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Li Z, Merrell MA, Eberth JM, Wu D, Hung P. Successes and Barriers of Health Information Exchange Participation Across Hospitals in South Carolina From 2014 to 2020: Longitudinal Observational Study. JMIR Med Inform 2023; 11:e40959. [PMID: 37768730 PMCID: PMC10570901 DOI: 10.2196/40959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 02/15/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The 2009 Health Information Technology for Economic and Clinical Health Act sets three stages of Meaningful Use requirements for the electronic health records incentive program. Health information exchange (HIE) technologies are critical in the meaningful use of electronic health records to support patient care coordination. However, HIE use trends and barriers remain unclear across hospitals in South Carolina (SC), a state with the earliest HIE implementation. OBJECTIVE This study aims to explore changes in the proportion of HIE participation and factors associated with HIE participation, and barriers to exchange and interoperability across SC hospitals. METHODS This study derived data from a longitudinal data set of the 2014-2020 American Hospital Association Information Technology Supplement for 69 SC hospitals. The primary outcome was whether a hospital participated in HIE in a year. A cross-sectional multivariable logistic regression model, clustered at the hospital level and weighted by bed size, was used to identify factors associated with HIE participation. The second outcome was barriers to sending, receiving, or finding patient health information to or from other organizations or hospital systems. The frequency of hospitals reporting each barrier related to exchange and interoperability were then calculated. RESULTS Hospitals in SC have been increasingly participating in HIE, improving from 43% (24/56) in 2014 to 82% (54/66) in 2020. After controlling for other hospital factors, teaching hospitals (adjusted odds ratio [AOR] 3.7, 95% CI 1.0-13.3), system-affiliated hospitals (AOR 6.6, 95% CI 3.2-13.7), and rural referral hospitals (AOR 8.0, 95% CI 1.2-53.4) had higher odds to participate in HIE than their counterparts, whereas critical access hospitals (AOR 0.1, 95% CI 0.02-0.6) were less likely to participate in HIE than their counterparts reimbursed by the prospective payment system. Hospitals with greater ratios of Medicare or Medicaid inpatient days to total inpatient days also reported higher odds of HIE participation. Despite the majority of hospitals reporting HIE participation in 2020, barriers to exchange and interoperability remained, including lack of provider contacts (27/40, 68%), difficulty in finding patient health information (27/40, 68%), adapting different vendor platforms (26/40, 65%), difficulty matching or identifying same patients between systems (23/40, 58%), and providers that do not typically exchange patient data (23/40, 58%). CONCLUSIONS HIE participation has been widely adopted in SC hospitals. Our findings highlight the need to incentivize optimization of HIE and seamless information exchange by facilitating and implementing standardization of health information across various HIE systems and by addressing other technical issues, including providing providers' addresses and training HIE stakeholders to find relevant information. Policies and efforts should include more collaboration with vendors to reduce platform compatibility issues and more user engagement and technical training and support to facilitate effective, accurate, and efficient exchange of provider contacts and patient health information.
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Affiliation(s)
- Zhong Li
- Department of Public Administration, School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Melinda A Merrell
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Jan M Eberth
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Department of Health Management and Policy, Drexel University, Philadelphia, PA, United States
| | - Dezhi Wu
- Department of Integrated Information Technology, College of Engineering and Computing, University of South Carolina, Columbia, SC, United States
| | - Peiyin Hung
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
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Heath ML, Porter TH. Physician leadership and health information exchange: literature review. BMJ Health Care Inform 2020; 26:bmjhci-2019-100080. [PMID: 31444230 PMCID: PMC7062346 DOI: 10.1136/bmjhci-2019-100080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/26/2019] [Accepted: 07/30/2019] [Indexed: 11/18/2022] Open
Abstract
Background Notwithstanding two decades of health information exchange (HIE) failures across the country, the US government has incorporated HIE into Meaningful Use Stage 2, which, in turn, has sparked renewed physicians’ interest in HIE. Objective The purpose of this paper was to conduct a literature review to understand how physician leadership might have assisted in supporting organisations in achieving HIE collaboration. Method The authors conducted a review of the literature about HIE and physician challenges from 2009 to present to identify peer-reviewed publications which might apply. Reviewers abstracted each publication for predetermined issues related to physician leadership. Themes were identified based on the literature findings. Results The literature review demonstrated four important themes (physician leader characteristics) that can assist in bridging the gap and creating collaboration in an HIE. The themes found in this study were: trust among physicians, promote involvement and buy-in, infuse value proposition and competition. Conclusion This paper contributes to the healthcare literature by conducting a literature review of the existing literature of surrounding HIE implementation and physician leaders. Specifically, we sought to gain insight into the change process and how physician leaders have demonstrated an impact on the process. This research is the first of its kind to synthesise leadership issues related to HIE and specifically explore the role of physician leader impact on HIE.
