Can Health IT Really Boost Hospital Productivity? Insights from Adler-Milstein et al.

In the complex world of healthcare, mounting costs, clinician shortages, and inefficiencies are constant challenges. Technologies like Electronic Health Records (EHR), decision support systems, and digital workflows are often proposed as solutions — but do they deliver real productivity gains in hospitals? In their influential research, Julia Adler-Milstein and colleagues examine just this question. Their work provides a nuanced understanding of how Health Information Technology (Health IT or HIT) impacts hospital productivity — the good, the mixed, and the lessons for the future.

Key Study & Context

Adler-Milstein and collaborators published multiple studies between 2015–2022 that analyze national-level data on HIT adoption in U.S. hospitals. They looked at how EHR systems (and related technologies) relate to hospital performance metrics, processes, and outcomes. This work is important not just for tech enthusiasts but for decision-makers: investing in health IT is expensive, disruptive, and requires careful justification.

Some of their relevant studies include:

• EHR Adoption and Hospital Performance: Time-Related Effects (2015) assessing performance gains over time. (Europe PMC)

• HITECH Act Drove Large Gains in Hospital Electronic Health Record Adoption (Adler-Milstein & Jha, 2017) showing how policy incentives spurred EHR uptake. (Health Affairs)

What They Found: Gains, But Not Explosive

1. Productivity Gains Are Real — But Modest

The researchers found that hospitals with more mature HIT systems tend to show improvements in certain operational metrics — shorter length of stay, lower readmission rates, marginally better adherence to protocols, etc. The 2015 “EHR Adoption and Hospital Performance” study noted that hospitals that adopted EHRs earlier or more comprehensively had better performance in more recent years compared to earlier adopter cohorts. (Europe PMC)

However, the gains are not dramatic or universal. HIT on its own does not guarantee large increases in productivity. Factors such as hospital size, organizational culture, workflow redesign, and clinician engagement modify how much benefit is realized.

2. Policy and Incentives Matter

One of the clearest findings is that policies like the U.S. HITECH Act (2009) played a major role in accelerating EHR adoption. The study “HITECH Act Drove Large Gains in Hospital Electronic Health Record Adoption” found that eligible hospitals (under the incentive scheme) increased EHR adoption rates dramatically compared to ineligible ones. (Health Affairs)

This suggests that external drivers (financial incentives, regulatory pressure, certification requirements) are crucial levers to move HIT adoption and, by extension, the downstream productivity effects.

3. Outcomes Improve Over Time

Interestingly, the association between EHR usage and hospital performance gets stronger over time. Early years of adoption show smaller or inconsistent benefits, but as usage becomes more established — workflows adjusted, staff trained, data flows improved — measurable performance improvements (e.g., efficiency, quality metrics) become more evident. (Europe PMC)

The Limits & What Doesn’t Improve Much

Not everything improves as quickly (or as much) as hoped. A few caveats that the studies emphasize:

• Clinical outcomes are mixed: Improvements in mortality, adverse drug events, or large mortality reductions are harder to detect in many settings. Some studies show little difference early on. (PubMed Central)

• Cost savings are not immediate: While efficiencies arise (less paperwork, fewer redundant tests, faster billing), actual cost savings are often modest in the first years and sometimes balanced out by the costs of implementation, training, and changes to infrastructure.

• Variability across settings: Large academic medical centers often see greater gains than small or rural hospitals. Those with more resources, better staffing, and willingness to adapt workflows do better.

• Technology alone isn’t enough: HIT must be paired with process redesign, staff support, and change management to see real productivity gains.

What Makes HIT More Effective: Key Enablers

From the research, some recurring themes emerge about what helps hospitals get more from their health IT investments:

1. Clinician and administrative buy-in: When users are involved in selecting, configuring, and refining systems, adoption tends to be smoother and more effective.

2. Workflow redesign: HIT forces organizations to rethink processes — how orders are entered, how data is retrieved, how communications happen across departments. Without re-engineering outdated workflows, technology can simply digitize inefficiency.

3. Training & Usability: Systems must be usable. If EHRs are cumbersome, slow, or frustrating, adoption suffers, and productivity gains dwindle.

4. Interoperability: Able systems to share data (via standards like HL7, FHIR) with labs, imaging, other care providers — reduces duplicates, reduces delays.

5. Incremental vs Radical Adoption: Hospitals that phased in HIT—piloting modules, scaling gradually—often fared better than those trying big-bang full rollouts.

6. Policy & Incentives: External factors like reimbursement incentives, regulatory compliance, penalties or rewards (e.g., meaningful use) influence both adoption and how systems are used.

Lessons & Implications for Healthcare Leaders

If you're in a position to assess or lead HIT/HMS adoption, here’s what these studies suggest:

• Don’t expect overnight returns. Be realistic about a multi-year horizon for cost, productivity, quality improvements.

• Budget not just for licenses, hardware, and deployment — also training, workflow revision, change management, ongoing maintenance.

• Measure what matters: Choose metrics like patient readmission rates, order turnaround time, length of stay, billing rejection rates, patient satisfaction—not just “HIT installed.”

• Ensure that usability is high. Clinician burden is often the Achilles’ heel of HIT implementations.

• Seek policy support or incentives where possible. Public funding, regulation, or certification helps push both adoption and effective use.

Outlook: Where HIT Productivity Gains Are Heading

Looking ahead, drawing on Adler-Milstein’s work as well as more recent trends:

• AI, predictive analytics, decision support are increasingly embedded in HIT to help hospitals anticipate capacity needs, detect sepsis, predict readmission risk, etc.

• Mobile and remote care tools are expanding HIT’s reach outside hospital walls.

• Patient data ownership & portability (enabled by standards like FHIR) will help patients’ records travel, reducing duplication and friction in care.

• Focus on equity: Ensuring that smaller, resource-constrained hospitals are not left behind; that technology is not just for big systems.

• Better measurement tools: Studies with more robust methods (causal inference, time-series data) are needed to prove impact in diverse settings.

Bottom Line

Julia Adler-Milstein and colleagues provide a valuable, balanced view of what Health IT delivers — not magic, but meaningful value when deployed thoughtfully.

Health IT systems can, and do, improve hospital productivity — but with key caveats:

• Gains are more likely over time, once workflows adapt and staffare trained.

• The biggest barriers are non-technical: resistance to change, usability, lack of process redesign.

• Policy incentives matter a lot.

For hospitals considering or optimizing HIT/HMS investments in 2025 and beyond, the message is clear: invest smartly, plan for the long haul, measure well—and the returns are real.

References:

• Adler-Milstein, Julia; Everson, Jordan; Lee, Shoou-Yih. “EHR Adoption and Hospital Performance: Time-Related Effects.” Health Services Research. Vol. 50 (6):1751-1771, 2015. (Europe PMC)

• Adler-Milstein, Julia; Jha, Ashish K. “HITECH Act Drove Large Gains in Hospital Electronic Health Record Adoption.” Health Affairs. 2017. (Health Affairs)