Overview of Research
Description
My research examines approaches to improving the performance of our health care delivery system with a primary focus on health information technology. Reflecting the interdisciplinary nature of my program, my dissertation draws upon theories and insights from various literatures to examine organizational and policy issues in this emerging area. My dissertation includes three empirical papers that assess the progress of IT adoption in health care, the impact of such adoption on health care costs, and complementarities between organizational structure and health IT use.
My first paper examines the progress and viability of regional efforts to establish electronic health information exchange, known as Regional Health Information Organizations (RHIOs). The data come from two surveys of RHIOs that I conducted with two co-authors. These studies, published in Health Affairs, provided the first robust evidence of RHIOs’ struggle to find sustainable business models. The second paper in my dissertation examines whether adoption of electronic health records (EHRs) leads to reductions in medical and pharmacy utilization. Using claims data, I assess whether patients in the three Massachusetts eHealth Collaborative EHR pilot communities had lower utilization than patients in matched control communities over a five-year period. This study offers the first large-scale assessment of whether EHRs save money. My third paper examines the relationship between EHR use and delegation, and the impact on productivity in primary care. This work contributes to our nascent understanding of how organizational structure and division of labor complement EHR use.
My research interests extend to two related areas: organizational performance improvement and chronic disease management. The first of my two papers in the former area examines managerial strategies that encourage front-line staff to share solutions to operational problems they encounter in the hospital. The second paper compares nurses’ and residents’ perceptions of team function in the ICU setting. I hope to expand this work to examine how IT changes team dynamics as communication patterns are altered. Such research contributes to the relatively new field of socio-technical systems research in which little work has been conducted in the health care setting. My interest in chronic disease management focuses on how to design programs that incorporate technology. My work examines the success of the current disease management model and how IT can be used to improve it.