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Adjerid I, Adler-Milstein J, Angst C. Reducing Medicare Spending Through Electronic Health Information Exchange: The Role of Incentives and Exchange Maturity. INFORMATION SYSTEMS RESEARCH 2018. [DOI: 10.1287/isre.2017.0745] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Idris Adjerid
- Mendoza College of Business, University of Notre Dame, Notre Dame, Indiana 46556
| | - Julia Adler-Milstein
- School of Information and School of Public Health, University of Michigan, Ann Arbor, Michigan 48109
| | - Corey Angst
- Mendoza College of Business, University of Notre Dame, Notre Dame, Indiana 46556
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Linking the health data system in the U.S.: Challenges to the benefits. Int J Nurs Sci 2017; 4:410-417. [PMID: 31406785 PMCID: PMC6626162 DOI: 10.1016/j.ijnss.2017.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 06/12/2017] [Accepted: 09/29/2017] [Indexed: 11/20/2022] Open
Abstract
In order to improve patient care in the United States there, the government made a mandate called HIE (Health Information Exchange). This order was created from the belief that sharing digital health information between, across, and within health communities will improve one's healthcare experience across their lifespan. Patient health information, i.e. the personal health record, should be shareable between healthcare providers; such as private practice physicians, home health agencies, hospitals and nursing care facilities. Most of the U.S. hospitals now have electronic health records, however, with a lack of standards for structuring health information and unified communication protocols to share health information across providers, only a small percentage of U.S. hospitals engage in computerized HIE. In order to understand barriers and facilitators in the U.S. of HIE adoption, we reviewed the published research literature between 2010 and 2015. Our search yielded 664 articles from Medline, PsychInfo, Global health, InSpec, Scopus and Business Source Complete databases. Thirty-nine articles met our inclusion criteria. This article presents the compiled organizational and end user barriers and facilitators along with suggested methods to achieve continuity of care through HIE.
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Schmit C, Sunshine G, Pepin D, Ramanathan T, Menon A, Penn M. Transitioning From Paper to Digital: State Statutory and Regulatory Frameworks for Health Information Technology. Public Health Rep 2017; 132:585-592. [PMID: 28813620 PMCID: PMC5593240 DOI: 10.1177/0033354917722994] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES In all health system sectors, electronic health information (EHI) is created, used, released, and reused. We examined states' efforts to address EHI uses in law to provide an understanding of the EHI legal environment. METHODS Attorney researchers used WestlawNext to search for EHI-related statutes and regulations of the US states, US territories, and the District of Columbia in effect as of January 2014. The researchers independently catalogued provisions by the EHI use described in the law. Researchers resolved discrepancies through peer review meetings and recorded the consensus codes for each law. RESULTS This study identified 2364 EHI-related laws representing 49 EHI uses in 54 jurisdictions. A total of 18 EHI uses were regulated by ≥10 jurisdictions. More than 750 laws addressed 2 or more EHI uses. Jurisdictions varied by the number of EHI laws in effect, with a mean of 44 laws. Texas had the most EHI laws (n = 145). Hawaii and South Carolina had the fewest (n = 14 each). CONCLUSIONS The EHI legal landscape is complex. The large quantity and diversity of laws complicate legal analysis, likely delay implementation of public health solutions, and might be detrimental to the development of emerging health information technology. Research is needed to understand the effect of EHI-related laws.
