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The Diffusion and Value of Healthcare Information Technology

The Diffusion and Value of Healthcare Information Technology

Anthony G. Bower
Copyright Date: 2005
Edition: 2
Published by: RAND Corporation
Pages: 98
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  • Book Info
    The Diffusion and Value of Healthcare Information Technology
    Book Description:

    This report characterizes the diffusion of use of electronic health records (EHRs). The author uses interviews and surveys and a literature review to investigate whether healthcare is expected to duplicate the gains enabled by information technology seen in several prominent industries. To accomplish this, the following questions are asked: What is the current diffusion of health information technology? How does EHR diffusion compare to innovations in other industries? What is such diffusion worth to society? What should the government do, if anything, to speed the adoption of EHRs?

    eISBN: 978-0-8330-4069-5
    Subjects: Technology, Health Sciences, Management & Organizational Behavior, Business

Table of Contents

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  1. Front Matter
    (pp. i-ii)
  2. Preface
    (pp. iii-iv)
  3. Table of Contents
    (pp. v-vi)
  4. Figures
    (pp. vii-viii)
  5. Tables
    (pp. ix-x)
  6. Summary
    (pp. xi-xvi)
  7. Acknowledgments
    (pp. xvii-xviii)
  8. Acronyms
    (pp. xix-xx)
  9. CHAPTER ONE Introduction
    (pp. 1-4)

    In 2002, the United States spent approximately 15 percent of its gross domestic product (GDP) on healthcare (National Health Expenditure Statistics, 2004). This spending represents the highest proportion in the world and the largest single sector of the U.S. economy. And yet, virtually no one would argue that it is spent efficiently. Americans are not much healthier than citizens in other nations, despite the mammoth expenditures.

    There is a well-documented productivity renaissance in the U.S. economy, dating from the mid-1990s (see Nordhaus, 2002, for example). A number of prominent industries, including wholesaling and retailing, have greatly increased productivity over the...

  10. CHAPTER TWO What Is the Current Diffusion of HIT?
    (pp. 5-10)

    We researched the current diffusion of HIT, and especially EHR, in three ways:

    1. We analyzed data from Sheldon Dorenfest and Associates, a major source of HIT data. Dorenfest conducts an extensive survey of provider organizations about their IT purchases, down to the provider and vendor level. We analyzed the Dorenfest data, using our own definition of EHR that works with the data available to us. We derived a penetration curve, one provider at a time, according to our definitions.

    2. We conducted a literature review of current diffusion of EHR and compared our results to those found by other authors, both...

  11. CHAPTER THREE EHR Past and Future Diffusion in Relation to Other Innovations
    (pp. 11-32)

    How does EHR diffusion compare to other innovations, and how fast will it likely diffuse if the healthcare system is left alone? To answer these questions, we (1) identified historical diffusion curves, (2) surveyed the diffusion literature to identify the key drivers of diffusion, and (3) generated a prediction of future EHR diffusion based on a historical diffusion curve under a “change nothing” scenario.

    Our objective was to place our project into a broader context and provide a rigorous foundation for empirically and theoretically based projections of future EHR growth. We needed a theory that would help us predict—or...

  12. CHAPTER FOUR The Potential Value of Wide HIT Diffusion
    (pp. 33-54)

    How much might HIT be worth in the long run? What magnitude of productivity gains is available? If HIT diffuses broadly, in particular if EHR diffuses broadly and transforms healthcare, what might society expect to gain? To answer these questions, we must first return to the broader term of HIT, rather than considering EHR alone, even though EHR is almost certainly the most important part of the investment and one that will be largely completed over the next 15 years.

    We use two complementary methodologies to answer the question of HIT value—“bottom-up” and “top-down.” The bottom-up method is a...

  13. CHAPTER FIVE Should the Government Intervene to Speed Diffusion of HIT?
    (pp. 55-68)

    To answer this question completely, policy analysis must quantify the costs and benefits of HIT,¹ forecast responses on the demand side and supply side of the market, and take into account the distortionary cost of raising a tax dollar.² Unfortunately, this is technically impossible because there is little recent empirically grounded research about how policy interventions change technology diffusion, let alone healthcare information technology diffusion. Some older sociological research from the 1970s details the failures of government mandates to change local practices, typically by failures of implementation (see Pressman and Wildavsky, 1984, for example).

    Leaders in diffusion research agree that...

  14. Bibliography
    (pp. 69-77)