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The Impact of a National Health Information Exchange Program Under a Single-payer System. Med Care 2019; 58:90-97. [PMID: 31688553 DOI: 10.1097/mlr.0000000000001227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to evaluate the impact of the PharmaCloud program, a health information exchange program implemented in 2013, on medication duplication under a single-payer, universal health insurance program in Taiwan. STUDY DESIGN This study employed a retrospective pre-post study design and used nationwide health insurance claim data from 2013 to 2015. A difference-in-difference analysis was conducted to evaluate the effects of inquiry rate on the probability of receiving duplicate medications and on the number of days of overlapping medication prescriptions after implementation of the PharmaCloud program. RESULTS The study subjects included patients receiving medications in 7 categories: antihypertension drugs, 217,200; antihyperlipidemic drugs, 69,086; hypoglycemic agents, 103,962; antipsychotic drugs, 15,479; antidepressant drugs, 12,057; sedative and hypnotic drugs, 56,048; and antigout drugs, 18,250. Up to 2015, the overall PharmaCloud inquiry rate has increased to 55.36%-69.16%. Compared with subjects in 2013, subjects in 2014 and 2015 had a significantly lower likelihood of receiving duplicate medication in all 7 medication groups; for instance, for antihypertension drug users, the odds ratio (OR) was 0.91 with 95% confidence interval (CI)=0.90-0.92 in 2014, and the OR was 0.81 with 95% confidence interval=0.81-0.82 in 2015. However, a higher inquiry rate led to a lower likelihood of receiving duplicate medication and shorter periods of overlapping medications only in some of the medication groups. CONCLUSIONS The health information exchange program has reduced medication duplication, yet the reduction was not entirely associated with record inquiries. The hospitals have responded to the challenge of medication duplication by enhancing internal prescription control via a prescription alert system, which may have contributed to the reduction in duplicate medications and is a positive, unintended consequence of the intervention.
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Holmgren AJ, Apathy NC. Hospital adoption of API-enabled patient data access. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2019; 7:100377. [PMID: 31471262 DOI: 10.1016/j.hjdsi.2019.100377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/17/2019] [Accepted: 08/23/2019] [Indexed: 11/27/2022]
Affiliation(s)
| | - Nate C Apathy
- Richard M. Fairbanks School of Public Health at Indiana University, Indianapolis, IN, USA
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Abstract
Digital data are anticipated to transform medicine. However, most of today’s medical data lack interoperability: hidden in isolated databases, incompatible systems and proprietary software, the data are difficult to exchange, analyze, and interpret. This slows down medical progress, as technologies that rely on these data – artificial intelligence, big data or mobile applications – cannot be used to their full potential. In this article, we argue that interoperability is a prerequisite for the digital innovations envisioned for future medicine. We focus on four areas where interoperable data and IT systems are particularly important: (1) artificial intelligence and big data; (2) medical communication; (3) research; and (4) international cooperation. We discuss how interoperability can facilitate digital transformation in these areas to improve the health and well-being of patients worldwide.
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Health Information Technology and Accountable Care Organizations: A Systematic Review and Future Directions. EGEMS 2019; 7:24. [PMID: 31328131 PMCID: PMC6625537 DOI: 10.5334/egems.261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Since the inception of Accountable Care Organizations (ACOs), many have acknowledged the potential synergy between ACOs and health information technology (IT) in meeting quality and cost goals. Objective: We conducted a systematic review of the literature in order to describe what research has been conducted at the intersection of health IT and ACOs and identify directions for future research. Methods: We identified empirical studies discussing the use of health IT via PubMed search with subsequent snowball reference review. The type of health IT, how health IT was included in the study, use of theory, population, and findings were extracted from each study. Results: Our search resulted in 32 studies describing the intersection of health IT and ACOs, mainly in the form of electronic health records and health information exchange. Studies were divided into three streams by purpose; those that considered health IT as a factor for ACO participation, health IT use by current ACOs, and ACO performance as a function of health IT capabilities. Although most studies found a positive association between health IT and ACO participation, studies that address the performance of ACOs in terms of their health IT capabilities show more mixed results. Conclusions: In order to better understand this emerging relationship between health IT and ACO performance, we propose future research should consider more quasi-experimental studies, the use of theory, and merging health, quality, cost, and health IT use data across ACO member organizations.
