Julia Adler-Milstein

Julia Adler-Milstein

Professor, Department of Medicine, UCSF
Director, Center for Clinical Informatics and Improvement Research, UCSF

Dissertation Title:  "The Use of Information Technology in US Health Care Delivery"

My dissertation examines a set of policy and management issues related to the use of information technology (IT) in US health care delivery. Health IT has received broad support as a potential solution to the rising costs and variable quality of health care, including a $30 billion allocation in the 2009 American Recovery and Reinvestment Act. My research contributes to the empirical evidence on the level of health IT adoption, and its impact on cost and productivity.

My first paper examines whether local and regional efforts to establish electronic health information exchange, known as Regional Health Information Organizations (RHIOs), are creating the foundation for a nationwide health information network. The data come from two censuses of RHIOs that I conducted (with Ashish Jha and David Bates). We find that although the number of RHIOs is growing, their scope remains limited and their viability uncertain. Our results support the current federal effort to allocate funding to states to build out capabilities.

My second paper uses a natural experiment to assess whether community-wide adoption of EHRs reduces health care costs. While I find limited evidence of an effect on total cost, specific types of ambulatory spending (radiology, laboratory and pharmacy) did not increase as quickly in intervention compared to control communities. I conclude that simply providing subsidies (or incentives) for EHRs is unlikely to meaningfully lower overall health care costs.

My third paper examines the productivity implications of EHR use, physician delegation, and the interaction between them. Using a novel panel data set from 42 primary care practices, I find that both greater EHR use and greater delegation are associated with higher levels of productivity, and the impact of EHR use on productivity is moderated by delegation. This work suggests that coordination problems may be introduced by decreased face-to-face communication following EHR adoption. Taken together, my dissertation papers point to the promising applications of health IT, but substantial shortfalls in their use. The extent to which IT transforms health care will therefore be more heavily determined by a broader set of changes in the organization and payment of care.


Graduation Year