Morton, PhD; Paul G. The authors of this article are responsible for its contents.
No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality. Statements made in this publication do not represent the official policy or endorsement of the Agency or the U. They also thank Drs. This work was produced under Agency for Healthcare Research and Quality contract no.
Department of Health and Human Services. Requests for Single Reprints: Wu, Mojica, and Shekelle, Ms. Experts consider health information technology key to improving efficiency learn more here quality of health care.
To systematically review evidence on the effect of health information technology on quality, efficiency, and costs of health care. We also added studies identified by experts up to April Two reviewers independently extracted information on system capabilities, design, effects on quality, system acquisition, implementation context, and costs. Most studies addressed decision support systems or electronic health records.
Three major benefits on quality were demonstrated: The primary domain of improvement was preventive health. The major efficiency benefit shown was decreased utilization of care. Data on another efficiency measure, time utilization, were mixed.
Empirical cost data were limited. Available quantitative research was limited and was done by a small number of institutions. Systems were heterogeneous and sometimes incompletely described. Available financial and contextual data were limited.
A Literature Review of Safety Culture the current endeavor was to conduct a review of the safety culture literature in order HSS Office of Health, Safety and. Literature Review On The Workplace If there is lack of proper health and safety measures then As according to the literature review the work environment is. Health Training A Literature Review Prepared by: Occupational safety and health training remains a fundamental work that offered the most positive evidence. Literature Review: Road Safety Work Group Background: Preventing injuries from road traffic collisions is simultaneously one of the greatest public health.
Four benchmark institutions have demonstrated the efficacy of health information technologies in improving quality and efficiency. Whether and how other institutions can achieve similar benefits, and at what costs, are unclear. Health Information Technology Frameworks. Search flow for health information technology HIT literature. All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP.
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Unauthorized use of the In the Clinic slide sets will constitute copyright infringement. Healthcare Delivery and Policy. Sign In Set Up Account. You will be directed to acponline. Open Athens Shibboleth Log In. Subscribe to Annals of Internal Medicine. Improving Patient Care is a special section within Annals supported in part by the U. Improving Patient Care 16 May Descriptive and comparative studies and systematic reviews of health information technology.
Health information technology has been shown to improve quality by increasing adherence to guidelines, enhancing disease surveillance, and decreasing medication errors.
Much of the evidence on quality improvement relates learn more here primary and secondary preventive care.
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The major efficiency benefit has been decreased utilization of care. Effect on time utilization is mixed. Empirically measured cost data are limited and inconclusive. Most of the high-quality literature regarding multifunctional health information technology systems comes from 4 benchmark research institutions.
Little evidence is available on the effect of multifunctional commercially developed systems. Little evidence is available on interoperability and consumer health information technology. A major limitation of the literature is its generalizability. Health care experts, policymakers, payers, and consumers consider health information technologies, such as electronic health records and computerized provider order entry, to be critical to transforming the health care industry Information management is fundamental to health care delivery 8.
Given the fragmented nature of health care, the large volume of transactions Literature Review On Health And Safety At Work the system, the need to integrate new scientific evidence into practice, and other complex information management activities, the limitations of paper-based information management are intuitively apparent. While the benefits of health information technology are clear in theory, adapting new information systems to health care has proven difficult and rates of use have been limited Most information technology applications have centered on administrative and financial transactions rather than on delivering clinical care The Agency for Healthcare Research and Quality asked us to systematically review evidence on the costs and benefits associated with use of health information technology and to identify gaps in the literature in order to provide organizations, policymakers, clinicians, and consumers an understanding of the effect of health information technology on clinical care this web page evidence report at www.
From among the many possible benefits and costs of implementing health information technology, we focus here on 3 important learn more here We used expert opinion and literature review to develop analytic frameworks Table that describe the components involved with implementing health information technology, types of health information technology systems, and the functional capabilities of a comprehensive health information technology system We modified a framework for clinical benefits from the Institute of Medicine's 6 aims for care 2 and developed a framework for costs using expert consensus that included measures such as initial costs, ongoing operational and maintenance costs, fraction of health information technology penetration, and productivity gains.
Financial benefits were divided into monetized benefits that is, benefits expressed in dollar terms and nonmonetized benefits that is, benefits that could not be directly expressed in dollar terms but could be assigned dollar values.
See the full list of search terms and sequence of queries in the full evidence report at www. We also searched the Cochrane Central Register of Controlled Trials, the Cochrane Database of Abstracts of Reviews of Effects, and the Periodical Abstracts Database; hand-searched personal libraries kept by content experts and project staff; and mined bibliographies of articles and systematic reviews for citations. We asked content experts to identify unpublished literature.