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Vest JR, Ben-Assuli O. Prediction of emergency department revisits using area-level social determinants of health measures and health information exchange information. Int J Med Inform 2019; 129:205-210. [PMID: 31445257 DOI: 10.1016/j.ijmedinf.2019.06.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/17/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Interoperable health information technologies, like electronic health records (EHR) and health information exchange (HIE), provide greater access to patient information from across multiple organizations. Also, an increasing number of public data sources exist to describe social determinant of health factors. These data may help better inform risk prediction models, but the relative importance or value of these data has not been established. This study assessed the performance of different classes of information individually, and in combination, in predicting emergency department (ED) revisits. METHODS In a sample of 279,611 adult ED encounters. We compared the performance of Two-Class Boosted Decision Trees machine learning algorithm using 5 classes of information: 1) social determinants of health measures only, 2) current visit EHR information only, 3) current and historical EHR information, 4) HIE information only, and 5) all available information combined. RESULTS The social determinants of health measure only model had the overall worst performance with an area under the curve AUC of 0.61. The model using all information classes together had the best performance (AUC = 0.732). The model using HIE information only performed better than all other single information class models. CONCLUSIONS Broad information sources, which are reflective of patients' reliance on multiple organizations for care, better support risk prediction modeling in the emergency department.
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Affiliation(s)
- Joshua R Vest
- Indiana University, Richard M. Fairbanks School of Public Health, Indianapolis, IN, United States; Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, United States.
| | - Ofir Ben-Assuli
- Ono Academic College, Faculty of Business Administration, Kiryat Ono, Israel.
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Warren LR, Clarke JM, Arora S, Barahona M, Arebi N, Darzi A. Transitions of care across hospital settings in patients with inflammatory bowel disease. World J Gastroenterol 2019; 25:2122-2132. [PMID: 31114138 PMCID: PMC6506584 DOI: 10.3748/wjg.v25.i17.2122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 02/05/2019] [Accepted: 02/23/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is a chronic, inflammatory disorder characterised by both intestinal and extra-intestinal pathology. Patients may receive both emergency and elective care from several providers, often in different hospital settings. Poorly managed transitions of care between providers can lead to inefficiencies in care and patient safety issues. To ensure that the sharing of patient information between providers is appropriate, timely, accurate and secure, effective data-sharing infrastructure needs to be developed. To optimise inter-hospital data-sharing for IBD patients, we need to better understand patterns of hospital encounters in this group.
AIM To determine the type and location of hospital services accessed by IBD patients in England.
METHODS This was a retrospective observational study using Hospital Episode Statistics, a large administrative patient data set from the National Health Service in England. Adult patients with a diagnosis of IBD following admission to hospital were followed over a 2-year period to determine the proportion of care accessed at the same hospital providing their outpatient IBD care, defined as their ‘home provider’. Secondary outcome measures included the geographic distribution of patient-sharing, regional and age-related differences in accessing services, and type and frequency of outpatient encounters.
RESULTS 95055 patients accessed hospital services on 1760156 occasions over a 2-year follow-up period. The proportion of these encounters with their identified IBD ‘home provider’ was 73.3%, 87.8% and 83.1% for accident and emergency, inpatient and outpatient encounters respectively. Patients living in metropolitan centres and younger patients were less likely to attend their ‘home provider’ for hospital services. The most commonly attended specialty services were gastroenterology, general surgery and ophthalmology.
CONCLUSION Transitions of care between secondary care settings are common for patients with IBD. Effective systems of data-sharing and care integration are essential to providing safe and effective care for patients. Geographic and age-related patterns of care transitions identified in this study may be used to guide interventions aimed at improving continuity of care.
