Literature
The academic literature on Healthcare Information Technology (Health IT or HIT) is scattered across many fields of research including medical informatics, medicine, and information systems. This website shares resources, primarily journal articles, for specific technology areas such as medication management (e-prescribing). This Literature page provides a table of contents and a brief description of the topics found on this website. These pages are a Work in Progress some in more complete form than others. You can always contact me about a particular topic.
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Medication Management
One cannot look at e-prescribing, the activity that generates and transmits the e-script artifact, in isolation of the broader medication management literature. End-to-end e-prescribing is a better term to describe medication management.
Literature in the following topics are provided: e-prescribing, pharmacies (their role in prescribing), patient's formulary, and of course the role of the pharmacy benefit manager in adjudication of the prescription (85% require third party approval).
There is a growing body of literature on e-prescribing which in 2008-9 is my primary research focus. The references provided on the linked page are those I've found valuable. Details on some of the key articles are described in further detail (e.g., data sources, research methods).
A list of references is provided on this page.
A list of references is provided on this page.Pharmacy Benefit Manager (PBM)
A list of references is provided on this page.
EMR/EHR
Electronic Medical Records are not my focus at the moment. However much of what is relevant to e-prescribing has come from the EMR/CPOE literature so I have quite a collection in this area.
Electronic Health Records are inter-connected EMRs such as in a regional health information organization (RHIO). There are some very difficult IT integration challenges and associated socio-organizational implications. I plan to move into this area in the future but at the moment I just keep track of trends. Here is a list of EHR functions.
My areas of interest within EMR/EHR are e-iatrogenesis and healthcare IT failures.
I started this section because the general impression seems to be that automation in healthcare reduces errors. I agree that certain kinds of errors are reduced. For example, errors that resulted from illegible handwriting on a prescription go away but errors from mistyped e-scripts are introduced (arguably harder to catch). Go to this section for the growing literature on this topic.
We know from the business world that most information system projects fail or reach their stated objectives. Will the deployment of healthcare information technology (HCIT) be any different?
E-iatrogenesis are unintended clinical outcomes but HCIT failure or user frustration are unintended (or intended) consequences of design.
Care Coordination
The typical elderly patient sees half a dozen physicians. Someday - the dreams of a nationwide (in USA) medication history may come to fruition. But care coordination is more than seeing what medications are being taken on a patient (assuming the list is up-to-date - see page on e-iatrogenesis). Other elements of care must also be coordinated. The literature on the two kinds of coordination among medical professionals is being gathered as I see this area as untouched in the IS field.
Physician - Physician
Pham et al (2009) found that the typical Medicare primary care physician must coordinate care with 229 other physicians working in 117 different practices. Given that most coordination is uncompensated, how does IS/IT support such activities?
Pham, HH, O'Malley, AS, Bach, PB, Saiontz-Martinez, C & Schrag, D 2009, 'Primary Care Physicians' Links to Other Physicians through Medicare Patients: The Scope of Care Coordination', Annals of Internal Medicine, Vol. 150, no. 4, pp. 236-42
Physician - Pharmacist
The physician-pharmacist relationship is being studied because of the changing professional roles between them. Pharmacists are pushing for more power to prescribe medications in certain situations. Some doctors are incorporating mini-pharmacies into their medical practices for the convenience of their customers and of course some extra revenue.
Interesting articles or sources of information related to electronic privacy in healthcare. This is not my primary interest but certainly pertinent.
Workarounds are the focus of my research with particular attention to workarounds found in healthcare information systems.
The article below was named 2009 AMIA Diana Forsythe Award Finalist.
Azad B, King NE, "Enacting Computer Workarounds within a Medication Dispensing System." European Journal of Information Systems, Vol. 17, No. 3, June 2008, pp. 264-278
Computer workarounds in health information systems (HIS) threaten the potential for gains in efficiency through computerization aimed at reducing process variability. Eliminating such workarounds is desirable, but information system (IS) researchers tend to treat computer workarounds as black-boxes, whereas HIS researchers are primarily concerned with descriptive or prescriptive remedies. We propose to open the black-box of computer workarounds and study them as situated practices that consist of adjustments to existing computer-based procedures, which are enabled by the negotiated order of a hospital. This negotiative property of a hospital’s organizational environment allows for interpretive flexibility, in which physicians stretch certain rules in practice, while inducing others to cooperate. We illustrate this conceptual framework with a non-participant observer case study of a medication dispensing system used in a teaching hospital to support a prior-approval policy for anti-microbial drugs. Within these enacted workaround practices, we found significant variety in roles, timing and interactions, which boil down to a pattern of four practices revolving around one function of an HIS. Our research extends the literature on computer workarounds in IS and HIS by proposing a theoretical understanding of workaround practices based on a contextual healthcare study.