Dissertation Title:  "Implementation and Management of Information Technology in Health Care Delivery"Since the passage of the HITECH Act in 2009, the federal government has spent over $30 billion dollars in an effort to digitize the US health care delivery system. While electronic health records (EHRs) are now ubiquitous in acute care hospitals and primary care physician offices, many of the theorized benefits of EHRs in reducing costs and improving quality have not materialized. Moving beyond digitizing clinical data towards using data and information technology to improve care requires a set of complementary changes in both policy and organizational management. This dissertation seeks to add to our understanding of how information technology use impacts health care delivery organizations and how policymakers and health system leaders can work towards using EHRs to improve care.

Chapter one examines organizational practices of the adoption and use of electronic health records using a novel national hospital survey and describes variation in organizational practices such as level of senior leadership engagement in EHR-related decision-making and level of clinician involvement in IT implementation. This study also finds specific organizational strategies, such as human capital investment and integration across technical systems, may complement EHR investments to help hospitals achieve more advanced adoption.

Chapter two focuses on the use of electronic health records and how they have changed clinician work. Using a unique dataset of EHR metadata from ambulatory care organizations with Epic Systems EHRs, this study compares differences between US and international clinicians, finding large differences in EHR work time. These results suggest that US-specific socio-technical factors may be driving a significant amount of EHR-related clinician work and associated burnout.

Chapter three focuses on the evaluation of electronic health records. Using data from a national assessment of hospital inpatient medication EHR safety, this chapter describes the current state of EHR safety performance to prevent adverse drug events. The study then uses a regression discontinuity design to determine the causal impact of providing hospitals with publicly reported negative feedback on their EHR safety, finding that hospitals who received the negative qualitative feedback improved significantly more in the subsequent year compared to hospitals who received positive feedback. These results have important implications regarding the value of quality assessment in health care. This study finds a small but significant “nudge” effect of providing hospitals with feedback on improvement in the next year, and provides evidence that measurement and feedback can improve quality.