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Affiliation(s)
- Leigh R Warren
- Patient Safety Translational Research Centre, Imperial College London, London W2 1NY, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
| | - Jonathan M Clarke
- Centre for Health Policy, Imperial College London Centre for Mathematics of Precision Healthcare, Imperial College London, London SW7 2BX, United Kingdom
- Department of Biostatistics, Harvard University, Boston, MA 02115, United States
- Department of Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
| | - Sonal Arora
- Patient Safety Translational Research Centre, Imperial College London, London W2 1NY, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
| | - Mauricio Barahona
- Centre for Health Policy, Imperial College London Centre for Mathematics of Precision Healthcare, Imperial College London, London SW7 2BX, United Kingdom
- Department of Mathematics, Imperial College London, London SW7 2BX, United Kingdom
| | - Naila Arebi
- Department of Gastroenterology, St. Marks Academic Institute, Harrow HA1 3UJ, United Kingdom
| | - Ara Darzi
- Patient Safety Translational Research Centre, Imperial College London, London W2 1NY, United Kingdom
- Department of Surgery and Cancer, Imperial College London, London W2 1NY, United Kingdom
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Atasoy H, Greenwood BN, McCullough JS. The Digitization of Patient Care: A Review of the Effects of Electronic Health Records on Health Care Quality and Utilization. Annu Rev Public Health 2019; 40:487-500. [DOI: 10.1146/annurev-publhealth-040218-044206] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Electronic health records (EHRs) adoption has become nearly universal during the past decade. Academic research into the effects of EHRs has examined factors influencing adoption, clinical care benefits, financial and cost implications, and more. We provide an interdisciplinary overview and synthesis of this literature, drawing on work in public and population health, informatics, medicine, management information systems, and economics. We then chart paths forward for policy, practice, and research.
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Affiliation(s)
- Hilal Atasoy
- Department of Accounting, Temple University, Philadelphia, Pennsylvania 19122, USA
| | - Brad N. Greenwood
- Carlson School of Management, University of Minnesota, Minneapolis, Minnesota 55455, USA
| | - Jeffrey Scott McCullough
- Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan 48109-2029, USA
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Rudin RS, Shi Y, Fischer SH, Shekelle P, Amill-Rosario A, Shaw B, Ridgely MS, Damberg CL. Level of agreement on health information technology adoption and use in survey data: a mixed-methods analysis of ambulatory clinics in 1 US state. JAMIA Open 2019; 2:231-237. [PMID: 31984358 PMCID: PMC6951962 DOI: 10.1093/jamiaopen/ooz004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/17/2019] [Accepted: 02/07/2019] [Indexed: 11/12/2022] Open
Abstract
Objective Adoption of health information technology (HIT) is often assessed in surveys of organizations. The validity of data from such surveys for ambulatory clinics has not been evaluated. We compared level of agreement between 1 ambulatory statewide survey and 2 other data sources: a second survey and interviews with survey respondents. Materials and methods We used 2016 data from 2 surveys of ambulatory providers in Minnesota-the Healthcare Information and Management Systems Society (HIMSS) survey and the Minnesota HIT Ambulatory Clinic Survey-and primary data collected through qualitative interviews with survey respondents. We conducted a concurrent triangulation mixed-methods assessment of the Minnesota HIT survey by assessing level of agreement between it and HIMSS, and a thematic analysis of interview data to assess the respondent's understanding of what was being asked and their approach to responding. Results We find high agreement between the 2 surveys on questions related to common HIT functionalities-such as computerized provider order entry, medication-based decision support, and e-prescribing-which were widely adopted by respondents' organizations. Qualitative data suggest respondents found wording of items about these functionalities clear but encountered multiple challenges including interpreting items for less commonly adopted functionalities, estimating degree of HIT usage, and indicating relevant barriers. Respondents identified multiple errors in responses and likely reported greater within-group homogeneity than actually existed. Conclusions Survey items related to the presence or absence of widely adopted HIT functionalities may be more valid than items about less common functionalities, degree of usage, and barriers.