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Affiliation(s)
- Cason Schmit
- Chenega Professional and Technical Services, LLC for Public Health Law Program, Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Department of Health Policy & Management, Texas A&M University School of Public Health, College Station, TX, USA
| | - Gregory Sunshine
- Chenega Professional and Technical Services, LLC for Public Health Law Program, Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Dawn Pepin
- Chenega Professional and Technical Services, LLC for Public Health Law Program, Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tara Ramanathan
- Public Health Law Program, Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Akshara Menon
- Chenega Professional and Technical Services, LLC for Public Health Law Program, Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Matthew Penn
- Public Health Law Program, Office for State, Tribal, Local and Territorial Support, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Ovretveit J, Nelson E, James B. Building a learning health system using clinical registers: a non-technical introduction. J Health Organ Manag 2017; 30:1105-1118. [PMID: 27700477 DOI: 10.1108/jhom-06-2016-0110] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to describe how clinical registers were designed and used to serve multiple purposes in three health systems, in order to contribute practical experience for building learning healthcare systems. Design/methodology/approach Case description and comparison of the development and use of clinical registries, drawing on participants' experience and published and unpublished research. Findings Clinical registers and new software systems enable fact-based decisions by patients, clinicians, and managers about better care, as well as new and more economical research. Designing systems to present the data for users' daily work appears to be the key to effective use of the potential afforded by digital data. Research limitations/implications The case descriptions draw on the experience of the authors who were involved in the development of the registers, as well as on published and unpublished research. There is limited data about outcomes for patients or cost-effectiveness. Practical implications The cases show the significant investments which are needed to make effective use of clinical register data. There are limited skills to design and apply the digital systems to make the best use of the systems and to reduce their disadvantages. More use can be made of digital data for quality improvement, patient empowerment and support, and for research. Social implications Patients can use their data combined with other data to self-manage their chronic conditions. There are challenges in designing and using systems so that those with lower health and computer literacy and incomes also benefit from these systems, otherwise the digital revolution may increase health inequalities. Originality/value The paper shows three real examples of clinical registers which have been developed as part of their host health systems' strategies to develop learning healthcare systems. The paper gives a simple non-technical introduction and overview for clinicians, managers, policy-advisors and improvers of what is possible and the challenges, and highlights the need to shape the design and implementation of digital infrastructures in healthcare services to serve users.
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Affiliation(s)
| | - Eugene Nelson
- The Dartmouth Institute, Dartmouth University , Dartmouth, New Hampshire, USA
| | - Brent James
- Institute for Healthcare Delivery Research, Intermountain Healthcare, Salt Lake City, Utah, USA
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Flaks-Manov N, Shadmi E, Hoshen M, Balicer RD. Health information exchange systems and length of stay in readmissions to a different hospital. J Hosp Med 2016; 11:401-6. [PMID: 26714040 DOI: 10.1002/jhm.2535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 11/29/2015] [Accepted: 12/04/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Readmission to a different hospital than the original discharge hospital may result in breakdowns in continuity of care. In different-hospital readmissions (DHRs), continuity can be maintained when hospitals are connected through health information exchange (HIE) systems. OBJECTIVE To examine whether length of readmission stay (LORS) differs between same-hospital readmissions and DHRs, and whether in DHRs the LORS differs by the availability of HIE. DESIGN A retrospective cohort study of all internal medicine 30-day readmissions in 27 Israeli hospitals between January 1, 2010 and December 31, 2010. SETTING Clalit Health Services-Israel's largest integrated healthcare provider and payer. POPULATION Adult Clalit members (aged 18 and older) with at least 1 readmission during the study period. METHODS A multivariate marginal Cox model tested the likelihood for discharge during each readmission day in same-hospital readmissions (SHRs), DHRs with HIE, and DHRs without HIE. RESULTS Of the 27,057 readmissions, 3130 (11.6%) were DHRs and 792 where DHRs with HIE in both the index and readmitting hospital. Partial continuity (DHRs with HIE) was associated with decreased likelihood of discharge on any given day compared with full continuity (SHRs) (hazard ratio [HR] = 0.85, 95% confidence interval [CI]: 0.79-0.91). Similar results were obtained for no continuity (DHRs without HIE) versus full continuity (HR = 0.90, 95% CI: 0.86-0.94). The difference between DHRs with and without HIE was not significant. CONCLUSIONS The prolonged LORS in DHRs versus SHRs was not mitigated by the existence of HIE systems. Future research is needed to further elucidate the effects of actual use of HIE on length of DHRs. Journal of Hospital Medicine 2016;11:401-406. © 2015 Society of Hospital Medicine.
