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Review related foreign studies of payment system

For permission to use where not already granted under a licence please go to http: This article has been cited by other articles in PMC. Abstract The purpose of this review is to consolidate existing evidence from published systematic reviews on health information system HIS evaluation studies to inform HIS practice and research.

Fifty reviews published during 1994—2008 were selected for meta-level synthesis. These reviews covered five areas: After reconciliation for duplicates, 1276 HIS studies were arrived at as the non-overlapping corpus. On the basis of a subset of 287 controlled HIS studies, there is some evidence for improved quality of care, but in varying degrees across topic areas.

Systematic reviews, meta-synthesis, health information systems, field evaluation studies Introduction The use of information technology to improve patient care continues to be a laudable goal in the health sector.

Some argue we are near the tipping point where one can expect a steady rise in the number of health information systems HISs implemented and their intensity of use in different settings, especially by healthcare providers at point of contact. Over 100 systematic reviews have also been published to date on various HIS evaluation studies. Despite the impressive number of HIS studies and reviews available, the cumulative evidence on the effects of HIS on the quality of care continues to be mixed or even contradictory.

For example, Han et al 4 reported an unexpected rise in mortality after their implementation of a computerized physician order entry CPOE system in a tertiary care children's hospital. Yet, Del Beccaro et al 5 found no association between increased mortality and their CPOE implementation in a pediatric intensive care unit. Even in a computerized hospital, Nebeker et al 6 found that high adverse drug event ADE rates persisted.

However, as demonstrated by Ash et al, 7 CPOE effects can be unpredictable because of the complex interplay between the HIS, users, workflows, and settings involved. There is a need for higher level synthesis to reconcile and make sense of these HIS evaluation studies, especially those systematic review findings already published. This review addresses the latter gap by conducting a meta-level synthesis to reconcile the HIS evidence base that exists at present.

Our overall aim is to consolidate published systematic reviews on the effects of HIS on the quality of care. This will help to better inform HIS practice and research. In particular, this meta-level synthesis offers three contributions to practitioners and researchers involved with HIS implementation and evaluation. Firstly, it provides a comprehensive guide on the work performed to date, allowing one to build on existing evidence and avoid repetition.

Secondly, by reconciling and reporting the systematic review findings in a consistent manner, we translate these synthesized reviews in ways that are relevant and meaningful to HIS practitioners. Lastly, the consolidated evidence provides a rational basis for our recommendations to improve HIS adoption and identify areas that require further research. In this paper, we first describe the review method used.


Then we report the review findings, emphasizing the meta-synthesis to make sense of the published systematic reviews found. Lastly, we discuss the knowledge and insights gained, and offer recommendations to guide HIS practice and research.

Review method Research questions This review is intended to address the current need for a higher level synthesis of existing systematic reviews on HIS evaluation studies to make sense of the findings. To do so, we focused on reconciling the published evidence and comparing the evaluation metrics and quality criteria of the multiple studies.

Our specific research questions were: Through this review, we aimed to synthesize the disparate HIS review literature published to date in ways that are rigorous, meaningful, and useful to HIS practitioners and researchers.

At the same time, by examining the quality of the HIS studies reviewed and the evaluation metrics used, we should be able to improve the rigor of planning, conduct, and critique of future HIS evaluation studies and reviews.

Review identification and selection An extensive search of systematic review articles on HIS field evaluation studies was conducted by two researchers using Medline and Cochrane Database of Systematic Reviews covering 1966—2008.

A review on systematic reviews of health information system studies

The search strategy combined terms in two broad themes of information systems and reviews: The search was repeated by a medical librarian to ensure all known reviews had been identified.

The reference sections of each article retrieved were scanned for additional reviews to be included. A hand search of key health informatics journals was carried out by the review related foreign studies of payment system researcher, and known personal collections of review articles were included.

The inclusion criteria used in this review focused on published systematic reviews in English on HIS used by healthcare providers in different settings. The reason for such exclusion was that separate reviews were planned in these areas for subsequent publication. All citation screening and article selection were performed independently by two researchers and a second librarian.

Discrepancies in the review process were resolved by consensus among the two researchers, and subsequently confirmed by the second librarian. Meta-synthesis of the reviews The meta-level synthesis involved reconciliation of key aspects of the systematic review articles through consensus by two researchers to make sense of the cumulative evidence.

The meta-synthesis involved six steps: Specifically, the type and relationship of specific HIS features, metrics, and their effects on quality of care were summarized using the methods and outputs found in the existing HIS reviews. These topics were adapted from the organizing schemes used in the reviews by Balas et al, 8 Cramer et al, 9 and Garg et al 10 which covered multiple healthcare domains.

To identify the subset of controlled HIS studies and their effects, two researchers worked independently to retrieve the full articles for all original HIS studies within the corpus to extract the data on designs, metrics, and results.

Of these 136 articles, 58 were considered relevant and reviewed in detail. Further examination of the 58 reviews showed that eight were updates or summaries of earlier publications.