Essays on the Economic and Clinical Impact of Health Information Technology




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The U.S. healthcare system is characterized as inefficient, with excessive expenditure but low care quality. Recent healthcare reform aims to address these concerns and advocates health information technology (IT) as a key component to assist in this goal. In this dissertation, we study the role of health IT innovations under the value-based care structure in reducing cost, boosting quality of care, and improving healthcare efficiency. In the first essay, we focus on the Medicare Accountable Care Organization (ACO) program, which is a major healthcare payment reform initiative. We find that electronic health record (EHR) as an enabler of health information exchange enhances the association between ACO efficiency and quality of care. Our results indicate that meaningful use of EHR contributes to the capability to pursue both performance dimensions with respect to delivery of high-quality care in an efficient manner. In the second essay, we further verify that health information sharing is beneficial in terms of shorter emergency department wait time, reduced inpatient expense, and lower length of stay. However, it is not easy to exchange patient health records across providers. We empirically show that hospitals that adopt electronic medical records (EMR) from commercial vendors are more likely to exchange clinical data when compared to hospitals that use self-developed EMR systems. We also find that both participating in a health information exchange (HIE) and using the same EMR as other regional peer hospitals contribute to the capability of communicating patient data. In the third essay, we focus on patient-centric health IT, termed “patient portals”. We examine the impact of effective usage of patient portal technologies on health outcomes of congestive heart failure patients. We observe that frequent usage of clinical-oriented features, including viewing lab results, requesting medication refills and advice, and interactive messaging with providers, is associated with improvements in several health outcome measures with respect to the frequency of inpatient and emergency visits, readmission risk, and length of hospital stay. Collectively, this dissertation reveals the impact and the mechanism through which health IT systems are improving healthcare delivery, thereby providing a foundation to better understand the role of health IT in the era of healthcare reform. We posit that our findings provide implications associated with the adoption and usage of health IT for healthcare practitioners and policy makers, in an endeavor to revive the U.S. healthcare system.



Medical care—Information technology, Medical records—Data processing, Medical informatics, Medical care—Evaluation, Outcome assessment (Medical care), Medical care, Cost of


©2019 Chenzhang Bao