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Gans EA, de Ruijter UW, de Groot JF, van den Bos F, van Munster BC. Recommendations for an Interdisciplinary Patient Review for patients with multiple long-term conditions in the hospital. Eur J Intern Med 2024; 126:33-37. [PMID: 38944575 DOI: 10.1016/j.ejim.2024.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 06/20/2024] [Indexed: 07/01/2024]
Affiliation(s)
- E A Gans
- University Center of Geriatric Medicine, University Medical Center Groningen, Groningen, the Netherlands; Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, the Netherlands.
| | - U W de Ruijter
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Internal Medicine, Northwest Clinics, Alkmaar, the Netherlands
| | - J F de Groot
- Knowledge Institute of the Dutch Association of Medical Specialists, Utrecht, the Netherlands
| | - F van den Bos
- Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - B C van Munster
- University Center of Geriatric Medicine, University Medical Center Groningen, Groningen, the Netherlands
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Petrova M, Barclay S. From "wading through treacle" to "making haste slowly": A comprehensive yet parsimonious model of drivers and challenges to implementing patient data sharing projects based on an EPaCCS evaluation and four pre-existing literature reviews. PLOS DIGITAL HEALTH 2024; 3:e0000470. [PMID: 38557799 PMCID: PMC10984410 DOI: 10.1371/journal.pdig.0000470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/19/2024] [Indexed: 04/04/2024]
Abstract
Conceptually, this study aimed to 1) identify the challenges and drivers encountered by England's Electronic Palliative Care Coordination System (EPaCCS) projects in the context of challenges and drivers in other projects on data sharing for individual care (also referred to as Health Information Exchange, HIE) and 2) organise them in a comprehensive yet parsimonious framework. The study also had a strong applied goal: to derive specific and non-trivial recommendations for advancing data sharing projects, particularly ones in early stages of development and implementation. Primary data comprised 40 in-depth interviews with 44 healthcare professionals, patients, carers, project team members and decision makers in Cambridgeshire, UK. Secondary data were extracted from four pre-existing literature reviews on Health Information Exchange and Health Information Technology implementation covering 135 studies. Thematic and framework analysis underpinned by "pluralist" coding were the main analytical approaches used. We reduced an initial set of >1,800 parameters into >500 challenges and >300 drivers to implementing EPaCCS and other data sharing projects. Less than a quarter of the 800+ parameters were associated primarily with the IT solution. These challenges and drivers were further condensed into an action-guiding, strategy-informing framework of nine types of "pure challenges", four types of "pure drivers", and nine types of "oppositional or ambivalent forces". The pure challenges draw parallels between patient data sharing and other broad and complex domains of sociotechnical or social practice. The pure drivers differ in how internal or external to the IT solution and project team they are, and thus in the level of control a project team has over them. The oppositional forces comprise pairs of challenges and drivers where the driver is a factor serving to resolve or counteract the challenge. The ambivalent forces are factors perceived simultaneously as a challenge and a driver depending on context, goals and perspective. The framework is distinctive in its emphasis on: 1) the form of challenges and drivers; 2) ambivalence, ambiguity and persistent tensions as fundamental forces in the field of innovation implementation; and 3) the parallels it draws with a variety of non-IT, non-health domains of practice as a source of fruitful learning. Teams working on data sharing projects need to prioritise further the shaping of social interactions and structural and contextual parameters in the midst of which their IT tools are implemented. The high number of "ambivalent forces" speaks of the vital importance for data sharing projects of skills in eliciting stakeholders' assumptions; managing conflict; and navigating multiple needs, interests and worldviews.
