Improving information technology adoption and implementation through the identification of appropriate benefits: creating IMPROVE-IT
Leonard KJ, Sittig DF. Improving information technology adoption and implementation through the identification of appropriate benefits: creating IMPROVE-IT. J Med Internet Res. 2007 May 4;9(2):e9.
For years, health IT has been implemented with the goals of improving clinical care processes, health care quality, and patient safety. It is believed to be the right thing to do. Vast amount of research has been done to prove its value but due to the complexity of the clinical setting it’s been difficult to establish. It is difficult to predict the impact of an implementation. As the investment in health IT is high, the need to know the true value of the implementation and its outcomes is absolutely essential. [1] This article attempts to provide the evidence that “increased information technology (IT) capabilities, availability, and use lead directly to improved clinical quality, safety, and effectiveness within the inpatient hospital setting”. The authors believe that the preliminary steps in measuring the overall impact, is in measuring the extent to which these clinical information systems (CIS) have been deployed and are being used. The goal of the IMPROVE-IT (indices measuring performance relating outcomes, value and expenditure through information technology) project was to demonstrate the relationship between IT and improved health outcomes. As a first step towards this goal they hosted a conference (November 11-12, 2004, Toronto, Canada) to gather the perspectives of the various stakeholders and to define the ideal metrics and how to measure them.
Measurements were decided to be implemented in phases; namely in three phases. Phase I would consist of the measurements required to demonstrate “availability” of the systems. Phase II would consist of the measurements required to demonstrate “use” of the systems. And Phase III would consist of the measurements required to demonstrate the effect of these systems on various performance measures. While many previous researchers have formulated technically oriented evaluations the authors believed focus needed to be on clinician behavior rather than technical attributes.
Three areas of focus were designated. (1) IT costs, which included both initial and ongoing investment in hardware & software over the last year, the cost of the human resources needed to operate and manage the new technology and the cost of office space in square feet required to house the IT personnel and hardware for the organization. (2) IT infusion, which included system availability, adoption, and deployment. System availability was to be measured using three indicators, the number of clinical applications that were available to 50% or more of the clinicians in an organization, the percentage of time the CIS was available for use by clinicians and the total number of unique patients with some type of clinical data available in the clinical repository. CIS use was measured by percentage of clinicians who actually log in to the system more than one time each day, percentage of patients with a completed chart within 24 hours of their hospital discharge or outpatient visit and application-specific use measures. (3) Health performance, measures selected were those that virtually all US hospitals were already making. The measures developed by the Center for Medicare and Medicaid Services as part of their National Voluntary Hospital Reporting Initiative were chosen to represent this area. Hospitals were required to report their performance in three areas of care; Acute Myocardial Infarction (AMI), Congestive Heart Failure (CHF) and Community Acquired Pneumonia (CAP).
In addition to these measurements each hospital was to be categorized according to size and type of hospital and the type of IT implemented in order to be consistent within peer groups.The IMPROVE-IT project intended to demonstrate the positive influence of IT on healthcare. Often quantitative evaluations alone can be misleading and it is essential to conduct qualitative analysis concomitantly. [1] The article describes a very comprehensive and easily customizable evaluation procedure with focus on the financial, utility and performance aspects of a clinical system in relation to health care.
