Avoidable mortality: The mediating role of communication in health IT

The adoption of health IT transforms communication between care providers and patients. Unfortunately, research on the transformation of communication has produced conflicting results, creating tension regarding its efficacy among healthcare professionals. In this paper, we propose that nurse and physician communication performance mediate the relationship between health IT implementation and patient outcomes. We test the mediating role of communication with a hospital-level data set spanning 2011 through 2015. The specific health information technologies we investigate include EMR documentation, computerized physician order entry (CPOE) systems, clinical decision support (CDS) systems, and health information exchanges (HIE). Our results provide that EMR documentation, CPOE, and HIE directly improve communication between care providers and patients as well as patient outcomes. Further, nurse-patient and physician-patient communication mediates the relationship between health IT implementation and patient outcomes. The mediating effect extends the positive benefits to patient outcomes following technology implementation. We also find that poor communication with patients directly increases mortality, decreases satisfaction, and decreases loyalty. Surprisingly, CDS has a negative relationship on communication and patient outcomes. Our findings contribute to the information systems and healthcare literatures by demonstrating the need to account for the multidimensional nature of healthcare and by providing context for the positive and negative effects previously discovered. Furthermore, the results offer practical and theoretical implications for leveraging specific health IT adoption and for realigning federal incentive structures for hospitals.