Enabling Patient-Centered Care through Health Information Technology

This project conducted a comprehensive literature review of the impact of health information technologies on patient-centered care (PCC). The project team looked at barriers and facilitators for the use of health information technology (IT) applications to deliver PCC, identified gaps in the literature, and recommended further areas for research. The impacts examined in the project included health care process outcomes; clinical outcomes; intermediate outcomes; responsiveness to the needs and preferences of individual patients; and shared decisionmaking between stakeholders, patient-clinician communication, and access to medical information. Several health IT applications were identified as being relevant to PCC including care management tools, telehealth, personal health records/patient portals, secure electronic messaging, and shared decisionmaking.

The main objectives of the project were to:

• Conduct a comprehensive literature review regarding the impact of health IT that enables PCC.
• Develop a final report on the impact of health IT that enables PCC.

The project team focused on four key questions: 1) Are health IT applications that address one or more components of PCC effective in improving specific outcomes, and how do the outcomes vary by type of health IT application?; 2) What are barriers or facilitators that clinicians, developers, patients, and their families or caregivers encounter that may impact implementation and use of health IT applications to enable PCC?; 3) What knowledge or evidence deficits exist regarding needed information to support estimates of cost, benefit, impact, sustainability, and net value with regard to enabling PCC through health IT?; and 4) What critical information regarding the impact of health IT applications implemented to enable PCC is needed to give consumers, their families, clinicians, and developers a clear understanding of the value proposition particular to them?

The team brought together a group of experts and advisors for the project, including a core team from Johns Hopkins University, representatives from AHRQ, and two external advisors. In addition, a Technical Expert Panel comprised of six external experts was brought together to serve as peer reviewers of the final report. Following the literature review, the research team concluded that significant evidence exists showing a positive impact of PCC-related health IT applications on health care outcomes, in particular in the following areas: health care process outcomes; clinical outcomes on diabetes, heart disease, cancer, and other health conditions; intermediate outcomes; improved responsiveness to the needs and preferences of patients; and improved shared decisionmaking, patient-clinician communication, and access to medical information. They did note, however, that there is not yet strong enough evidence to provide guidance to health care systems around the best use of these applications in promoting PCC system wide.

A number of barriers to PCC-related health IT applications were seen in the literature including the lack of usability; problems with access to the application due to older age, low income, low education, cognitive impairment, and other factors; low computer literacy in patients and clinicians; insufficient basic formal training in health IT applications; physicians’ concerns about more work; workflow issues; problems related to new system implementation, including concerns about confidentiality of patient information; depersonalization; incompatibility with current health care practices; lack of standardization; and problems with reimbursement. Facilitators noted in the literature included ease of use, perceived usefulness, efficiency of use, availability of support, comfort in use, and site location.

Areas identified as needing additional research included the need to determine the degree to which these interventions would be able to improve the delivery of PCC and improve outcomes for individuals with a variety of clinical conditions. More research is needed to improve the information available to health care providers so that this group is better able to weigh the benefits of these tools against the needed resources required to be invested to implement the tools. The project team recommended that future research and development in this area incorporate the principles of PCC in a more comprehensive and systematic manner.