Information and Communications Technology in Chronic Disease Care: Why is Adoption So Slow and Is Slower Better?

Unlike the widespread adoption of information and communications technology (ICT) in much of the economy, adoption of ICT in clinical care is limited. We examine how a number of not previously emphasized features of the health care and ICT markets interact and exacerbate each other to create barriers for adoption. We also examine how standards can address these barriers and the key issues to consider before investing in ICT. We conclude that the ICT market exhibits a number of unique features that may delay or completely prevent adoption, including low product differentiation, high switching costs, and lack of technical compatibility. These barriers are compounded by the many interlinked markets in health care, which substantially blunt the use of market forces to influence adoption. Patient heterogeneity also exacerbates the barriers by wide variation in needs and ability for using ICT, by high demands for interoperability, and by higher replacement costs. Technical standards are critical for ensuring optimal use of the technology. Careful consideration of the socially optimal time to invest is needed. The value of waiting in health care is likely to be so much greater than in other sectors because the costs of adopting the wrong type of ICT are so much higher.

Exploration of Health Technology Nonuse: The Case of Online Medical Records

Online Medical Records (OMR) platforms remain a key enabler to health management. Yet, how beliefs toward OMR and its subsequent nonuse are related is not understood. Applying the status quo bias (SQB) theory and the privacy paradox paradigm the study examines OMR nonusers and contributes to the health technology use literature. Using the Health Information National Trends Survey (HINTS) iteration 5, Cycle 1 and 3 data, mediation analysis reveals that inertia expressed as preference for speaking directly with healthcare providers predicts perceived need for OMR and partially mediates the relationship between perceived privacy concerns and need; having a chronic disease partially moderates such relationships. Thus, not all nonusers are created equal. Attaining benefits that come with capabilities and functionalities of OMR necessitates meaningful use of OMR by individuals. Healthcare providers or policymakers should intervene to dispel inertia or patient concerns to expand OMR use to facilitate healthcare decision making

Data standardization

With data rapidly becoming the lifeblood of the global economy, the ability to improve its use significantly affects both social and private welfare. Data standardization is key to facilitating and improving the use of data when data portability and interoperability are needed. Absent data standardization, a “Tower of Babel” of different databases may be created, limiting synergetic knowledge production. Based on interviews with data scientists, this Article identifies three main technological obstacles to data portability and interoperability: metadata uncertainties, data transfer obstacles, and missing data. It then explains how data standardization can remove at least some of these obstacles and lead to smoother data flows and better machine learning. The Article then identifies and analyzes additional effects of data standardization. As shown, data standardization has the potential to support a competitive and distributed data collection ecosystem and lead to easier policing in cases where rights are infringed or unjustified harms are created by data-fed algorithms. At the same time, increasing the scale and scope of data analysis can create negative externalities in the form of better profiling, increased harms to privacy, and cybersecurity harms. Standardization also has implications for investment and innovation, especially if lock-in to an inefficient standard occurs. The Article then explores whether market-led standardization initiatives can be relied upon to increase welfare, and the role governmental-facilitated data standardization should play, if at all

Factors Affecting Outsourcing for Information Technology Services in Rural Hospitals: Theory and Evidence

As health information technology becomes more prevalent for most healthcare facilities, hospitals across the nation are choosing between performing this service in-house and outsourcing to a technology firm in the health industry. This paper examines factors affecting the information technology (IT) outsource decision for various hospitals. Using 2004 data from the American Hospital Association, logistic regression models find that governmental ownership and a proxy variable for hospitals that treat more severe injuries positively impact the probability of outsourcing for IT services.Health Information Technology, Outsourcing, Hospital, Health Economics and Policy, Labor and Human Capital, Research and Development/Tech Change/Emerging Technologies, I12, C140,

The Impact of Information Technology on Emergency Health Care Outcomes

This paper analyzes the productivity of technology and job design in emergency response systems, or 911 systems.' During the 1990s, many 911 systems adopted Enhanced 911' (E911), where information technology is used to link automatic caller identification to a database of address and location information. A potential benefit to E911 is improved timeliness of the emergency response. We evaluate the returns to E911 in the context of a panel dataset of Pennsylvania counties during 1994-1996, when almost half of the 67 counties experienced a change in technology. We measure productivity using an index of health status of cardiac patients at the time of ambulance arrival, where the index should be improved by timely response. We also consider the direct effect of E911 on several patient outcomes, including mortality within the first hours following the incident and the total hospital charges incurred by the patient. Our main finding is that E911 increases the short-term survival rates for patients with cardiac diagnoses by about 1%, from a level of 96.2%. We also provide evidence that E911 reduces hospital charges. Finally, we analyze the effect of job design, in particular the use of Emergency Medical Dispatching' (EMD), where call-takers gather medical information, provide medical instructions over the telephone, and prioritize the allocation of ambulance and paramedic services. Controlling for EMD adoption does not affect our results about E911, and we find that EMD and E911 do not have significant interactions in determining outcomes (that is, they are neither substitutes nor complements).

