexander|last2=Florez Builes|first2=Luisa F.|date=2021|title=Using Natural Language Processing to Measure and Improve Quality of Diabetes Care: A Systematic Review|journal=Journal of Diabetes Science and Technology|language=en|volume=15|issue=3|pages=553–560|doi=10.1177/19322968211000831|issn=1932-2968|pmc=8120048|pmid=33736486}}</ref>

===Clinical point of care technology===

====Computerized provider (physician) order entry====
{{Main|Computerized physician order entry}}
Prescribing errors are the largest identified source of preventable errors in hospitals. A 2006 report by the Institute of Medicine estimated that a hospitalized patient is exposed to a medication error each day of his or her stay.<ref name=iom06>{{cite journal | year = 2006 | title = Preventing Medication Errors | last = The Institute of Medicine | journal = The National Academies Press | doi = 10.17226/11623 | isbn = 978-0-309-10147-9 | url = http://www.nap.edu/catalog/11623.html | access-date = 2006-07-21 }}</ref>
Computerized provider order entry (CPOE), also called computerized physician order entry, can reduce total medication error rates by 80%, and adverse (serious with harm to patient) errors by 55%.<ref name="Bates-et_al-1998">{{cite journal | last1 = Bates | first1 = DW | last2 = Leape | first2 = LL | last3 = Cullen | first3 = DJ | last4 = Laird | first4 = N | last5 = Petersen | first5 = LA | last6 = Teich | first6 = JM | last7 = Burdick | first7 = E | last8 = Hickey | first8 = M | last9 = Kleefield | first9 = S | last10 = Shea | first10 = B | last11 = Vander Vliet | first11 = M | last12 = Seger | first12 = DL | date = 21 October 1998 | title = Effect of Computerized Physician Order Entry and a Team Intervention on Prevention of Serious Medication Errors | journal = JAMA | volume = 280 | issue = 15 | pages = 1311–1316 | doi = 10.1001/jama.280.15.1311 | pmid = 9794308 | doi-access = free }}</ref>  A 2004 survey by found that 16% of US clinics, hospitals and medical practices are expected to be utilizing CPOE within 2 years.<ref>{{cite web  | title = Hospital Quality & Safety Survey  | publisher = The Leapfrog Group  | year = 2004  | url = http://www.leapfroggroup.org/media/file/Leapfrog-Survey_Release-11-16-04.pdf  | access-date = 2006-07-08  | url-status = dead  | archive-url = https://web.archive.org/web/20060903214906/http://www.leapfroggroup.org/media/file/Leapfrog-Survey_Release-11-16-04.pdf  | archive-date = 2006-09-03  }}</ref> In addition to electronic prescribing, a standardized [[bar code]] system for dispensing drugs could prevent a quarter of drug errors.<ref name=iom06 /> Consumer information about the risks of the drugs and improved drug packaging (clear labels, avoiding similar drug names and dosage reminders) are other error-proofing measures. Despite ample evidence of the potential to reduce medication errors, competing systems of barcoding and electronic prescribing have slowed adoption of this technology by doctors and hospitals in the United States, due to concern with interoperability and compliance with future national standards.<ref>{{cite news   | last = Kaufman  | first = Marc  | title = Medication Errors Harming Millions, Report Says. Extensive National Study Finds Widespread, Costly Mistakes in Giving and Taking Medicine  | pages = A08  | newspaper = The Washington Post   | date = 2005-07-21  | url = https://www.washingtonpost.com/wp-dyn/content/article/2006/07/20/AR2006072000754.html  | access-date = 2006-07-21 }}</ref> Such concerns are not inconsequential; standards for [[electronic prescribing]] for [[Medicare Part D]] conflict with regulations in many US states.<ref name=iom06 />
And, aside from regulatory concerns, for the small-practice physician, utilizing CPOE requires a major change in practice work flow and an additional investment of time. Many physicians are not full-time hospital staff; entering orders for their hospitalized patients means taking time away from scheduled patients.<ref>[http://www.physicianspractice.com/blog/content/article/1462168/2052940 "Computerized Physician Order Entry: Coming to a Hospital Near You"] {{Webarchive|url=https://web.archive.org/web/20120705111857/http://www.physicianspractice.com/blog/content/article/1462168/2052940 |date=2012-07-05 }} J. Scott Litton, Physicians Practice, March 2012.</ref>

