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ThinkMind // International Journal On Advances in Life Sciences, volume 9, numbers 1 and 2, 2017 // View article lifsci_v9_n12_2017_1
Assessing an Electronic Health Record (EHR): How Do Basic Assumptions in Traditional Health Technology Assessment (HTA), and Empirical Features Fit?
 Authors:
Anne Granstrøm Ekeland
Gunnar Ellingsen Keywords: health technology assessment (HTA); approaches and methods in randomized controlled trials (RCT); empirical features of electronic health records; assumptions in constructive assessments Abstract:
The use of health technology assessment (HTA) in the field of information and communication technologies (ICT) is receiving increasing attention. However, assessments this far are limited. In HTA, randomized controlled trials (RCTs) are the gold standard approach, building on a coherent set of basic philosophical assumptions. Scholars have raised questions concerning the assumptions and their fit with e-health, and thus questioned the ability of HTAs to produce useful assessments. The failure of assumptions to reflect empirical features of e-health is one explanation. This paper discusses this tension. Based upon the conference paper “Assessing Electronic Health Records: Are Basic Assumptions in Health Technology Assessment Useful?,” presented at The Eight International Conference on eHealth, Telemedicine, and Social Medicine eTELEMED 2016, April 24–28, 2016, in Venice, Italy, we have elaborated the empirical substantiation and present an extended version. Using a sociotechnical perspective, we studied a large-scale electronic health record program in northern Norway. Drawing on data over a 5-year period, we discuss how the program’s plans, organization, and activities correspond to RCT assumptions. We found that the RCT assumptions of a stable world, fixed interventions, and controlled implementation processes differ substantially from the real-life processes. Thus, RCT approaches that build on such assumptions fail to address important features of the program and fail to produce knowledge that fully demonstrates (the causes of) empirical benefits or pitfalls. As a result, we suggest embedding a world in flux in the assumptions of HTA where social, technical, and clinical entities continuously shape each other in dynamic processes. This may increase the relevance of HTA in ICT implementation projects. Pages: 1 to 10 Copyright: Copyright (c) to authors, 2017. Used with permission. Publication date: June 30, 2017 Published in: journal ISSN: 1942-2660
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