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Literature Review
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Literature Review

Introduction

The topic of this literary review is the enhancements and profitability that the use of

technology can bring to smaller healthcare facilities. Some smaller facilities may be reticent to

adopt new technologies due to a number of factors. The aim of my doctoral study is to show that

the expenses demanded technology is worth the while by making the smaller practices more

profitable.

Qualitative Review

Zinszer, Tamblyn, Bates, and Buckeridge (2013) conducted a qualitative study in the

Canadian public health system. The results revealed that health information technologies

enhanced and improved communications between provinces. Also, a better understanding of the

necessity for interoperable systems was increased. The implementation of health information

technologies presented a challenge due to the reticence of facilities to incorporate them into their

practices (Zinser, et. al., 2013). More evidence and data need to be shown that would encourage

a more enthusiastic approach to including health information technologies, which the study did

not provide to their participants.

Kim, Coiera, and Magrabi (2017) conducted a study to determine problems with the

delivery of health care and patient outcomes as a result of issues with health information

technology. The authors found that a key component that the majority of the 34 studies involved

that restricted information technology problems was commission. Specifically, the user

interfaces of the information technology programs and software were such that it was obtuse for

the health professional to adequately and successfully use it. Consequently, the delivery of care

was delayed, system access was limited, and software updates caused further delays (Kim,
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Coiera & Magrabi, 2017). Information technology products need to be made to both alleviate

unnecessary delays and make their ubiquity validated through a simpler user interface and

updates that do not cause delays or are intrusive.

Das, Yaylacicegi, and Menon (2011) conducted a longitudinal study of the effect of

information technology in hospitals and the associated economic value. The study used 26 years

of data to determine any lag presented by information technology in addition to the effect

information technology had on costs and labor productivity. The results showed that when

healthcare facilities invest in information technology there are improvements to key areas. For

instance, medical labor productivity is improved along with administrative labor productivity

(Das, Yaylacicegi & Menon, 2011). However, the use of information technology did not have a

marked reduction in operating costs. While a decrease in operational costs would be a strong and

weighted incentive for smaller healthcare facilities to invest in information technology, so too

could be pointing out that their introduction will not increase operational costs. The focus would

then be on the other benefits of using information technology such as labor productivity,

communication, and data exchange.

Quantitative Review

Ammenworth, Graber, Herrmann, Burkle, and Konig (2003) conducted an evaluation of

information systems with a focus on the problems and challenges presented with facilities that

use information systems. The authors found that one issue with the introduction of information

technology is that it is not successfully introduced quickly or rapidly. It takes time to fully

integrate information technology. Users have to get used to the new tools and programs they are

using. Also, the evaluation of results from using information technology can change during the

first phase of use, leading to changes in quality. This change in quality is one that is ongoing and
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steady throughout the initial phase and beyond. The authors present that in a flexible healthcare

environment, a stable situation for evaluation results is nearly impossible to achieve.

Furthermore, there are variances in the workflow and used functionality of information

technology among different healthcare facilities (Ammenworth, et.al., 2003). The authors

propose that a long-term perspective be used to allow enough time for the information systems to

be ingratiated into the environment. More attention should also be given to the potential

unfavorable effects that may accompany the introduction and use of information technology.

Areas to focus on would be patient care and effects on workflows.

Kruse, Bolton, and Freriks (2015) studied the effect that patient portals have on quality

outcomes for patients with chronic conditions. The authors used articles from CINAHL,

PubMed, Google Scholar. The authors found that in the 27 articles that were analyzed out of

4000 that were screened, a small number of them associated patient portals with improved

outcomes. However, the results of the study did find that there were improvements to patient

adherence to medication requirements, self-management of disease, and disease awareness.

Also, there was a decrease in office visits. This decrease in office visits could have been a direct

result of an increase in preventative medicine and extended office visits through the use of

patient portals (Kruse, Bolton & Freriks, 2015). A limitation of this article is the fact that full

patient portals were not studied, but rather only a few features of the patient portal. To have a

better grasp and obtain a more substantive result, a more encompassing approach to patient

portals and their effects on quality outcomes needs to be done.

Kannisto, Koivunen, and Valimaki (2014) researched the impact of text messages

received by patients from their healthcare providers regarding services and appointment

reminders. The authors used the databases of PubMed, MEDLINE, Proquest, EMBASE,
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Cochrane Library, and CINAHL, as well as hand searching since 2003. The authors also

included the use of SMS text messages that were used as reminders for patient appointments and

services. The authors selected 60 studies out of the initial 911 for their review. They found that

in 73% of the studies, text message reminders were used as the only means of intervention. SMS

was linked to another, more comprehensive health intervention system in the remaining 27% of

the studies. The most common recipients of SMS messages were patients suffering from

HIV/AIDS at 15% and patients with diabetes at 13%. Text messages were sent on a routine,

daily basis (Kannisto, Koivunen & Valimaki, 2014). The study revealed that using SMS to

contact patients yielded improved patient outcomes. This is intuitive, as direct communication

with patients means a higher probability that the healthcare providers instructions and message

will be received and that the patient is more likely to follow. More studies should be conducted

on the impact SMS messages may have on patients and how this affects the healthcare facility

and their overall profitability.

Conclusion

There exists a dearth of information on the impact and usefulness of information

technology in healthcare. The studies discussed in this literature review are but a small portion

of the total. Yet, these articles offer a glimpse into how information technology has impacted the

healthcare field, and how the healthcare field has responded to that impact. Additionally, the

benefit for patients can be seen through the results of these studies. When patients are promoted

back to health, and with oftentimes fewer required visits due in part to information technology,

the healthcare facility benefits by reputation and value of given care.

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References

Ammenwerth, E., Gräber, S., Herrmann, G., Bürkle, T., & König, J. (2003). Evaluation of health

information systems—problems and challenges. International Journal of Medical

Informatics, 71(2), 125–135. doi:10.1016/S1386-5056(03)00131-X

Das, S., Yaylacicegi, U., & Menon, N. (2011). The Effect of Information Technology

Investments in Healthcare: A Longitudinal Study of its Lag, Duration, and Economic

Value. (2011). IEEE Transactions on Engineering Management, Engineering

Management, IEEE Transactions on, IEEE Trans. Eng. Manage, (1),

124. doi:10.1109/TEM.2010.2048906

Kannisto, K. A., Koivunen, M. H., & Välimäki, M. A. (2014). Use of mobile phone text message

reminders in health care services: a narrative literature review. Journal Of Medical

Internet Research, 16(10), e222. doi:10.2196/jmir.3442

Kim, M. O., Coiera, E., & Magrabi, F. (2017). Problems with health information technology and

their effects on care delivery and patient outcomes: a systematic review. Journal Of The

American Medical Informatics Association: JAMIA, 24(2), 246–250.

doi:10.1093/jamia/ocw154

Kruse, C. S., Bolton, K., & Freriks, G. (2015). The effect of patient portals on quality outcomes

and its implications to meaningful use: a systematic review. Journal Of Medical Internet

Research, 17(2), e44. doi:10.2196/jmir.3171

Zinszer, K., Tamblyn, R., Bates, D. W., & Buckeridge, D. L. (2013). A qualitative study of
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health information technology in the Canadian public health system. BMC Public

Health, 13, 509. doi:10.1186/1471-2458-13-509