==Technological innovations, opportunities, and challenges==
Handwritten reports or notes, manual order entry, non-standard abbreviations and poor legibility lead to substantial errors and injuries, according to the Institute of Medicine (2000) report.  The follow-up IOM (2004) report, ''Crossing the quality chasm: A new health system for the 21st century'', advised rapid adoption of electronic patient records, electronic medication ordering, with computer- and internet-based information systems to support clinical decisions.<ref>{{cite book | author=Institute of Medicine | year=2001 | url=http://www.nap.edu/books/0309072808/html | title=Crossing the Quality Chasm: A New Health System for the 21st Century | publisher=The National Academies Press | location=Washington, DC | access-date=2006-06-29 | archive-date=2007-06-26 | archive-url=https://web.archive.org/web/20070626083607/http://www.nap.edu/books/0309072808/html/ | url-status=dead }}</ref>  However, many system implementations have experienced costly failures.<ref>Ammenwerth, E., Talmon, J., Ash, J. S., Bates, D. W., Beuscart-Zephir, M. C., Duhamel, A., Elkin, P. L., Gardner, R. M., & Geissbuhler, A. (2006).  Impact of CPOE on mortality rates&nbsp;– contradictory findings, important messages." Methods Inf Med, 45(6): 586-593.</ref> Furthermore, there is evidence that CPOE may actually contribute to some types of adverse events and other medical errors.<ref>Campbell, E. M., [[Sittig, D. F.]], Ash, J. S., Guappone, K. P., & Dykstra, R. H. (2007).  In reply to:  "e-Iatrogenesis: The most critical consequence of CPOE and other HIT.  Journal of the American Medical Informatics Association.</ref> For example, the period immediately following CPOE implementation resulted in significant increases in reported adverse drug events in at least one study,<ref>Bradley, V. M., Steltenkamp, C. L., & Hite, K. B. (2006).  Evaluation of reported medication errors before and after implementation of computerized practitioner order entry.  Journal Healthc Inf Manag, 20(4): 46-53.</ref> and evidence of other errors have been reported.<ref name="Bates-et_al-1998" /><ref>{{cite journal | author = Bates D | year = 2005 | title = Computerized Physician Order entry and medication errors: finding a balance | journal = Journal of Biomedical Informatics | volume = 38 | issue = 4| pages = 250–261 | doi = 10.1016/j.jbi.2005.05.003 | pmid = 15964247 | doi-access = free }}</ref><ref>{{cite journal | author = Bates D.W. | year = 2005 | title = Physicians and ambulatory electronic health records | journal = Health Affairs | volume = 24 | issue = 5| pages = 1180–1189 | doi = 10.1377/hlthaff.24.5.1180 | pmid = 16162561 | s2cid = 26709237 }}</ref> Collectively, these reported adverse events describe phenomena related to the disruption of the [[complex adaptive system]] resulting from poorly implemented or inadequately planned technological innovation.

