Essays on the impact of health information technology on health care providers and patients
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Information technology has been transforming health care industry. This dissertation investigates the use of health information technology by health care providers and patients as well as its outcomes. This dissertation consists of three essays studying workflow optimization in hospital emergency departments, people's search for online health information, and the relationships between EMR (Electronic Medical Records) usage and health care outcomes, respectively. Hospital emergency departments' capacities to deal with a patient surge play an important role in preparedness for natural or man-made disasters. The first essay examines how emergency departments could optimize workflows during extreme events when there is a patient surge. This essay proposes a framework to reconfigure workflows while maintaining treatment quality. Our results show that reorganizing lower-priority processes and relocating the resources associated with those processes can shorten total waiting time in emergency departments, allowing better management of patient flows. People are increasingly using the Internet to access health information and the information obtained has an impact on their health care outcomes. The second essay examines the impacts of IT enablers and health motivators on people's online health information search behaviors. We characterize users' online health information search behaviors along three dimensions: the frequency of online health information search, the diversity of online health information usage, and the preference of the Internet for initial search. Using the 2003 Health Information National Trends Survey (HINTS) data on cancers, we find that ease of access to Internet and trust in online health information could affect all three dimensions of search behaviors. While perceived quality of communication with doctors has an impact on diversity of search and preference of search, we surprisingly do not find an impact on the frequency of search for online health information. In addition, our results find that perceived health status could affect both frequency and diversity of search for online health information. But we do not find evidence that perceived health status could lead to a preference for using the Internet as a source for health information. The US government has initiated incentive programs to encourage the adoption of Electronic Medical Records (EMR). To qualify for the incentive payment, health care providers need to demonstrate "meaningful use" of EMR systems, which requires the use of certified EMRs and the implementation of a set of standard functionalities. In the third essay, we examine how the meaningful use of EMRs would affect health care outcomes in outpatient settings. Our results show that the use of core functionalities required by "meaningful use" criteria and the use of certified EMRs have a positive impact on the quality and efficiency of care. In addition, we find the relationship between the "meaningful use" and quality of care is moderated by the length of EMR use.
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