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Affiliation(s)
| | - Efrat Shadmi
- Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Moshe Hoshen
- Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel
| | - Ran D Balicer
- Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel
- Department of Public Health, Ben-Gurion University of the Negev, Beersheba, Israel
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Socias C, Liang Y, Delclos G, Graves J, Hendrikson E, Cooper S. The Feasibility of Using Electronic Health Records to Describe Demographic and Clinical Indicators of Migrant and Seasonal Farmworkers. J Agromedicine 2016; 21:71-81. [PMID: 26479964 PMCID: PMC4744472 DOI: 10.1080/1059924x.2015.1074633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Few extensive, national clinical databases exist on the health of migrant and seasonal farmworkers (MSFWs). Electronic health records (EHRs) are increasingly utilized by Federally Qualified Health Centers (FQHCs) and have the potential to improve clinical care and complement current surveillance and epidemiologic studies of underserved working populations, such as MSFWs. The aim of this feasibility study was to describe the demographics and baseline clinical indicators of patients at an FQHC by MSFW status. The authors described 2012 patient demographics, social history, medical indicators, and diagnoses by MSFW status from the de-identified EHR database of a large, multisite Colorado Migrant Health Center (MHC). Included in the study were 41,817 patients from 2012: 553 (1.3%) MSFWs, 20,665 (49.4%) non-MSFWs, and 20,599 (49.3%) who had no information in the MSFW field. MSFWs were more often male, married, employed, Hispanic, and Spanish-speaking compared with non-MSFWs. The most frequent diagnoses for all patients were hypertension, overweight/obesity, lipid disorder, type 2 diabetes, or a back disorder. Although there were significant missing values, this feasibility study was able to analyze medical data in a timely manner and show that Meaningful Use requirements can improve the usability of EHR data for epidemiologic research of MSFWs and other patients at FQHCs. The results of this study were consistent with current literature available for MSFWs. By reaching this vulnerable working population, EHRs may be a key data source for occupational injury and illness surveillance and research.
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Affiliation(s)
- Christina Socias
- The University of Texas Health Sciences Center, School of Public Health, Houston, Texas
| | - Yuanyuan Liang
- The University of Texas Health Sciences Center, School of Public Health, Houston, Texas
| | - George Delclos
- The University of Texas Health Sciences Center, School of Public Health, Houston, Texas
| | - Julie Graves
- American University of the Caribbean, Cupecoy, Dutch Lowlands, St. Maarten
| | | | - Sharon Cooper
- The University of Texas Health Sciences Center, School of Public Health, Houston, Texas
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Bahous MC, Shadmi E. Health information exchange and information gaps in referrals to a pediatric emergency department. Int J Med Inform 2015; 87:68-74. [PMID: 26806713 DOI: 10.1016/j.ijmedinf.2015.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/06/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE to assess the extent of information gaps between three information sources available at admission to a pediatric Emergency Department (ED): Health Information Exchange (HIE) system, physicians' referral letters and information collected from patients/parents at admission to the ED (patient's medical history). MATERIALS AND METHODS A retrospective cohort study of 170 medical records of children aged 6 months to 18 years referred to a pediatric ED for a common childhood disease. Each record was reviewed for information on lab and imaging tests, vaccinations, allergies, previous diagnoses, recent and chronic medical treatment in the HIE system and referral letter, or from the patient's medical history taken on admission to the ED. The percent overlap between information sources and information gaps was assessed. RESULTS The most informative source, in terms of addressing all key areas, was the patient's medical history, with an average of 73.5% indication of each information key area. Next was the HIE system, with 54.1% indication of each key area; the least informative was the referral letter (43.9%). The overall overlap in data availability among all information sources occurred on average in 23% of the cases. HIE's ability to provide data missing from other routinely available sources was mainly in the area of chronic medication dosages (37% of cases). CONCLUSIONS Each of the three major information sources available at admission to a pediatric ED lack important data and each makes its own unique contribution. Improving documentation in electronic health records, on which HIE systems feed from can narrow significant information gaps at the most critical time-point-admission to a pediatric ED.