The Future of Personal Health Records in the Presence of Misaligned Incentives

We posit that the emergence of the independent personal health record (PHR) platforms is potentially a major development toward the cause of digitizing healthcare. Not only do these platforms empower the patients by giving them complete control over their records, but they also can help promote the adoption of electronic health records (EHRs) by healthcare providers. In a pluralistic healthcare system like that which exists in the United States, where many healthcare providers lack the incentive to adopt EHR and electronically share their patients’ records with competing providers, we believe that PHR platforms can facilitate the adoption and use of EHRs in the healthcare sector

Adoption of Electronic and Personal Health Records: An Ecconomic Analysis

We investigate strategic issues surrounding the adoption of electronic health records (EHR) and personal health records (PHR) using an economic framework. Through our analysis, we find evidence that health care providers do not have an incentive to implement interoperable EHR systems even though the implementation of EHR systems (interoperable or otherwise) will increase consumer surplus. In this context, we conjecture that PHR platforms can fundamentally alter the incentives of health care providers, potentially leading to increased EHR adoption under some conditions. In a pluralistic health care system like that which exists in the United States, where health care providers have varying incentives to implement interoperable electronic health records, an online PHR platform can provide an alternative means for consumers to freely exchange their health records among different providers

Toward Universal Broadband in Rural Alaska

The TERRA-Southwest project is extending broadband service to 65 communities in the Bristol Bay, Bethel and Yukon-Kuskokwim regions. A stimulus project funded by a combination of grants and loans from the Rural Utilities Service (RUS), TERRA-Southwest has installed a middle-mile network using optical fiber and terrestrial microwave. Last-mile service will be through fixed wireless or interconnection with local telephone networks. The State of Alaska, through its designee Connect Alaska, also received federal stimulus funding from the National Telecommunications and Information Administration (NTIA) for tasks that include support for an Alaska Broadband Task Force “to both formalize a strategic broadband plan for the state of Alaska and coordinate broadband activities across relevant agencies and organizations.” Thus, a study of the impact of the TERRA project in southwest Alaska is both relevant and timely. This first phase provides baseline data on current access to and use of ICTs and Internet connectivity in rural Alaska, and some insights about perceived benefits and potential barriers to adoption of broadband. It is also intended to provide guidance to the State Broadband Task Force in determining how the extension of broadband throughout the state could contribute to education, social services, and economic activities that would enhance Alaska’s future. Results of the research could also be used proactively to develop strategies to encourage broadband adoption, and to identify applications and support needed by users with limited ICT skills.Connect Alaska. The National Telecommunications and Information Administration. General Communications Incorporated.Part 1: An Analysis of Internet Use in Southwest Alaska / Introduction / Previous Studies / Current Connectivity / Analytical Framework and Research Methodology / Demographics / Mobile Phones: Access and Use / Access to the Internet / Internet Useage / Considerations about Internet Service / Interest in Broadband / Sources of News / Comparison with National Data / Internet Use by Businesses and Organizations / What Difference may Broadband make in the Region? / Conclusiongs / Part 2 Literature Review / Reference

Health Information Exchange, Interoperability, and Network Effects

Health information exchange (HIE) is the electronic exchange of patient medical records among hospitals. I investigate how two defining characteristics of HIE can cause under-adoption. First, HIE represents an information-sharing network, and participation for any hospital is valuable if others participate. This is a network effect. Second, HIE involves exchange of medical records, which may be competitive assets for hospitals. Therefore, hospitals may have disincentive to exchange with competitors despite social benefits. This is a competitive effect. I present a theoretical framework of hospitalsâ?? decisions to adopt HIE and show how presence of network and competitive effects can result in under-adoption relative to the social optimal. I then test for evidence of network and competitive effects in hospital HIE adoption. In the empirical analysis, I use two measure of HIE adoption. The first is a measure of general adoption in which all hospitals that have adopted any HIE capability are assumed to be able to exchange information with each other. The second takes into account that much information-sharing occurs through interoperable IT systems and currently, most IT systems of different vendors are not interoperable. I find evidence of network effects in general HIE adoption and vendor choice. I find that a 10% increase in market adoption rate results in a hospital being 9.2% more likely to adopt HIE. I also find that a 10% increase in adoption rate of a vendor results in a hospital being 1.5% more likely to adopt the vendor. I also find evidence of competitive effects. Specifically, hospitals that are more vulnerable to losing market share are less likely to adopt a prominent vendor in a market. I estimate a model of patientsâ?? hospital preferences and hospitalsâ?? HIE adoption decision. Through counterfactual simulation, I show effects of widespread HIE adoption on market share redistribution. Finally, I evaluate current policies such as the federal governmentâ??s $30 billion adoption incentive program (HITECH Act). The program may be inadequate to promote widespread interoperability in the presence of competitive effects. I also discuss the implications of network effects for competition and innovation in the health IT industry