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Affiliation(s)
- Mila Petrova
- Palliative and End of Life Care Group in Cambridge (PELiCam), Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom
| | - Stephen Barclay
- Palliative and End of Life Care Group in Cambridge (PELiCam), Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom
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Everson J, Healy D, Patel V. Experiences with information blocking in the United States: a national survey of hospitals. J Am Med Inform Assoc 2023; 30:1150-1157. [PMID: 37029919 PMCID: PMC10198516 DOI: 10.1093/jamia/ocad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/06/2023] [Accepted: 03/31/2023] [Indexed: 04/09/2023] Open
Abstract
OBJECTIVE The 21st Century Cures Act Final Rule's information blocking provisions, which prohibited practices likely to interfere with, prevent, or materially discourage access, exchange, or use of electronic health information (EHI), began to apply to a limited set of data elements in April 2021 and expanded to all EHI in October 2022. We sought to describe hospital leaders' perceptions of the prevalence of practices that may constitute information blocking, by actor and hospital characteristics, following the rule's applicability date. MATERIALS AND METHODS Cross-sectional analysis of a national survey of hospitals fielded in 2021. The analytic sample included 2092 nonfederal acute care hospitals in the United States. We present descriptive statistics on the perception of the prevalence of information blocking and results of multivariate regression models examining the association between hospital, health information technology (IT) developer and market characteristics and the perception of information blocking. RESULTS Overall, 42% of hospitals reported observing some behavior they perceived to be information blocking. Thirty-six percent of responding hospitals perceived that healthcare providers either sometimes or often engaged in practices that may constitute information blocking, while 17% and 19% perceived that health IT developers (such as EHR developers) and State, regional and/or local health information exchanges did the same, respectively. Prevalence varied by health IT developer market share, hospital for-profit status, and health system market share. CONCLUSIONS AND RELEVANCE These results support the value of efforts to further reduce friction in the exchange of EHI and support the need for continued observation to provide a sense of the prevalence of information blocking practices and for education and awareness of information blocking regulations.
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Affiliation(s)
- Jordan Everson
- Office of the National Coordinator for Health Information Technology, Department of Health and Human Services, Washington, District of Columbia, USA
| | - Daniel Healy
- Office of the National Coordinator for Health Information Technology, Department of Health and Human Services, Washington, District of Columbia, USA
| | - Vaishali Patel
- Office of the National Coordinator for Health Information Technology, Department of Health and Human Services, Washington, District of Columbia, USA
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Abstract
BACKGROUND Increasing electronic health information exchange (HIE) between provider organizations is a top policy priority that has been pursued by establishing varied types of networks. OBJECTIVES To measure electronic connectivity enabled by these networks, including community, electronic health record vendor, and national HIE networks, across US hospitals weighted by the volume of shared patients and identify characteristics that predict connectivity. RESEARCH DESIGN Cross-sectional analysis of 1721 hospitals comprising 16,344 hospital pairs and 6,492,232 shared patients from 2018 CareSet Labs HOP data and national hospital surveys. SUBJECTS Pairs of US acute care hospitals that delivered care to 11 or more of the same fee-for-service Medicare beneficiaries in 2018. MEASURES Whether a patient was treated by a pair of hospitals connected through participation in the same HIE network ("connected hospitals") or not connected because the hospitals participated in different networks, only 1 participated, or both did not participate. RESULTS Sixty-four percent of shared patients were treated by connected hospitals. Of the remaining shared patients, 14% were treated by hospital pairs that participated in different HIE networks, 21% by pairs in which only 1 hospital participated in an HIE network, and 2% by pairs in which neither participated. Patients treated by pairs with at least 1 for-profit hospital, and by pairs located in competitive markets, were less likely to be treated by connected hospitals. CONCLUSIONS While the majority of shared patients received care from connected hospitals, remaining gaps could be filled by connecting HIE networks to each other and by incentivizing certain types of hospitals that may not participate because of competitive concerns.
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Affiliation(s)
- Jordan Everson
- Department of Health and Human Services, Office of the National Coordinator for Health Information Technology, Washington, DC
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Everson J, Patel V. Hospital's adoption of multiple methods of obtaining outside information and use of that information. J Am Med Inform Assoc 2022; 29:1489-1496. [PMID: 35652172 PMCID: PMC9382382 DOI: 10.1093/jamia/ocac079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/19/2022] [Accepted: 05/10/2022] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVE Hospitals have multiple methods available to engage in health information exchange (HIE); however, it is not well understood whether these methods are complements or substitutes. We sought to characterize patterns of adoption of HIE methods and examine the association between these methods and increased availability and use of patient information. MATERIALS AND METHODS Cross-sectional analysis of 3208 nonfederal acute care hospitals in the 2019 American Hospital Association Information Technology Supplement. RESULTS The median hospital obtained outside information through 4 methods. Hospitals that obtained data through a regional HIE organization were 2.2 times more likely to also obtain data via Direct using a health information service provider (HISP) than hospitals that did not (P < .001). Hospitals in a single electronic health record (EHR) vendor network were no more or less likely to participate in a HISP or HIE. Six of 7 methods were associated with greater information availability. Only 4 of 7 methods (portals, interfaces, single vendor networks and multi-vendor networks but not access to outside EHR, regional exchange or Direct using a HISP) were associated with more frequent use of information, and single vendor networks were most strongly associated with more frequent use (odds ratio = 4.7, P < .001). DISCUSSION Adoption of some methods was correlated, indicating complementary use. Few methods were negatively correlated, indicating limited competition. Although information availability was common, low correlation with use indicated that challenges related to integration may be slowing use of information. CONCLUSION Complementarities between methods, and the role of integration in supporting information use, indicate the potential value of efforts aimed at ensuring exchange methods work well together, such as the Trusted Exchange Framework and Common Agreement.