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Affiliation(s)
- Marta Chacour Bahous
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, Haifa University, Mount Carmel 31905, Israel; Pediatric Emergency Department, The Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa 31096, Israel.
| | - Efrat Shadmi
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, Haifa University, Mount Carmel 31905, Israel
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Kim KK, Rudin RS, Wilson MD. Health information technology adoption in California community health centers. THE AMERICAN JOURNAL OF MANAGED CARE 2015; 21:e677-e683. [PMID: 26760431 PMCID: PMC4948293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES National and state initiatives to spur adoption of electronic health records (EHRs) and health information exchange (HIE) among providers in rural and underserved communities have been in place for 15 years. Our goal was to systematically assess the impact of these initiatives by quantifying the level of adoption and key factors associated with adoption among community health centers in California. STUDY DESIGN Cross-sectional statewide survey. METHODS We conducted a telephone survey of all California primary care community health centers (CHCs) from August to September 2013. Multiple logistic regressions were fit to test for associations between various practice characteristics and adoption of EHRs, meaningful use-certified EHRs, and HIE. For the multivariable model, we included those variables which were significant at the P = .10 level in the univariate tests. RESULTS We received responses from 194 CHCs (73.5% response rate). Adoption of any EHRs (80.3%) and meaningful use-certified EHRs (94.6% of those with an EHR) was very high. Adoption of HIE is substantial (48.7%) and took place within a few years (mean = 2.61 years; SD = 2.01). More than half (54.7%) of CHCs are able to receive data into the EHR indicating some level of interoperability. Patient engagement capacity is moderate, with 21.6% offering a PHR, and 55.2% electronic visit summaries. Rural location and belonging to a multi-site clinic organization both increase the odds of adoption of EHRs, HIE, and electronic visit summary, with the odds ratio ranging from 0.63 to 3.28 (all P values < .05). CONCLUSIONS Greater adoption of health information technology (IT) in rural areas may be the result of both federal and state investments. As CHCs lack access to capital for investments, continued support of technology infrastructure may be needed for them to further leverage health IT to improve healthcare.
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Affiliation(s)
- Katherine K Kim
- University of California Davis, Betty Irene Moore School of Nursing, 2450 48th St, Ste 2600, Sacramento, CA 95817. E-mail:
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Outlook for state-designated health information exchange: Learning from the information systems and economics literatures. Health Syst (Basingstoke) 2015. [DOI: 10.1057/hs.2014.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kruse CS, Regier V, Rheinboldt KT. Barriers over time to full implementation of health information exchange in the United States. JMIR Med Inform 2014; 2:e26. [PMID: 25600635 PMCID: PMC4288063 DOI: 10.2196/medinform.3625] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 08/15/2014] [Accepted: 09/01/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although health information exchanges (HIE) have existed since their introduction by President Bush in his 2004 State of the Union Address, and despite monetary incentives earmarked in 2009 by the health information technology for economic and clinical health (HITECH) Act, adoption of HIE has been sparse in the United States. Research has been conducted to explore the concept of HIE and its benefit to patients, but viable business plans for their existence are rare, and so far, no research has been conducted on the dynamic nature of barriers over time. OBJECTIVE The aim of this study is to map the barriers mentioned in the literature to illustrate the effect, if any, of barriers discussed with respect to the HITECH Act from 2009 to the early months of 2014. METHODS We conducted a systematic literature review from CINAHL, PubMed, and Google Scholar. The search criteria primarily focused on studies. Each article was read by at least two of the authors, and a final set was established for evaluation (n=28). RESULTS The 28 articles identified 16 barriers. Cost and efficiency/workflow were identified 15% and 13% of all instances of barriers mentioned in literature, respectively. The years 2010 and 2011 were the most plentiful years when barriers were discussed, with 75% and 69% of all barriers listed, respectively. CONCLUSIONS The frequency of barriers mentioned in literature demonstrates the mindfulness of users, developers, and both local and national government. The broad conclusion is that public policy masks the effects of some barriers, while revealing others. However, a deleterious effect can be inferred when the public funds are exhausted. Public policy will need to lever incentives to overcome many of the barriers such as cost and impediments to competition. Process improvement managers need to optimize the efficiency of current practices at the point of care. Developers will need to work with users to ensure tools that use HIE resources work into existing workflows.
