A Decade of Health Information Technology and the Impact on Health Care in the U.S.: Systematic Review (Preprint)

Abstract

BACKGROUND In 2004, the Office of the National Coordinator for Health Information Technology (ONC) was established to facilitate the nationwide adoption and use of health information technology (health IT). Since its inception, the health IT landscape has evolved with a diverse array of federal investments, programs, and policies to advance its use. Previous systematic reviews of literature related to health IT focused on assessing the adoption and use of technology. As health IT has evolved, research has pivoted from tracking adoption of specific health IT features to assessing the impact of these technologies and tools. OBJECTIVE This paper provides a comprehensive review of peer-reviewed publications published over the past decade to closely examine the impacts of health IT including the impact of federal policies, changing priorities, and how the expanded use of EHR features, and effect of health IT on people, processes, and outcomes. METHODS All health IT-related peer-reviewed published between January 2013 and June 2023 were evaluated to identify articles that focused on the impact of health IT. Articles and studies were extracted through a review of PubMed. A stepwise process was used to identify articles that met the inclusion criteria, focused on the impact of health IT, and demonstrated sufficient scientific rigor. RESULTS The resulting 408 articles were coded based on their primary focus (provider-facing or patient-facing technology), or based on topics that pertained to the systemwide use of health IT. Within each of these categories, articles were organized around key themes. Overwhelmingly, research studies reported that health IT generated a positive impact. More than half of all articles focused on provider-facing technology with a focus on measurable outcomes including quality, safety, and costs. A number of studies evaluated the increased use of patient portals and other tools to support engagement. Studies on interoperability highlighted the value of increased health information exchange. An emerging area of study included a focus on the role of health IT in advancing public and population health. Over three-quarters of the published literature concluded that health IT generated a positive, mixed, or neutral impact. These effects were consistent across the different categories of health IT that were examined whether provider-facing, patient-facing, or systemwide impact of health IT. CONCLUSIONS Over the past decade, the focus of studies on the impact of health IT has evolved, transitioning from a concentration on health IT adoption to optimizing its potential. This includes assessing the effectiveness of EHR functions as well as increasing information exchange. As the landscape evolved with broader acceptance of health IT, the focus shifted with greater interest in technology’s impact on patient engagement, and opportunities to use data to advance health care including population and public health. CLINICALTRIAL N/A