Health Information Technology Research Presentations Growing at NAPCRG Meetings

Almost 15% of the presentations at the 2012 NAPCRG Annual Conference in New Orleans examined the use of health information technology (HIT). This is an increase from nearly 10% at the 2011 conference in Banff. The definition of HIT can be quite broad, but in general it is the use of electronic technologies to improve human health. Annual conference HIT presentations and posters included examinations of electronic health record (EHR) implementation, home tele-monitoring of clinical data, personal health record use, electronic clinical decision support, educational simulations, and use of electronic patient registry data. While the range of research is fairly broad, all explore how we can exploit recent technologic capabilities to improve health. Some investigators even found that these technologies, despite great promise, did not improve health compared to more conventional approaches that did not use new technologies.

What accounts for this growing interest in HIT research among NAPCRG members? As primary care researchers, our focus on knowledge management is not new.^1,2 This is an obvious direction for our inquiries because management of knowledge and information is so vitally important to primary care. Primary care clinicians routinely struggle to integrate all possible information to inform shared decision-making with their patients. Assimilating and processing this information is a Herculean task that frequently challenges or exceeds our cognitive capacities.

Many look to information technology to assist us with the important task of managing clinical information. Beasley and colleagues have defined “information chaos” as 5 types of information problems that primary care physicians routinely face: information overload, information underload, information scatter, information conflict, and erroneous information.³ This information chaos decreases clinician situational awareness and takes time to navigate, enabling loss of productivity, decreased patient access, physician burnout, and medical errors. Primary care clinicians are desperate for tools that will lighten this load, and this creates a research imperative to find and test new tools, interfaces, and ways to deliver care.

Much of HIT research is, in fact, implementation science. Researchers and clinicians are trying to use electronic tools to ensure that evidence-based interventions are successfully implemented to the fullest extent possible for patients and populations. As such, examination of the use of HIT in clinical care is a natural target for primary care researchers, who best understand the interface between clinical evidence and successful implementation of recommendations in clinical practice.

Another likely reason that HIT research is becoming more prevalent is that questions about the technologies we use arise so often in the everyday life of clinicians. The EHR has become such a huge factor in our work lives that it naturally provokes reactions and questions. Furthermore, these reactions and questions often center on less-than-expected EHR usability, and less-than-expected clinician satisfaction with many EHR systems.⁴ Frequently, EHR and personal health portal implementations do not go as well as expected,⁵ creating the perfect storm for the generation and examination of research questions: an unhappy clinician user with a passion to find an answer. That these implementations can dramatically affect productivity only heightens our interest. And so we are driven to examine the difference between the reality and the imagined concept, or even between what is and what should be. Our 2012 Annual Conference plenary speaker, Trisha Greenhalgh, and her colleagues, illuminated this “design-reality gap” in their description of abandonment of a personal electronic health record by the English National Health Service.⁶

We can expect a continued focus on HIT research as EHR adoption becomes more widespread and as new technologies and capabilities emerge. Certainly we can expect primary care researchers to continue to be at the vanguard of investigating how to use HIT to deliver better care.

• © 2013 Annals of Family Medicine, Inc.