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Affiliation(s)
- Clemens Scott Kruse
- School of Health Administration, College of Allied Health Professions, Texas State University, San Marcos, TX, United States.
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Cano Martín JA, Martínez-Pérez B, de la Torre-Díez I, López-Coronado M. Economic impact assessment from the use of a mobile app for the self-management of heart diseases by patients with heart failure in a Spanish region. J Med Syst 2014; 38:96. [PMID: 24994514 DOI: 10.1007/s10916-014-0096-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/18/2014] [Indexed: 10/25/2022]
Abstract
Currently, cardiovascular diseases are the deadliest diseases with a total of 17 million deaths worldwide. Hence, they are the focus of many mobile applications for smartphones and tablets. This paper will assess the ex-ante economic impact as well as will determine the cost-effectiveness analysis that the use of one of this app, CardioManager, by patients with heart failure will have in a Spanish community, Castile and Leon. For this, a cost-effectiveness analysis using the hidden Markov model were performed in a hypothetical cohort of patients diagnosed with heart failure, based on the information of epidemiological parameters and the costs derived from the management and care of heart failure patients by the Public Health Care System of Castile and Leon. The costs of patient care were estimated from the perspective of the Ministry of Health of Spain using a discount rate of 3 %. Finally, an estimation of the ex-ante impact that would suppose the introduction of CardioManager in the Health Care System is performed. It is concluded that the introduction of CardioManager may generate a 33 % reduction in the cost of management and treatment of the disease. This means that CardioManager may be able to save more than 9,000 € per patient to the local Health Care System of Castile and Leon, which can be translated in a saving of 0.31 % of the total health expenditure of the region.
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Affiliation(s)
- José Antonio Cano Martín
- Department of Signal Theory and Communications, and Telematics Engineering, University of Valladolid Paseo de Belén, 15. 47011, Valladolid, Spain,
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Yeager VA, Walker D, Cole E, Mora AM, Diana ML. Factors related to health information exchange participation and use. J Med Syst 2014; 38:78. [PMID: 24957395 DOI: 10.1007/s10916-014-0078-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 06/03/2014] [Indexed: 11/21/2022]
Abstract
This study examines factors facilitating and delaying participation and use of the Health Information Exchange (HIE) in Louisiana. Semi-structured qualitative interviews were conducted with health care representatives throughout the state. Findings suggest that Meaningful Use requirements are a critical factor influencing the decision to participate in the HIE, specifically the mandate that hospitals be able to electronically transfer summary of care documents. Creating buy-in within a few large hospital networks legitimized the HIE and hastened interest in those markets. Fees charged by electronic health record (EHR) vendors to develop HIE interfaces have been prohibitive. Funding from the federal incentive program is intended to offset the costs associated with EHR implementation and increase the likelihood that HIEs can provide value to the population; however, costs and time delays of EHR interface development may be key barriers to fully integrated HIEs. State HIEs may benefit from targeted involvement of state health care leaders who can champion the potential value of the HIE.