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Affiliation(s)
| | - Yunfeng Shi
- The Pennsylvania State University, University Park, Pennsylvania, USA
| | | | - Paul Shekelle
- RAND Corporation, Santa Monica, California, USA.,West Los Angeles VA Medical Center, Los Angeles, California, USA
| | | | - Bethany Shaw
- The Pennsylvania State University, University Park, Pennsylvania, USA
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Chen M, Guo S, Tan X. Does Health Information Exchange Improve Patient Outcomes? Empirical Evidence From Florida Hospitals. Health Aff (Millwood) 2019; 38:197-204. [DOI: 10.1377/hlthaff.2018.05447] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Min Chen
- Min Chen is an assistant professor in the Department of Information Systems and Business Analytics, College of Business, Florida International University, in Miami
| | - Sheng Guo
- Sheng Guo is an instructor in the Department of Economics, Steven J. Green School of International and Public Affairs, Florida International University
| | - Xuan Tan
- Xuan Tan is a doctoral student in the Department of Information Systems and Business Analytics, College of Business, Florida International University
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60
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Lin SC, Hollingsworth JM, Adler-Milstein J. Alternative payment models and hospital engagement in health information exchange. THE AMERICAN JOURNAL OF MANAGED CARE 2019; 25:e1-e6. [PMID: 30667611 PMCID: PMC6526138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To assess whether hospital participation in alternative payment models (APMs) is associated with greater engagement in health information exchange (HIE) along 4 dimensions: volume of patients for whom information is exchanged, diversity of information types, breadth of partner types, and depth of technical approach. STUDY DESIGN Pooled, cross-sectional analysis of data on US hospitals from 2014 to 2015. METHODS APM participation came from Leavitt Partners data, Medicare public use files, and the American Hospital Association (AHA) Annual Survey. We used Medicare data to measure HIE volume for 798 hospitals attesting to stage 2 Meaningful Use and the AHA Information Technology Supplement to measure HIE diversity, breadth, and depth for 1730 hospitals. We used mixed-effects regression to estimate the association between participation in APMs and each dimension of HIE. RESULTS Compared with nonparticipating hospitals, full-year APM participation was associated with lower HIE volume (data were sent for 11 percentage points fewer discharges; P = .003), greater HIE diversity (of 4 data types, 0.3 more were transmitted; P <.001), greater HIE breadth (of 3 partner types, data were sent to 0.3 more; P <.001), and greater HIE depth (the odds of using a push and pull approach were 1.68 times greater; P = .004). CONCLUSIONS Our finding that APM participation was associated with greater HIE diversity, breadth, and depth suggests that value-based payment may be spurring improvements in HIE infrastructure. However, our finding that APM participation is associated with lower HIE volume suggests that there may be an incentive to focus HIE investments on a limited number of partners.
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Affiliation(s)
- Sunny C Lin
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109.
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61
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Thompson MP, Graetz I. Hospital adoption of interoperability functions. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2018; 7:100347. [PMID: 30595558 DOI: 10.1016/j.hjdsi.2018.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/06/2018] [Accepted: 12/10/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The seamless transmission of patient health information across health care settings, commonly referred to as interoperability, is a focal point of federal electronic health record (EHR) incentive programs. The objective of this study was to examine the extent to which interoperability functions outlined in Promoting Interoperability Stage 3 (PI3) requirements have been adopted by US hospitals, and barriers to interoperability. METHODS We conducted a cross-sectional analysis of 2781 non-federal, acute-care hospitals responding to the 2015 American Hospital Association Information Technology (IT) Supplement survey. We described the percentage of hospitals that adopted PI3 functionalities, identified hospital characteristics associated with adoption, and compared barriers to interoperability between hospitals that have and have not adopted PI3 functionalities. RESULTS Only 16.7% of hospitals had adopted all six core functionalities required to meet PI3 objectives. Over 70% of hospitals had implemented at least four of six functionalities, while 1.8% implemented none. Major teaching (adjusted odds ratio [aOR]=1.66), system affiliated (aOR=1.63), and regional health information exchange participating hospitals (aOR=1.86) were more likely to adopt PI3 functionalities, while for-profit hospitals (OR=0.11) were less likely. Hospitals that adopted PI3 functionalities more frequently reported experiencing barriers to interoperability, including the receiving provider's ability and interest to send/receive data. CONCLUSIONS While only a small proportion of hospitals had implemented all six PI3 functionalities at the time the requirements were finalized, the vast majority had already implemented most of the required functionalities. Still, several barriers stand in the way of achieving seamless interoperability, many of which lie outside hospitals' control.