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Affiliation(s)
- Jordan Everson
- Corresponding Author: Jordan Everson, PhD, MPP, Data Analysis Branch, Office of the National Coordinator for Health Information Technology, 330 C St SE, 7th floor, Washington, DC 20024, USA;
| | - Vaishali Patel
- Data Analysis Branch, Office of the National Coordinator for Health Information Technology, Washington, District of Columbia, USA
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Khalifa A, Mason CC, Garvin JH, Williams MS, Del Fiol G, Jackson BR, Bleyl SB, Huff SM. A qualitative investigation of biomedical informatics interoperability standards for genetic test reporting: benefits, challenges, and motivations from the testing laboratory's perspective. Genet Med 2021; 23:2178-2185. [PMID: 34429527 DOI: 10.1038/s41436-021-01301-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Genetic laboratory test reports can often be of limited computational utility to the receiving clinical information systems, such as clinical decision support systems. Many health-care interoperability (HC) standards aim to tackle this problem, but the perceived benefits, challenges, and motivations for implementing HC interoperability standards from the labs' perspective has not been systematically assessed. METHODS We surveyed genetic testing labs across the United States and conducted a semistructured interview with responding lab representatives. We conducted a thematic analysis of the interview transcripts to identify relevant themes. A panel of experts discussed and validated the identified themes. RESULTS Nine labs participated in the interview, and 24 relevant themes were identified within five domains. These themes included the challenge of complex and changing genetic knowledge, the motivation of competitive advantage, provided financial incentives, and the benefit of supporting the learning health system. CONCLUSION Our study identified the labs' perspective on various aspects of implementing HC interoperability standards in producing and communicating genetic test reports. Interviewees frequently reported that increased adoption of HC standards may be motivated by competition and programs incentivizing and regulating the incorporation of interoperability standards for genetic test data, which could benefit quality control, research, and other areas.
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Affiliation(s)
- Aly Khalifa
- Department of Biomedical Informatcs, School of Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Clinton C Mason
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jennifer Hornung Garvin
- Department of Biomedical Informatcs, School of Medicine, University of Utah, Salt Lake City, UT, USA.,Health Information Management and Systems Division, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH, USA.,Indianapolis VA Medical Center, Indianapolis, IN, USA
| | | | - Guilherme Del Fiol
- Department of Biomedical Informatcs, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Brian R Jackson
- Department of Biomedical Informatcs, School of Medicine, University of Utah, Salt Lake City, UT, USA.,ARUP Laboratories, Salt Lake City, UT, USA
| | - Steven B Bleyl
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, UT, USA.,Genome Medical Services, San Francisco, CA, USA
| | - Stanley M Huff
- Department of Biomedical Informatcs, School of Medicine, University of Utah, Salt Lake City, UT, USA.,Department of Biomedical Informatics, Intermountain Healthcare, Murray, UT, USA
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Everson J, Patel V, Adler-Milstein J. Information blocking remains prevalent at the start of 21st Century Cures Act: results from a survey of health information exchange organizations. J Am Med Inform Assoc 2021; 28:727-732. [PMID: 33410891 DOI: 10.1093/jamia/ocaa323] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/09/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Recent policy making aims to prevent health systems, lectronic health record (EHR) vendors, and others from blocking the electronic sharing of patient data necessary for clinical care. We sought to assess the prevalence of information blocking prior to enforcement of these rules. MATERIALS AND METHODS We conducted a national survey of health information exchange organizations (HIEs) to measure the prevalence of information blocking behaviors observed by these third-party entities. Eighty-nine of 106 HIEs (84%) meeting the inclusion criteria responded. RESULTS The majority (55%) of HIEs reported that EHR vendors at least sometimes engage in information blocking, while 30% of HIEs reported the same for health systems. The most common type of information blocking behavior EHR vendors engaged in was setting unreasonably high prices, which 42% of HIEs reported routinely observing. The most common type of information blocking behavior health systems engaged in was refusing to share information, which 14% of HIEs reported routinely observing. Reported levels of vendor information blocking was correlated with regional competition among vendors and information blocking was concentrated in some geographic regions. DISCUSSION Our findings are consistent with early reports, revealing persistently high levels of information blocking and important variation by actor, type of behavior, and geography. These trends reflect the observations and experiences of HIEs and their potential biases. Nevertheless, these data serve as a baseline against which to measure the impact of new regulations and to inform policy makers about the most common types of information blocking behaviors. CONCLUSION Enforcement aimed at reducing information blocking should consider variation in prevalence and how to most effectively target efforts.