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Affiliation(s)
- Valerie A Yeager
- Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 1900, New Orleans, LA, 70112, USA,
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Vest JR, Gamm LD, Ohsfeldt RL, Zhao H, Jasperson 'JS. Factors associated with health information exchange system usage in a safety-net ambulatory care clinic setting. J Med Syst 2012; 36:2455-61. [PMID: 21523428 PMCID: PMC3398743 DOI: 10.1007/s10916-011-9712-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 04/12/2011] [Indexed: 10/18/2022]
Abstract
The Meaningful Use criteria promises to make health information exchange (HIE) much more widespread. However, the usage of the information systems made available by existing HIE efforts tends to be very low. This study sought to examine the factors associated with usage of an operational HIE system during ambulatory care visits to safety-net clinics. Overall the HIE system was accessed for 21% of encounters. However, system access took on two distinct forms. In general, usage was more likely for patients with recent emergency department visits and chronic conditions. This study indicates the organizational commitment to engage in HIE does not necessarily mean that the information systems will be always used. In addition, system usage will take on various forms for different reasons. These results reveal considerations for the development, operation and evaluation of HIE efforts.
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Affiliation(s)
- Joshua R Vest
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA.
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Vest JR, Miller TR. The association between health information exchange and measures of patient satisfaction. Appl Clin Inform 2011; 2:447-59. [PMID: 23616887 DOI: 10.4338/aci-2011-06-ra-0040] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 09/28/2011] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Health information exchange (HIE) is the interorganizational sharing of patient information and is one of many health information technology initiatives expected to transform the U.S. healthcare system. Two outcomes expected to be improved by HIE are patient-provider communication and patient satisfaction . This analysis examined the relationship between the level of HIE engagement and these two factors in a sample of U.S. hospitals. METHODS Independent variables came from existing secondary sources and the dependent measures were from the Hospital Consumer Assessment of Healthcare Providers and Systems. The analysis included 3,278 hospitals. Using ordinary least squares regression, implemented HIE was positively associated with the percentage of patients reporting nurses communicated well and higher satisfaction. Due to the potential for selection bias, results were further explored using a propensity score analysis. RESULTS Hospitals that had adopted HIE, but not yet implemented saw no benefits. Hospitals' level of HIE was not associated with the percentage of patients reporting doctors communicated well. According to propensity score corrected estimates, implemented HIE was associated with the percentage of patients who reported nurses always communicated well and who would definitely recommend the hospital. CONCLUSION Few studies have examined the impact of HIE at the organizational level. This examination provides some evidence that hospitals engaging in HIE are associated with higher patient satisfaction.
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Affiliation(s)
- J R Vest
- Jiann-Ping Hsu College of Public Health, Georgia Southern University
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Dobalian A, Claver ML, Pevnick JM, Stutman HR, Tomines A, Fu P. Organizational challenges in developing one of the Nationwide Health Information Network trial implementation awardees. J Med Syst 2010; 36:933-40. [PMID: 20703640 PMCID: PMC3313038 DOI: 10.1007/s10916-010-9557-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 07/05/2010] [Indexed: 12/02/2022]
Abstract
Health care in the United States is rarely delivered in a coordinated manner. Current methods to share patient information are inefficient and may lead to medical errors, higher readmission rates, and delays in the delivery of needed health services. This qualitative study describes lessons learned concerning the early implementation of one Nationwide Health Information Network (NHIN) site in Long Beach, CA during its first year of operation. The Long Beach Network for Health (LBNH) focused on an incremental effort to exchange health information. Despite a limited concentration on emergency department care, virtually all respondents noted concerns regarding the sustainability, or business case, for the exchange of health information. Nevertheless, respondents were encouraged by progress on technological challenges and user requirements during this first year. The early gains in this process may, in turn, have laid the groundwork for future efforts to expand beyond the emergency department.
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Affiliation(s)
- Aram Dobalian
- Department of Veterans Affairs Greater Los Angeles Healthcare System, HSR&D Center for the Study of Healthcare Provider Behavior, Sepulveda, CA 91343, USA.
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