Use and Effects of Health Information Technologies in Surgical Practice

Abstract

Increasing health information technology (HIT) adoption has led to growth in research on its implementation and use, the majority of which has been conducted in primary care and medical specialty settings. This thesis comprises three research projects that expand the knowledge base about HIT in surgery. A systematic review summarized the evidence about the effects of major categories of HIT (e.g., electronic health records, computerized order entry) on surgical outcomes and demonstrated improvement in the quality of surgical documentation, increased adherence to guidelines for perioperative prophylactic medication administration, and improvements in patient care with provider alerts. The review identified gaps in the literature about consumer HIT use by surgical patients and providers. A second study demonstrated modest use of a patient portal by surgical patients during hospitalizations and found increased inpatient use for patients who were white, male, and had longer lengths of stay. This study showed that a patient portal designed for the outpatient setting could be employed by surgical patients during hospitalizations. A third study analyzed the nature of the communications in patient portal messages threads between surgeons and their patients. Two-thirds of message threads involved medical care with predominantly straightforward and low complexity decision-making. This study highlighted the need for expanded models for compensation of online care. This thesis provides insights into the use and effects of HIT in surgical practice. As HIT continues to evolve, the unique perspectives of surgical providers and patients should be represented in the design, implementation, evaluation, and regulation of its use.