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Affiliation(s)
- Michael P Thompson
- Center for Healthcare Outcomes and Policy, University of Michigan, USA; Section of Health Services Research and Quality, Department of Cardiac Surgery, University of Michigan Medical School, 5331K Frankel Cardiovascular Center, 1500 E. Medical Center Dr., SPC 5864, Ann Arbor, MI 48109, USA.
| | - Ilana Graetz
- Department of Preventive Medicine, University of Tennessee Health Science Center, USA
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Clarke JM, Warren LR, Arora S, Barahona M, Darzi AW. Guiding interoperable electronic health records through patient-sharing networks. NPJ Digit Med 2018; 1:65. [PMID: 31304342 PMCID: PMC6550264 DOI: 10.1038/s41746-018-0072-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/09/2018] [Indexed: 01/01/2023] Open
Abstract
Effective sharing of clinical information between care providers is a critical component of a safe, efficient health system. National data-sharing systems may be costly, politically contentious and do not reflect local patterns of care delivery. This study examines hospital attendances in England from 2013 to 2015 to identify instances of patient sharing between hospitals. Of 19.6 million patients receiving care from 155 hospital care providers, 130 million presentations were identified. On 14.7 million occasions (12%), patients attended a different hospital to the one they attended on their previous interaction. A network of hospitals was constructed based on the frequency of patient sharing between hospitals which was partitioned using the Louvain algorithm into ten distinct data-sharing communities, improving the continuity of data sharing in such instances from 0 to 65-95%. Locally implemented data-sharing communities of hospitals may achieve effective accessibility of clinical information without a large-scale national interoperable information system.
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Affiliation(s)
- Jonathan M. Clarke
- NIHR Patient Safety Translational Research Centre, Imperial College London, London, W2 1NY UK
- EPSRC Centre for Mathematics of Precision Healthcare, Imperial College London, London, SW7 2AZ UK
- Centre for Health Policy, Imperial College London, London, W2 1NY UK
| | - Leigh R. Warren
- NIHR Patient Safety Translational Research Centre, Imperial College London, London, W2 1NY UK
| | - Sonal Arora
- NIHR Patient Safety Translational Research Centre, Imperial College London, London, W2 1NY UK
| | - Mauricio Barahona
- EPSRC Centre for Mathematics of Precision Healthcare, Imperial College London, London, SW7 2AZ UK
- Department of Mathematics, Imperial College London, London, SW7 2AZ UK
| | - Ara W. Darzi
- NIHR Patient Safety Translational Research Centre, Imperial College London, London, W2 1NY UK
- Centre for Health Policy, Imperial College London, London, W2 1NY UK
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Ikeda DJ, Hollander L, Weigl S, Sawicki SV, Belanger DR, West NY, Brey Magnani N, Wells CG, Gordon P, Morne J, Agins BD. The Facility-Level HIV Treatment Cascade: Using a Population Health Tool in Health Care Facilities to End the Epidemic in New York State. Open Forum Infect Dis 2018; 5:ofy254. [PMID: 30386808 PMCID: PMC6202506 DOI: 10.1093/ofid/ofy254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/18/2018] [Indexed: 11/12/2022] Open
Abstract
Background The HIV treatment cascade is a tool for characterizing population-level gaps in HIV care, yet most adaptations of the cascade rely on surveillance data that are ill-suited to drive quality improvement (QI) activities at the facility level. We describe the adaptation of the cascade in health care organizations and report its use by HIV medical providers in New York State (NYS). Methods As part of data submissions to the NYS Department of Health, sites that provide HIV medical care in NYS developed cascades using facility-generated data. Required elements included data addressing identification of people living with HIV (PLWH) receiving any service at the facility, linkage to HIV medical care, prescription of antiretroviral therapy (ART), and viral suppression (VS). Sites also submitted a methodology report summarizing how cascade data were collected and an improvement plan identifying care gaps. Results Two hundred twenty-two sites submitted cascades documenting the quality of care delivered to HIV patients presenting for HIV- or non-HIV-related services during 2016. Of 101 341 PLWH presenting for any medical care, 75 106 were reported as active in HIV programs, whereas 21 509 had no known care status. Sites reported mean ART prescription and VS rates of 94% and 80%, respectively, and 60 distinct QI interventions. Conclusions Submission of facility-level cascades provides data on care utilization among PLWH that cannot be assessed through traditional HIV surveillance efforts. Moreover, the facility-level cascade represents an effective tool for identifying care gaps, focusing data-driven improvement efforts, and engaging frontline health care providers to achieve epidemic control.
