Appl Clin Inform 2019; 10(03): 528-533
DOI: 10.1055/s-0039-1693456
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Linking Quality Improvement and Health Information Technology through the QI-HIT Figure 8

Trevor Jamieson
1   General Internal Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
2   Women's College Hospital Institute for Health Systems Solutions and Virtual Care (WIHV), Toronto, Ontario, Canada
3   Department of Medicine, University of Toronto, Toronto, Ontario, Canada
Muhammad M. Mamdani
4   Li Ka Shing Centre for Healthcare Analytics Research and Training (LKS-CHART), St Michael's Hospital, Toronto, Ontario, Canada
Edward Etchells
5   Centre for Quality Improvement and Patient Safety, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
› Author Affiliations
Further Information

Publication History

11 March 2019

10 June 2019

Publication Date:
24 July 2019 (online)


The implementation of health information technology (HIT) is complex. A method for mitigating complexity is incrementalism. Incrementalism forms the foundation of both incremental software development models, like agile, and the Plan-Do-Study-Act cycles (PDSAs) of quality improvement (QI), yet we often fail to be incremental at the union of the disciplines. We propose a new model for HIT implementation that explicitly links incremental software development cycles with PDSAs, the QI-HIT Figure 8 (QIHIT-F8). We then detail a subsequent local HIT implementation where we demonstrated its use. The QIHIT-F8 requires a reprioritization of project management activities around tests of change, strong QI principles to detect these changes, and the presence of both baseline and prospective data about the chosen indicators. These conditions are most likely to be present when applied to indicators of high strategic importance to an organization.

Protection of Human and Animal Subjects

This implementation received a quality improvement waiver and did not require research ethics board approval. This was not considered human subjects research.