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Affiliation(s)
- Jordan Everson
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Vaishali Patel
- Data Analysis Branch, Office of the National Coordinator for Health Information Technology, Washington, DC, USA
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A qualitative study of prevalent laboratory information systems and data communication patterns for genetic test reporting. Genet Med 2021; 23:2171-2177. [PMID: 34230635 DOI: 10.1038/s41436-021-01251-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/08/2021] [Accepted: 06/09/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The availability of genetic test data within the electronic health record (EHR) is a pillar of the US vision for an interoperable health IT infrastructure and a learning health system. Although EHRs have been highly investigated, evaluation of the information systems used by the genetic labs has received less attention-but is necessary for achieving optimal interoperability. This study aimed to characterize how US genetic testing labs handle their information processing tasks. METHODS We followed a qualitative research method that included interviewing lab representatives and a panel discussion to characterize the information flow models. RESULTS Ten labs participated in the study. We identified three generic lab system models and their relevant characteristics: a backbone system with additional specialized systems for interpreting genetic results, a brokering system that handles housekeeping and communication, and a single primary system for results interpretation and report generation. CONCLUSION Labs have heterogeneous workflows and generally have a low adoption of standards when sending genetic test reports back to EHRs. Core interpretations are often delivered as free text, limiting their computational availability for clinical decision support tools. Increased provision of genetic test data in discrete and standard-based formats by labs will benefit individual and public health.
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Vest JR, Unruh MA, Casalino LP, Shapiro JS. The complementary nature of query-based and directed health information exchange in primary care practice. J Am Med Inform Assoc 2021; 27:73-80. [PMID: 31592529 DOI: 10.1093/jamia/ocz134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/27/2019] [Accepted: 07/07/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Many policymakers and advocates assume that directed and query-based health information exchange (HIE) work together to meet organizations' interoperability needs, but this is not grounded in a substantial evidence base. This study sought to clarify the relationship between the usage of these 2 approaches to HIE. MATERIALS AND METHODS System user log files from a regional HIE organization and electronic health record system were combined to model the usage of HIE associated with a patient visit at 3 federally qualified health centers in New York. Regression models tested the hypothesis that directed HIE usage was associated with query-based usage and adjusted for factors reflective of the FITT (Fit between Individuals, Task & Technology) framework. Follow-up interviews with 8 key informants helped interpret findings. RESULTS Usage of query-based HIE occurred in 3.1% of encounters and directed HIE in 23.5%. Query-based usage was 0.6 percentage points higher when directed HIE provided imaging information, and 4.8 percentage points higher when directed HIE provided clinical documents. The probability of query-based HIE was lower for specialist visits, higher for postdischarge visits, and higher for encounters with nurse practitioners. Informants used query-based HIE after directed HIE to obtain additional information, support transitions of care, or in cases of abnormal results. DISCUSSION The complementary nature of directed and query-based HIE indicates that both HIE functionalities should be incorporated into EHR Certification Criteria. CONCLUSIONS Quantitative and qualitative findings suggest that directed and query-based HIE exist in a complementary manner in ambulatory care settings.
