The impact of health information technology on organ transplant care: A systematic review

Health Information Technology (HIT) has a potential to promote transplant care. However, a
systematic appraisal on how HIT application has so far affected transplant care is greatly missing from the
literature. We systematically reviewed trials that evaluated HIT impact on process and patient outcomes
as well as costs in organ transplant care.
Methods: A systematic search was conducted in OVID versions of MEDLINE, EMBASE, Cumulative Index
to Nursing and Allied Health Literature (CINAHL), the Cochrane, and IEEE databases from January 1990
to December 2015. Studies were included if they: (i) evaluated HIT interventions; (ii) reported results for
organ transplant population; (iii) reported quantitative data on process, patient, and cost outcomes; and
(iv) used a randomized controlled trial or quasi-experimental study design.
Results: Primarily, 12,440 publications were identified; from which ten met inclusion criteria. Among
HIT systems, uses of clinical decision support systems (CDSS) targeting different aspects of the complex
organ transplant care were common. In terms of process outcomes, HIT positively impacted the timeliness
of care, laboratory and medication management practices such as promoting therapeutic or diagnostic
protocol compliance by clinicians, and reducing medication errors. Regarding patient outcomes, HIT
demonstrated a beneficial impact on the percentage of post-transplant patients with normal lab values
and decreasing immunosuppressive toxicity and also deviation from the predefined immunosuppressive
therapeutic window. However, in terms of mortality, readmission, rejection, and antiviral resistance
rates, the impact was not clearly established in the literature. Finally, these systems were associated
with savings in the costs of transplant care in three studies.
Conclusion: This is the first study reviewing HIT impact on transplant care outcomes. CDSSs have mainly
been reported to support transplant care in realizing the above-mentioned benefits. However, to make
conclusions, more evidence with less risk of bias is warranted. Several gaps in the literature, including
comparison of the impact of commercial systems in different transplant settings, was identified which
can motivate future research.