UCLA

Health information technology (IT) has become an increasingly common part of the U.S. healthcare system. This three-paper dissertation examines barriers, facilitators, and correlates of health IT adoption and impacts of health IT use in several important settings.

The first paper examines the impact of electronic warnings in diverting non-indicated prescriptions in ambulatory settings. Specifically, we measured the incidence of antibiotic prescriptions for acute bronchitis and upper respiratory infections using a nationally-representative dataset. We found evidence that, overall, electronic warnings reduce the likelihood of antibiotic prescription receipt by about 20%. However, despite the recent increase in use of electronic warnings, antibiotic prescribing is not on the decline, suggesting that electronic warnings alone may not be sufficient to eliminate non-indicated prescriptions.

The second paper provides the first cross-year comparison of the use of electronic health records (EHRs) at local public health departments (LHDs) in the U.S. Using 2005 and 2010 data from the National Association of City and County Health Officials, we found that EHR usage has remained relatively steady at local public health departments. There is substantial churn, however, with approximately one-quarter of the sample adopting EHRs and another fifth of the sample discontinuing use of EHRs. Our study suggests that EHRs are not diffusing throughout LHDs as they are in other healthcare settings. Our results highlight departmental characteristics under which EHRs are commonly used and suggest potential places, such as poor or rural areas, where use of EHRs may be lower than expected.

The third paper examines participation in health information exchange (HIE) in two settings where HIEs have proven slow to diffuse--smaller-sized physician practices and federally qualified health centers (FQHCs). We conducted key informant interviews with stakeholders at practices and clinics. Our results suggest barriers to HIE adoption that exist at three levels--regional (e.g., existence of other area-level exchanges; number, type, and size of partner organizations), inter-organizational (e.g., strong relationships with exchange partners; achieving a critical mass of users), and intra-organizational (e.g., type of electronic medical record used; integration into organization's workflow). While some of these factors may be modifiable by health care organizations, limited solutions to overcome these barriers currently present a major challenge to the broad and effective use of HIE.