Another study, demonstrating the clinical utility of Clinical Information Technology (CIT)—including some positive influence on mortality and cost of care, albeit in non-oncology conditions, was published earlier this year. Use of the four domains of information technology (test results, notes and records, order entry, and decision-support) in the inpatient setting was studied in a statstically valid selection of forty-one Texas hospitals and reported here with a comment by David Bates here. This has drawn the attention of The Economist, which has a special section on health care technology.

Study Methods

The Texas hospitals were studied by surveying individual physicians and matching their responses to the hospitals in which they practiced. The survey tool—Clinical Information Technology Assesment Tool (CITAT)—was developed as described here and here. The survey tool inquired about the physician's use of technology to retrieve test results, to record notes and read records, to enter orders, and to use the technology's decision support tools. Answers were scored from 0-100. Three factors were were "required to achieve a high score on any individual item: the information process must be available as a fully computerized process; the physician must know how to activate the computerized process; and he or she must choose the computerized process over other alternatives." Note that in order to score highly, the technology had to actually be used by the doc.

Dependent or outcome variables were mortality, complications, costs, and length of stay (LOS). No cancer diagnoses were studied, but they focused on four conditions—myocardial infarction, heart failure, coronary artery bypass grafting, and pneumonia.

Information Technology Adoption

Highest scores were in the domain of test results (CITAT score of 50.1)—many of the physicians had access to, and used the HIT for retrieving lab and test results. The lowest score (2.6) was for decision support. Notes and records scored 28.5, and order entry scored 3.7.

Mortality Reduction, Complication Reduction, Cost Reduction

For all medical conditions studied, a 10-point increase in the automation of notes and records was associated with a 15% decrease in the adjusted odds of fatal hospitalizations (0.85; 95% confidence interval, 0.74-0.97). Higher scores in order entry were associated with 9% and 55% decreases in the adjusted odds of death for myocardial infarction and coronary artery bypass graft procedures, respectively. For all causes of hospitalization, higher scores in decision support were associated with a 16% decrease in the adjusted odds of complications (0.84; 95% confidence interval, 0.79-0.90). Higher scores on test results, order entry, and decision support were associated with lower costs for all hospital admissions (–$110, –$132, and –$538, respectively; P
My Take on This

First of all, this is survey data, and not the result of a randomized clinical trial. This is a useful result for those of us evangalists for health information technology. To be fair, it should be repeated, but it fits with my prejudice.

Nonetheless, the survey is large, it surveyed the actual users of the technology, and seemed to use a validated instrument. However, the results are hard for me to relate to my world. I use a notes and records, as well as a lab and results, all of time whenever I practice, but seldom use electronic order entry, and never have decision support available. It's hard for me to know what my score would be for each domain.

Furthermore, it's hard to conceive of practicing in a hospital which doesn't have an automated test result reporting system that is not used by physicians. The ubiquity of these systems, in my experience, makes it hard for me to believe that their score was only ~50. I would think that every doc would demand this technology, and make maximum use of it when available. Either I don't understand the scoring system, or there are some docs out there who rely on paper lab and radiology reports.

The results in mortality reduction, complications and costs are all generally in the same direction, favoring use of HIT. Some reached statistical significance. One explanation for the positive results is that adoption of HIT is a surrogate marker for a good hospital—a hospital and medical staff who would deliver good care without the health information technology. There may be correlation with these outcomes with adoption of other technology—advanced imaging technology, or advanced surgery or cardiac catheterization technology.