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Affiliation(s)
- Daniel J Ikeda
- New York State Department of Health AIDS Institute, New York, New York.,HEALTHQUAL, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California
| | - Leah Hollander
- New York State Department of Health AIDS Institute, New York, New York
| | - Susan Weigl
- New York State Department of Health AIDS Institute, New York, New York
| | - Steven V Sawicki
- New York State Department of Health AIDS Institute, New York, New York
| | - Daniel R Belanger
- New York State Department of Health AIDS Institute, New York, New York
| | - Nova Y West
- New York State Department of Health AIDS Institute, New York, New York
| | | | | | - Peter Gordon
- Division of Infectious Diseases, Department of Medicine, Columbia University, New York, New York
| | - Johanne Morne
- New York State Department of Health AIDS Institute, New York, New York
| | - Bruce D Agins
- New York State Department of Health AIDS Institute, New York, New York.,HEALTHQUAL, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California.,Institute for Implementation Science in Population Health, New York.,Graduate School of Public Health and Health Policy, City University of New York, New York
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64
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Vest JR, Simon K. Hospitals' adoption of intra-system information exchange is negatively associated with inter-system information exchange. J Am Med Inform Assoc 2018; 25:1189-1196. [PMID: 29860502 DOI: 10.1093/jamia/ocy058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/22/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction U.S. policy on interoperable HIT has focused on increasing inter-system (ie, between different organizations) health information exchange. However, interoperable HIT also supports the movement of information within the same organization (ie, intra-system exchange). Methods We examined the relationship between hospitals' intra- and inter-system information exchange capabilities among health system hospitals included in the 2010-2014 American Hospital Association's Annual Health Information Technology Survey. We described the factors associated with hospitals that adopted more intra-system than inter-system exchange capability, and explored the extent of new capability adoption among hospitals that reported neither intra- or inter-system information capabilities at baseline. Results The prevalence of exchange increased over time, but the adoption of inter-system information exchange was slower; when hospitals adopt information exchange, adoption of intra-system exchange was more common. On average during our study period, hospitals could share 4.6 types of information by intra-system exchange, but only 2.7 types of information by inter-system exchange. Controlling for other factors, hospitals exchanged more types of information in an intra-system manner than inter-system when the number of different inpatient EHR vendors in use in health system is larger. Conclusion Consistent with the U.S. goals for more widely accessible patient information, hospitals' ability to share information has increased over time. However, hospitals are prioritizing within-organizational information exchange over exchange between different organizations. If increasing inter-system exchanges is a desired goal, current market incentives and government policies may be insufficient to overcome hospitals' motivations for pursuing an intra-system-information-exchange-first strategy.
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Affiliation(s)
- Joshua R Vest
- Indiana University Richard M. Fairbanks School of Public Health, Department of Health Policy & Management, Indianapolis, Indiana, USA.,Regenstrief Institute, Indianapolis, Indiana, USA
| | - Kosali Simon
- Indiana University School of Public & Environmental Affairs
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65
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Menachemi N, Rahurkar S, Harle CA, Vest JR. The benefits of health information exchange: an updated systematic review. J Am Med Inform Assoc 2018; 25:1259-1265. [PMID: 29718258 PMCID: PMC7646861 DOI: 10.1093/jamia/ocy035] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/08/2018] [Accepted: 03/18/2018] [Indexed: 11/14/2022] Open
Abstract
Objective Widespread health information exchange (HIE) is a national objective motivated by the promise of improved care and a reduction in costs. Previous reviews have found little rigorous evidence that HIE positively affects these anticipated benefits. However, early studies of HIE were methodologically limited. The purpose of the current study is to review the recent literature on the impact of HIE. Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct our systematic review. PubMed and Scopus databases were used to identify empirical articles that evaluated HIE in the context of a health care outcome. Results Our search strategy identified 24 articles that included 63 individual analyses. The majority of the studies were from the United States representing 9 states; and about 40% of the included analyses occurred in a handful of HIEs from the state of New York. Seven of the 24 studies used designs suitable for causal inference and all reported some beneficial effect from HIE; none reported adverse effects. Conclusions The current systematic review found that studies with more rigorous designs all reported benefits from HIE. Such benefits include fewer duplicated procedures, reduced imaging, lower costs, and improved patient safety. We also found that studies evaluating community HIEs were more likely to find benefits than studies that evaluated enterprise HIEs or vendor-mediated exchanges. Overall, these finding bode well for the HIEs ability to deliver on anticipated improvements in care delivery and reduction in costs.
