The DNA of Health IT

Mendoza researchers, inspired by DNA sequencing, developed a novel way to prove that the order in which Health IT systems are integrated affects hospital performance

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You don't have to be a scientist, just a regular viewer of television dramas to know that DNA technology helps prove parenthood, predict diseases and point the finger at bad guys. But it can also inspire researchers in fields only tangentially related to medical science, even though the findings take place in a hospital setting.

Notre Dame Management professors Corey Angst, Sarv Devaraj and Carolyn Queenan, along with Ph.D. candidate Brad Greenwood of the University of Maryland, College Park, took a new tack to studying how hospitals integrate information technology by applying DNA sequencing principles. Specifically, they looked at the cardiac units of 555 hospitals nationwide and examined whether bringing cardiology information technology online in a particular order impacted patient care or cost.

"There is a natural order to most events in life," says Angst. "Everything follows some predetermined, structured methodology that has been refined to yield improved results."

Health IT, or HIT, is "the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making" (Brailer & Thompson, 2004). Patients can readily see evidence of the IT system from the moment they check in and all their records are accessible with a click of a mouse. In a cardiac unit, this would include the equipment that not only accesses your medical record, but also captures images such as ultrasounds, X-rays and CT scans, and stores them for retrieval by others.

A hospital has to decide when and how to integrate its medical technologies—whether they are the latest and greatest HIT components or existing ones that are currently stand-alone technologies working in isolation—and focus on the order that the pieces plug into the system.

What the researchers found was that sequencing mattered. Fully integrated information systems where each medical technology worked seamlessly with the others helped hospitals save money and make decisions related to patient care more quickly. In addition they found that some integration sequences delivered those benefits more rapidly than others.

"One of our findings was that when the hospitals implemented the more complex technology first, they actually outperformed other sequences," said Devaraj. "It formed what we would call a foundational technology—a kind of building block. And the hospitals that were able to do that first were able to set the foundation straight. The actions that they did after that really meshed together well and the hospital got better performance."

Further, the research team also was able to derive a way to measure how far off a hospital's configuration might be from an optimal sequence. The further the unit was off the mark, the poorer its performance was in terms of information integration.

"Historically, it has been easy to identify the hospitals with the best clusters," said Devaraj. "But for those with worse performance, there hasn't been a way to measure how far they are from the top performers. Using the DNA sequencing model, we were able to measure the distance, so that was another contribution our research made to the health IT field."

The study, "Performance Effects Related to the Sequence of Integration of Healthcare Technologies" is forthcoming in the publication Production and Operations Management (Special Issue on Healthcare Operations Management).