===Technological iatrogenesis===
Technology may introduce new sources of error.<ref>{{cite journal | author = Ross Koppel | year = 2005 | title = Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors | journal = JAMA | volume = 293 | pages = 1197–1203 | doi = 10.1001/jama.293.10.1197 | pmid = 15755942 | issue = 10 | display-authors = 2 | last2 = Cohen | first2 = A | last3 = Abaluck | first3 = B | last4 = Localio | first4 = AR | last5 = Kimmel | first5 = SE | last6 = Strom | first6 = BL | doi-access = free }}</ref><ref>{{cite news  | last = Lohr  | first = Steve  | title = Doctors' Journal Says Computing Is No Panacea  | work = The New York Times  | date = 2005-03-09 | url = https://www.nytimes.com/2005/03/09/technology/09compute.html?ei=5089&en=402b792e748d99a2&ex=1268110800&adxnnl=1&partner=rssyahoo&adxnnlx=1150474153-xVix1BcYkvTKJpuLyHStrQ  | access-date = 2006-07-15 }}</ref>  Technologically induced errors are significant and increasingly more evident in care delivery systems.  Terms to describe this new area of error production include the label technological [[iatrogenesis]]<ref>{{cite journal | author = Patrick Palmieri | year = 2007 | title = Technological iatrogenesis: New risks force heightened management awareness | journal = Journal of Healthcare Risk Management | volume = 27 | url = http://www.hom.ba.ttu.edu/FordPub/Palmieri_JHCRM_2008_Technological%20iatrogenesis.pdf | pages = 19–24 | access-date = 2008-07-02 | doi = 10.1002/jhrm.5600270405 | pmid = 20200891 | issue = 4 | display-authors = 1 | last2 = Peterson | first2 = Lori T. | last3 = Ford | first3 = Eric W. | url-status = dead | archive-url = https://web.archive.org/web/20081217113718/http://www.hom.ba.ttu.edu/FordPub/Palmieri_JHCRM_2008_Technological%20iatrogenesis.pdf | archive-date = 2008-12-17 }}</ref> for the process  and e-iatrogenic<ref>{{cite journal | author = Weiner | year = 2007 | title =e-Iatrogenesis: The most critical unintended consequence of CPOE and other HIT | journal = Journal of the American Medical Informatics Association | volume = 14 | url = http://www.jamia.org/cgi/reprint/14/3/387.pdf | pages = 387–388 | access-date = 2008-08-24 | doi = 10.1197/jamia.M2338 | pmid = 17329719 | last2 = Kfuri | first2 = T | last3 = Chan | first3 = K | last4 = Fowles | first4 = JB | issue = 3 | pmc = 2244888 | display-authors = 1}}</ref> for the individual error.  The sources for these errors include:
*prescriber and staff inexperience may lead to a false sense of security; that when technology suggests a course of action, errors are avoided.
*shortcut or default selections can override non-standard medication regimens for elderly or underweight patients, resulting in toxic doses.
*CPOE and automated drug dispensing were identified as a cause of error by 84% of over 500 health care facilities participating in a surveillance system by the [[United States Pharmacopoeia]].<ref>{{cite web | last=Santell | first=John P | year=2004 | url=http://www.usp.org/pdf/EN/patientSafety/slideShows2004-12-09.pdf | title=Computer Related Errors: What Every Pharmacist Should Know | publisher=United States Pharmacopia | access-date=2006-06-20 | url-status=dead | archive-url=https://web.archive.org/web/20081120194519/http://www.usp.org/pdf/EN/patientSafety/slideShows2004-12-09.pdf | archive-date=2008-11-20 }}</ref>
*irrelevant or frequent warnings can interrupt work flow

Healthcare information technology can also result in iatrogenesis if design and engineering are substandard, as illustrated in a 14-part detailed analysis done at the University of Sydney.<ref>{{Cite web |url=http://sydney.edu.au/engineering/it/~hitru/index.php?option=com_content&task=view&id=91&Itemid=146 |title=A Study of An Enterprise Health Information System |access-date=2013-04-05 |archive-url=https://web.archive.org/web/20160417222006/http://sydney.edu.au/engineering/it/~hitru/index.php?option=com_content&task=view&id=91&Itemid=146 |archive-date=2016-04-17 |url-status=dead }}</ref> Numerous examples of bias introduced by artificial intelligence (AI) have been cited as the use of AI-assisted healthcare increases. See [[Algorithmic bias]].

==Revenue Cycle HIT==
The HIMSS Revenue Cycle Improvement Task Force was formed to prepare for the IT changes in the U.S. (e.g. the [[American Recovery and Reinvestment Act of 2009]] (HITECH), Affordable Care Act, 5010 (electronic exchanges), ICD-10). An important change to the revenue cycle is the international classification of diseases (ICD) codes from 9 to 10. ICD-9 codes are set up to use three to five alphanumeric codes that represent 4,000 different types of procedures, while ICD-10 uses three to seven alphanumeric codes increasing procedural codes to 70,000. ICD-9 was outdated because there were more procedures than codes available, and to document for procedures without an ICD-9 code, unspecified codes were utilized which did not fully capture the procedures or the work involved in turn affecting reimbursement. Hence, ICD-10 was introduced to simplify the procedures with unknown codes and unify the standards closer to world standards (ICD-11). One of the main parts of Revenue Cycle HIT is charge capture, it utilizes codes to capture costs for reimbursements from different payers, such as CMS.<ref>{{cite web|title=The Future of Revenue Cycle: Preparing for Near-Term Change|url=http://himss.files.cms-plus.com/HIMSSorg/content/files/FutureofRevenueCycleWhitePaper-EDITED5-24NV.pdf|website=HIMSS Revenue Cycle Improvement Task Force|access-date=18 May 2013|url-status=dead|archive-url=https://web.archive.org/web/20131214000714/http://himss.files.cms-plus.com/HIMSSorg/content/files/FutureofRevenueCycleWhitePaper-EDITED5-24NV.pdf|archive-date=14 December 2013}}</ref>

