Performing Without a Net: Transitioning Away From a Health Information Technology-Rich Training Environment

Johnson, Kevin MD, MS; Chark, Davin MD, MSc; Chen, Qingxia PhD; Broussard, Alexis; Rosenbloom, S Trent MD, MPH

Academic Medicine:
doi: 10.1097/ACM.0b013e31818c6d57
Technology and Medical Education
Abstract

Purpose: In many academic medical centers (AMCs), health information technology (HIT) has become a foundational component of patient care. Medical training in these environments generates dependence on HIT. The authors conducted this study to determine how transitioning from an HIT-rich environment affects practitioners’ self-perceptions of competence, practice efficiency, and patient safety.

Method: In 2004 and 2005, the authors performed a cross-sectional survey study involving medical students and residents who had graduated from Vanderbilt University Medical Center (VUMC), an HIT-rich AMC. The authors distributed surveys to 679 graduates from 2001 to 2003 who transferred to other institutions.

Results: Although 128 surveys were returned undelivered because of wrong addresses, 328 (60%) were returned complete and analyzed. Among respondents, 255 (78%) reported transitioning to environments with less HIT than VUMC. The authors compared responses from this group with those of peers who transitioned to environments with the same or greater HIT penetration. After controlling for confounding effects, the authors found that graduates who transitioned to lower-HIT institutions reported feeling less able to practice safe patient care (P = .02), to utilize evidence at the point of care (P = .05), to work efficiently (P < .001), to share and communicate information (P = .03), and to work effectively within the local system (P = .007).

Conclusions: Providers who transition away from HIT-rich environments may perceive their care as less safe and less efficient. These results support greater adoption of HIT and underscore the need for formal education for new trainees, faculty, and staff transitioning to a new system of care.

Author Information

Dr. Johnson is associate professor and vice chair, Biomedical Informatics, and associate professor, Pediatrics, Vanderbilt University, Nashville, Tennessee.

Dr. Chark is resident, Otolaryngology, University of California–Irvine, Irvine, California.

Dr. Chen is assistant professor, Department of Biostatistics, Vanderbilt University, Nashville, Tennessee.

Ms. Broussard is editorial assistant, Vanderbilt University, Nashville, Tennessee.

Dr. Rosenbloom is assistant professor, Biomedical Informatics, Vanderbilt University, Nashville, Tennessee.

Correspondence should be addressed to Dr. Johnson, Eskind Biomedical Library, 2209 Garland Avenue, Nashville, TN 37232-8340; telephone: (615) 936-1556; fax: (615) 936-1427; e-mail: (kevin.johnson@vanderbilt.edu).

© 2008 Association of American Medical Colleges