Finally, we asked content experts and peer reviewers to identify newly published articles up to April Two reviewers independently selected for detailed review the following types of articles that addressed the workings or implementation of a health technology system: We further categorized hypothesis-testing studies for example, randomized and nonrandomized, controlled trials, controlled before-and-after Literature Review On Health And Safety At Work according to whether a concurrent comparison group was used.
Hypothesis-testing studies without a concurrent comparison group included those using Literature Review On Health And Safety At Work pre—post, time-series, and historical control designs. Remaining hypothesis-testing studies were classified as cross-sectional designs and other. These studies typically used hybrid methods—frequently mixing primary data collection with secondary data collection plus expert opinion and assumptions—to make quantitative estimates for data that had otherwise not been empirically measured.
Cost-effectiveness and cost-benefit studies generally fell into this group. Two reviewers independently appraised and extracted details of selected articles using standardized abstraction forms and resolved discrepancies by consensus. We then used narrative synthesis methods to integrate findings into descriptive summaries.
We grouped syntheses by institution and by whether visit web page systems were commercially or internally developed. The funding sources had no role in the design, analysis, or interpretation of the study or in the decision to submit the manuscript for publication. Of articles, we rejected during initial screening: Of the remaining articles, we excluded descriptive reports that did not examine barriers Figure.
We recorded details of and summarized each of the articles that we did include in an interactive database healthit. Twenty-four percent of all studies came from the following 4 benchmark institutions: The reports addressed the following types of primary systems: Of the hypothesis-testing studies, 84 contained some data on costs. Several studies assessed interventions with limited functionality, such as stand-alone decision support systems Such studies provide limited information about issues that today's decision makers face when selecting and implementing health information technology.
Thus, we preferentially highlight in the following paragraphs studies that were conducted in the United States, that had empirically measured data on multifunctional systems, and that included health information and data storage in the form of electronic documentation or order-entry capabilities.
Predictive analyses were excluded.
Health and Safety Executive A literature review of the health and safety This report and the work it describes were funded by the Health and Safety Executive. European Agency for Safety and Health at Work. Emergency Services: A Literature Review on Occupational Safety and Health Risks. Wellbeing at work: creating a positive work environment. Authors. A report prepared for the European Agency for Safety and Health at Work, EU-OSHA, by the Topic. The business benefits of health and safety. A literature review June Edition 1 cocktail24.info ‘Leading occupational health and safety at work. Review of Literature on Health & Safety. Literature Review on Health & Safety To provide a framework for epidemiological research on work and health that.
Seventy-six studies met these criteria: The health information technology systems evaluated by the benchmark leaders shared many characteristics.
All the systems were multifunctional and included decision support, all were internally developed by research experts at the respective academic institutions, and all had capabilities added incrementally over several years.
Furthermore, most reported studies of these systems used research designs with high internal validity for example, randomized, controlled trials. Appendix Table 1 provides a structured summary of each study from the 4 benchmark institutions. This table also includes studies that met inclusion criteria not highlighted in this synthesis 26, 27, 30, 39, 40, 53, 62, 65, 70, The data supported 5 primary themes 3 directly related to quality and 2 addressing efficiency.
Implementation of a multifunctional health information technology system had the following effects: The major effect of health information technology on quality of care was its role in increasing adherence to guideline- or protocol-based care. Decision support, usually in the form of computerized reminders, was a component of all adherence studies.
The decision support functions were usually embedded in electronic health records or computerized provider order-entry systems. Electronic health records systems were more frequently examined in the outpatient setting; provider order-entry systems were more often assessed in the inpatient setting.
Improvements in processes of care delivery ranged from absolute increases of 5 to 66 percentage points, with most increases clustering in the range of 12 to 20 percentage points. Twelve of the 20 adherence studies examined the effects of health information technology on enhancing preventive health care delivery 18,29,35, Eight studies included measures for primary preventive care 18,31, 334 studies included secondary preventive measures 29, 33, 35, 37and 1 study assessed screening not mutually exclusive The most common primary preventive measures examined were rates of influenza vaccination improvement, 12 read more 18 percentage pointspneumococcal vaccinations improvement, 20 to 33 percentage pointsand fecal occult blood testing improvement, 12 to 33 percentage points 18, 22, Three studies examined the effect of health information technology on secondary preventive care for complications related to hospitalization.