==International comparisons through HIT==
International health system performance comparisons are important for understanding health system complexities and finding better opportunities, which can be done through health information technology. It gives policy makers the chance to compare and contrast the systems through established indicators from health information technology, as inaccurate comparisons can lead to adverse policies.<ref>{{cite web|title=Health system performance comparison: an agenda for policy, information and research (2012)|url=http://www.euro.who.int/en/data-and-evidence/evidence-informed-policy-making/publications/2012/health-system-performance-comparison-an-agenda-for-policy,-information-and-research-2012|website=World Health Organization {{!}} Europe}}</ref>

==See also==
{{Portal|Medicine}}
{{div col|colwidth=30em}}
* [[Artificial intelligence in healthcare]]
* [[Bioinformatics]]
* [[Clinical documentation improvement]]
* {{sectionlink|Computer security|Medical systems}}
* [[Consumer health informatics]]
* [[eHealth]]
* [[European Institute for Health Records]] (EuroRec)
* [[Health data]]
* [[Hospital information system]]
* [[Imaging informatics]]
* [[List of open source healthcare software]]
* [[Medical imaging]]
* [[mHealth]]
* [[Patient safety]]
* [[Patient tracking system]]
* [[Personal health record]]
* [[Information technology]]
* [[Picture archiving and communication system]]
* [[Radiology information system]]
* [[Software programs for pharmacy workflow management]]
* [[Computer science]]

{{div col end}}
<!-- please keep entries in alphabetical order -->

==References==
{{reflist}}

==Further reading==
* {{cite journal | author = Ash J. S., Sittig D. F., Poon E. G., Guappone K., Campbell E., Dykstra R. H. | year = 2007 | title = The extent and importance of unintended consequences related to computerized provider order entry | journal = Journal of the American Medical Informatics Association | volume = 14 | issue = 4| pages = 415–423 | doi = 10.1197/jamia.m2373 | pmid = 17460127 | pmc = 2244906 }}
*[[Margo Edmunds|Edmunds M]], Peddicord D, [[Don E. Detmer|Detmer DE]], [[Edward Shortliffe|Shortliffe E]].  Health IT Policy and Politics:  A Primer on Moving Policy Into Action. Featured Session, American Medical Informatics Association Annual Symposium (2009).  Available as a webinar at https://knowledge.amia.org/amia-55142-a2009a-1.626575?qr=1.
* {{cite journal | author = Holden Richard J., Brown Roger L., Alper Samuel J., Scanlon Matthew C., Patel Neal R., Karsh Ben-Tzion | year = 2011 | title = That's nice, but what does IT do? Evaluating the impact of bar coded medication administration by measuring changes in the process of care | journal = International Journal of Industrial Ergonomics | volume = 41 | issue = 4| pages = 370–379 | doi = 10.1016/j.ergon.2011.02.007 | pmid = 21686318 | pmc = 3113497 }}
*{{cite journal |vauthors=Mettler T |title=Anticipating mismatches of HIT investments: Developing a viability-fit model for e-health services |journal=International Journal of Medical Informatics |volume=85 |issue=1 |pages=104–115 |year=2016 |doi=10.1016/j.ijmedinf.2015.10.002 |pmid=26526279 }}
* Moore, An'nita & Fisher, Kathleen (2012, March). Healthcare Information Technology and Medical-Surgical Nurse: The Emergence of a New Care Partnership.  Computers, Informatics, Nursing, 30(3),157-163.
* Milstein, Julia A. & Bates, David W. (2010, March–April). Paperless healthcare: Progress and challenges of an IT-enabled healthcare system. Business Horizons, 53(2), 119–130.
*{{cite journal | author = Sidrov J | year = 2006 | title = It ain't necessarily so: The electronic health record and the unlikely prospect of reducing healthcare costs | journal = Health Affairs | volume = 25 | issue = 4| pages = 1079–1085 | doi = 10.1377/hlthaff.25.4.1079 | pmid = 16835189 | doi-access = free }}
*Snedaker, Susan, Leading Healthcare IT: Managing to Succeed, Taylor & Francis Group, LLC, Boca Raton, FL, 2017. {{ISBN|978-1-4987-7409-3}}.

==External links==
<!-- NOTE - THIS IS NOT THE PLACE FOR LINKS TO COMMERCIAL SOFTWARE PROVIDERS -->
* [https://web.archive.org/web/20080916045057/http://www.hrsa.gov/healthit/  Health Resources and Services Administration (HRSA)]
* [https://www.healthit.gov Health Information Technology] at US Department of Health & Human Services

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