Governance of Health Information Technology (GoHIT) Project
Investigating the Organizational, Professional and Legal Challenges of New Information Technologies in Healthcare
This study explores the organizational, professional and legal challenges posed by new clinical information technologies in American healthcare. Although technologies such as electronic health records (EHR) and computerized provider order-entry (CPOE) promise to improve the quality and efficiency of patient care, they also raise the specter of new forms of competition, regulation, surveillance, and inequality. The present study focuses on the “governance mechanisms” -- laws, rules, ethics and norms -- that are emerging to manage this HIT revolution. Of particular interest are the new federal privacy, security and data-standardization regulations adopted under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as well as the policies and practices that healthcare organizations have implemented to become “HIPAA-compliant.”
Findings from the GoHIT project will help policymakers to develop the immense potential of clinical IT systems, while avoiding the equally immense pitfalls. At the same time, the research will also help social scientists to understand the basic forces that shape innovation, standardization, trust, accountability, and legal compliance in the healthcare arena. The GoHIT project is yielding important insights into how a diverse set of governance mechanisms intersect with one another, as legal enactments, organizational cultures, and professional ethics combine to determine the fate of HIT initiatives both within particular healthcare organizations and throughout the healthcare sector as a whole.
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The GoHIT project examines a significant yet under-studied question in health policy: How can public and private actors construct appropriate laws, rules and norms to exploit the promise of HIT, while avoiding the dangers?
In recent years, proponents have touted various HIT innovations as remedies for a wide variety of healthcare ills, from geographic inequities, to paperwork costs, to medication errors, to fragmented case management. Recent estimates suggest, for example, that computerized order-entry alone could reduce medication errors enough to save thousands of lives and billions of dollars annually -- and other technologies possess equally impressive potential.
Yet, despite such benefits, HIT adoption remains relatively rare, with even the most well-established technologies appearing in only a small fraction of the nation’s hospitals.
In part, this may reflect the fact that, while these new systems promise to
improve the timeliness, accuracy, efficiency and rigor of American healthcare,
they also threaten to disrupt the sector’s established order, raising the
specter of new forms of competition, coercion, surveillance and inequality.
Consequently, as new HIT comes on line, professions, organizations, social movements
and public authorities vie for control, each pursuing its own distinctive
vision of healthcare's “inherent” technical, economic, clinical, and ethical
“imperatives.”
In this climate, an even-handed understanding of real-world governance dynamics
is crucial. Broadly speaking, “governance”, refers to the ways in which
individuals, organizations and societies manage interdependence and sustain
cooperation in the face of vulnerability. For new CITs to surmount such vexing challenges
as standardization, trust, and accountability, policymakers must develop
effective governance systems both within individual healthcare orgaizations and
throughout the healthcare sector as a whole. Within each organizational
setting, decision-makers face the problem of crafting a practice regime that
reconciles shifting technical and regulatory pressures with the daily work of
medicine. Meanwhile, at the level
of the sector as a whole, decision-makers face the problem of crafting a
regulatory regime that promotes sound IT practices across a wide range of
organizational settings, each with its own structure, culture, practices and
politics.
Unless
researchers develop solid theoretical frameworks and reliable empirical data to
inform governance at both levels, much of the new technologies’ potential could
be squandered in political stalemate -- or, worse yet, subverted by ill-advised
policy choices.
Yet, despite the likely importance of governance mechanisms in determining the
fate of healthcare IT, few broad-based empirical investigations of these issues
currently exist. Professional associations and consulting firms occasionally
conduct pragmatically-oriented surveys of IT budgets and the like, but such
studies seldom examine non-technical governance structures or underlying causal
mechanisms. Medical sociologists and health policy researchers, for their part,
generally treat IT as being too peripheral to the "core" enterprise
of medicine to merit sustained attention. And investigations of economic and
legal governance outside the healthcare arena rarely consider the distinctive
issues that emerge in the context of overlapping professional jurisdictions,
significant public-goods problems, intense civil-liberties concerns, and
extensive state involvement -- all of which characterize healthcare IT.
Consequently, although impending HIT developments hold the potential to transform American healthcare, we currently lack both the conceptual and the factual infrastructure to address responsibly this crucial area of policy concern. The GoHIT project seeks to fill this gap in our knowledge.
Principal Investigator:
Mark C. Suchman, JD PhD
Professor of Sociology
Brown University