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Affiliation(s)
- Nir Menachemi
- Department of Health Policy and Management, Indiana University (IU) Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Saurabh Rahurkar
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Christopher A Harle
- Department of Health Policy and Management, Indiana University (IU) Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Joshua R Vest
- Department of Health Policy and Management, Indiana University (IU) Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
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Xu S, Papier A. Returning to (Electronic) Health Records That Guide and Teach. Am J Med 2018; 131:723-725. [PMID: 29427581 DOI: 10.1016/j.amjmed.2017.12.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 12/23/2017] [Accepted: 12/28/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Shuai Xu
- Department of Dermatology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 1600, Chicago, Ill 60611
| | - Arthur Papier
- Department of Dermatology, University of Rochester School of Medicine & Dentistry, NY; Logical Images Inc, Rochester, NY.
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Blockchain Technology for Healthcare: Facilitating the Transition to Patient-Driven Interoperability. Comput Struct Biotechnol J 2018; 16:224-230. [PMID: 30069284 PMCID: PMC6068317 DOI: 10.1016/j.csbj.2018.06.003] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/12/2018] [Accepted: 06/18/2018] [Indexed: 11/23/2022] Open
Abstract
Interoperability in healthcare has traditionally been focused around data exchange between business entities, for example, different hospital systems. However, there has been a recent push towards patient-driven interoperability, in which health data exchange is patient-mediated and patient-driven. Patient-centered interoperability, however, brings with it new challenges and requirements around security and privacy, technology, incentives, and governance that must be addressed for this type of data sharing to succeed at scale. In this paper, we look at how blockchain technology might facilitate this transition through five mechanisms: (1) digital access rules, (2) data aggregation, (3) data liquidity, (4) patient identity, and (5) data immutability. We then look at barriers to blockchain-enabled patient-driven interoperability, specifically clinical data transaction volume, privacy and security, patient engagement, and incentives. We conclude by noting that while patient-driving interoperability is an exciting trend in healthcare, given these challenges, it remains to be seen whether blockchain can facilitate the transition from institution-centric to patient-centric data sharing.
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Vendor of choice and the effectiveness of policies to promote health information exchange. BMC Health Serv Res 2018; 18:405. [PMID: 29866179 PMCID: PMC5987601 DOI: 10.1186/s12913-018-3230-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As more hospitals adopt Electronic Health Records (EHR), focus has shifted to how these records can be used to improve patient care. One barrier to this improvement is limited information exchange between providers. In this work we examine the role of EHR vendors, hypothesizing that vendors strategically control the exchange of clinical care summaries. Their strategy may involve the creation of networks that easily exchange information between providers with the same vendor but frustrate exchange between providers with different vendors, even as both Federal and State policies attempt to incentivize exchange through a common format. METHODS Using data from the 2013 American Hospital Association's Information Technology Supplement, we examine the relationship between a hospital's decision to share clinical care summaries outside of their network and EHR vendor market share, measured by the percentage of hospitals that have the same vendor in a Hospital Referral Region. RESULTS Our findings show that the likelihood of a hospital exchanging clinical summaries with hospitals outside its health system increases as the percentage of hospitals with the same EHR vendor in the region increases. The estimated odds of a hospital sharing clinical care summaries outside their system is 5.4 (95% CI, 3.29-8.80) times greater if all hospitals in the Hospital Referral Region use the same EHR Vendor than the corresponding odds for a hospital in an area with no hospitals using the same EHR Vendor. When reviewing the relationship of vendor market concentration at the state level we find a positive significant relationship with the percentage of hospitals that share clinical care summaries within a state. We find no significant impact from state policies designed to incentivize information exchange through the State Health Information Exchange Cooperative Program. CONCLUSION There are benefits to exchanging using proprietary methods that are strengthened when the vendors are more concentrated. In order to avoid closed networks that foreclose some hospitals, it is important that future regulation attempt to be more inclusive of hospitals that do not use large vendors and are therefore unable to use proprietary methods for exchange.
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Martin T. The impact of net neutrality on digital health. Mhealth 2018; 4:36. [PMID: 30225241 PMCID: PMC6131349 DOI: 10.21037/mhealth.2018.08.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/13/2018] [Indexed: 11/06/2022] Open
Affiliation(s)
- Thomas Martin
- Department of Health Services, St. Joseph's University, Philadelphia, PA, USA
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