The push is on to bring the U. S. health care system into the digital age by replacing paper-based systems now used at many medical facilities with electronic medical records systems and other information technology (IT) tools. To understand how best to realize the benefits these systems can provide, a team of experts at Worcester Polytechnic Institute (WPI) has launched a three-year study of health information technology (HIT) systems now in various stages of implementation at four medical organizations—two in the United States and one each in Canada and Israel.
Funded by a $750,000 grant from the National Science Foundation, the study will focus on the primary care setting to examine and analyze how implementing HIT systems impacts medical providers, their patients, and the operations of the health care delivery system. The goal of the study is to develop new insights and best practices to help guide future HIT implementations at other medical facilities. “Adapting to computer systems will be a learning process for primary care organizations, for physicians, and even for patients,” said Diane Strong, Ph.D., professor of management at WPI. “From what we observe, we will develop new ideas and new concepts for health care delivery, such as better ways of organizing work flow and decision making to take advantage of the new opportunities enabled by these IT systems.”
Strong and colleagues Sharon Johnson, Ph.D., associate professor of industrial engineering, and Isa Bar-On, Ph.D., professor of mechanical engineering, are the principal investigators leading the study. The team has extensive experience analyzing the impact of IT systems in other large organizations, such as global manufacturing companies, which have been using enterprise-wide computer systems for decades, with varying degrees of success. “As we’ve seen in many other complex organizations, just installing an IT system alone typically doesn’t achieve efficiencies,” Johnson said. “What has to happen is that an organization and its processes need to adapt to realize the efficiencies and quality improvements that are enabled by IT—and that’s tough to do. If processes don’t adapt, then just imposing at IT system alone can be counter-productive.”
In the United States, the study will focus on two organizations in Massachusetts: Fallon Clinic, a large group medical practice located throughout Central Massachusetts, and UMass Memorial Heath Care, an integrated medical system with 700 primary care physicians, several community hospitals, and an academic medical center serving Central New England. In Canada, which has universal coverage and a single-payer funding system, the study will include primary care offices of the Vancouver Coastal Health District. In Israel, which has a hybrid health care delivery model with four health funds that provide medical care to the entire population, the study will examine primary care practices in two of the health funds.
These four sites were chosen because of their diversity of operating models, management structures, financial systems and cultural differences. The sites are all at different points on the continuum of migrating from paper-based systems to fully digital systems, giving the researchers a broader range of perspectives and data for analysis. Israel, for example, has the most extensive experience with HIT, with more than 90-percent of physicians there already using the technology. “Looking at the experience in Israel will give us a reality check,” Professor Bar-On said. “We’ll see what works, and what doesn’t, and learn from people who have been using these systems for more than 10 years. And we will examine how the organization changes in response to the implementation of these systems. We want to see how people live with the systems.”
Over the course of the three-year study, the research team, working closely with the leadership at each of the primary care sites, will conduct an extended series of interviews and observational sessions with physicians, management and support staff. The researchers will observe the planning for HIT implementations and the roll-out of the systems in various locations, and examine how management and staff adapt to the new systems and tools.
“We are fortunate to have outstanding partners at the four clinical sites to work with on this project,” Professor Strong said. “We are not evaluating any particular software package or software vendor. Our focus is on how organizations must adapt to realize the potentially transformative benefits that can be achieved by the use of these new systems and the data they will collect.”