Investments in information technology (IT) in healthcare are greater than they have ever been, and in most countries, not less than 2.6–6% of health budgets are dedicated to IT [1]. In the United States, as part of the February 2009 economic stimulus package, Congress appropriated more than U.S. $20 billion for health information technology (HIT). In Western Europe, the healthcare sector modernization will generate a growth in IT spendings from U.S. $9 billion in 2006 to U.S. $12 billion in 2011 [2]. In the healthcare sector, HITs are being presented as a means to improve productivity, quality of health and/or system efficiency [3], [4]. However, there is growing concern about the lack of actual positive outcomes that can be directly tied to HIT implementation [5].
On the one hand, the reasons cited in favour of the implementation of new HITs are numerous and diverse, both in the scientific literature and in government reports [6], [7], [8]. HITs are presented as one of the principal ways to improve quality of care [6], [7], [9], [10]. It can improve medical practices, assist the decision-making process by facilitating access to good practice guidelines, simplifying the prescription of diagnostic procedures, and producing reminders [7], [11], [12]. Also, the use of IT in health is said to translate into lower rates of medication errors and adverse drug events [13], [14], [15]. Finally, some studies show that it can lead to greater productivity among professionals, and lower costs [6], [7], [16].
On the other hand, some findings on the actual effectiveness and efficiency of HIT remain inconclusive [5], [17], [18]. Some studies have even suggested that, in some cases, HIT implementations appear to be counter-productive [19]. Moreover, according to the literature in information systems and health informatics, not many HIT implementations have been successful [13], [20], [21], [22], [23].
Faced with contradictory evidence, some researchers, health professionals and hospital administrators have expressed doubts about the actual value of investing time, money and energy in the implementation of new HITs [17], [24], [25], [26]. Being able to explain these contradictions and finding a way to determine the actual impacts of IT on health has therefore become a crucial endeavour that stands to benefit both research and practice.
In this paper, we seek to make sense out of the contradictory findings reported in the literature by providing a comprehensive framework that can be further used to improve the evaluation of IT impacts in healthcare. In the following sections, we review the literature on the impacts of HIT in healthcare and introduce the productivity paradox [27] and stakeholder theory [28]. From these, and based on empirical evidence from three case studies of HIT implementations, we propose our HIT Comprehensive Assessment Framework. Finally, we discuss the implications of our paper and its limitations.