Background
In 2005, an innovative health-information technology (HIT) system of hospital-community on-line medical records ("OFEK") was established in Clalit Health Services (CHS) as a way to cope with cost-containment and the demand for quality improvement.

Study Goals
Examine the implications of introducing OFEK for CHS and study the implications of the extent of OFEK utilization  for selected measures.

Methods
Examine OFEK data utilization; identify relevant quality and medical-service utilization indicators; examine OFEK's impact on the extent of indicator change, by comparing indicator levels "before" and "after" implementation in "experimental" versus matched "control" groups; examine the impact of the extent of utilization by comparing high-use "experimental" groups to matched "control" groups.

Results
OFEK utilization in clinics greatly increased between 2005 and 2006; and continued rising in 2007 and 2008. Use was greatest in clinics in catchment areas of hospitals with the OFEK system. Within those areas, and among clinics using the system extensively, OFEK reduced utilization of imaging services and laboratory use and improved several quality measures. Broadening the analysis to include all catchment area clinics, or all clinics in the study, weakened these effects. In hospitals, use of OFEK increased each year. Internal medicine wards showed a significant decline in the number of tests in the experimental compared to the control group; wards using OFEK extensively also showed a significant decrease in one of the imaging tests and in the frequency of ambulatory hospitalizations in the experimental compared to the control group.   

Conclusions
OFEK affected some of the outcome measures examined. It affected community-clinics and hospitals differently and accumulated evidence regarding OFEK's effect on outcome measures reveals a clearer picture in the community than in hospitals. 

Health-Policy Contribution
The study contributes to assessing the attainment OFEK's goals, and to the development and selection of indicators examining the use of systems of this type; utilization of medical services; treatment efficiency; and quality of care. These indicators can be useful in evaluating other HIT systems in Israel and abroad.

(1) Myers-JDC-Brookdal Institute
(2) Clalit Health Services

Research number: R/106/2005