Systematic Review: Impact of Health Information Technology on
Quality, Efficiency, and Costs of Medical Care
Basit Chaudhry, MD; Jerome Wang, MD; Shinyi Wu, PhD; Margaret Maglione, MPP; Walter Mojica, MD; Elizabeth Roth, MA;
Sally C. Morton, PhD; and Paul G. Shekelle, MD, PhD
Background: Experts consider health information technology key to
improving efficiency and quality of health care.
Purpose: To systematically review evidence on the effect of health
information technology on quality, efficiency, and costs of health
Data Sources: The authors systematically searched the English-
language literature indexed in MEDLINE (1995 to January 2004),
the Cochrane Central Register of Controlled Trials, the Cochrane
Database of Abstracts of Reviews of Effects, and the Periodical
Abstracts Database. We also added studies identified by experts up
to April 2005.
Study Selection: Descriptive and comparative studies and system-
atic reviews of health information technology.
Data Extraction: Two reviewers independently extracted informa-
tion on system capabilities, design, effects on quality, system ac-
quisition, implementation context, and costs.
Data Synthesis: 257 studies met the inclusion criteria. Most studies
addressed decision support systems or electronic health records.
Approximately 25% of the studies were from 4 academic institu-
tions that implemented internally developed systems; only 9 studies
evaluated multifunctional, commercially developed systems. Three
major benefits on quality were demonstrated: increased adherence
to guideline-based care, enhanced surveillance and monitoring, and
decreased medication errors. The primary domain of improvement
was preventive health. The major efficiency benefit shown was
decreased utilization of care. Data on another efficiency measure,
time utilization, were mixed. Empirical cost data were limited.
Limitations: Available quantitative research was limited and was
done by a small number of institutions. Systems were heteroge-
neous and sometimes incompletely described.