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Affiliation(s)
- Joshua R Vest
- Indiana University Richard M Fairbanks School of Public Health at IUPUI, Department of Health Policy & Management; Center for Biomedical Informatics, the Regenstrief Institute, Inc, Indianapolis, IN
| | - Mark A Unruh
- Department of Healthcare Policy and Research, Weill Medical College, New York, NY, USA
| | - Lawrence P Casalino
- Department of Healthcare Policy and Research, Weill Medical College, New York, NY, USA
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Liss DT, Brown T, Wakeman J, Dunn S, Cesan A, Guzman A, Desai A, Buchanan D. Development of a Smartphone App for Regional Care Coordination Among High-Risk, Low-Income Patients. Telemed J E Health 2020; 26:1391-1399. [DOI: 10.1089/tmj.2019.0176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- David T. Liss
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tiffany Brown
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Julie Wakeman
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Shira Dunn
- Erie Family Health Centers, Chicago, Illinois, USA
| | - Ana Cesan
- Oak Street Health, Chicago, Illinois, USA
| | - Adriana Guzman
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Amish Desai
- Erie Family Health Centers, Chicago, Illinois, USA
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Everson J, Adler-Milstein J. Gaps in health information exchange between hospitals that treat many shared patients. J Am Med Inform Assoc 2019; 25:1114-1121. [PMID: 30010887 DOI: 10.1093/jamia/ocy089] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/14/2018] [Indexed: 11/13/2022] Open
Abstract
Objective Hospitals that routinely share patients are those that most critically need to engage in electronic health information exchange (HIE) with each other to ensure clinical information is available to inform treatment decisions. We surveyed pairs of hospitals in a nationwide sample to describe whether and how hospitals within each hospital referral region (HRR) that have the highest shared patient (HSP) volume engaged in HIE with each other. Methods We used Medicare's Physician Shared Patient Patterns data to identify hospital pairs with the highest shared patient volume in each hospital referral region. We surveyed a purposeful sample of pairs and then calculated descriptive statistics to compare: (1) HIE with the HSP hospital vs HIE with other hospitals, and (2) HIE with the HSP hospital versus federal measures of HIE engagement that are not partner-specific. Results We received responses from 25.5% of contacted hospitals and 33.5% of contacted pairs, allowing us to examine information sharing among 68 hospitals in 63 pairs. 23% of respondents reported worse information sharing with their HSP hospital than with other hospitals while 17% indicated better sharing with their HSP hospital and 48% indicated no difference. Our HSP-specific measures of HIE differed from federal measures of HIE engagement: while 97% of respondents are classified as routinely sending information electronically in federal measures, in our data only 63% did so with their HSP hospital. Conclusions Despite increased HIE engagement, our descriptive results indicate that HIE is not developing in a way that facilitates information exchange where it might benefit the most patients. New policy efforts, particularly those emerging from the 21st Century Cures Act, need to explicitly pursue strategies that ensure that HSP providers engage in exchange with each other.
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Affiliation(s)
- Jordan Everson
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA
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Schmit CD, Wetter SA, Kash BA. Falling short: how state laws can address health information exchange barriers and enablers. J Am Med Inform Assoc 2019; 25:635-644. [PMID: 29106555 DOI: 10.1093/jamia/ocx122] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 10/13/2017] [Indexed: 11/13/2022] Open
Abstract
Objective Research on the implementation of health information exchange (HIE) organizations has identified both positive and negative effects of laws relating to governance, incentives, mandates, sustainability, stakeholder participation, patient engagement, privacy, confidentiality, and security. We fill a substantial research gap by describing whether comprehensive state and territorial HIE legal frameworks address identified legal facilitators and barriers. Materials and Methods We used the Westlaw database to identify state and territorial laws relating to HIEs in effect on June 7, 2016 (53 jurisdictions). We blind-coded all laws and addressed coding discrepancies in peer-review meetings. We recorded a consensus code for each law in a master database. We compared 20 HIE legal attributes with identified barriers to and enablers of HIE activity in the literature. Results Forty-two states, the District of Columbia, and 2 territories have laws relating to HIEs. On average, jurisdictions address 8.32 of the 20 criteria selected in statutes and regulations. Twenty jurisdictions unambiguously address ≤5 criteria in statutes and regulations. None of the significant legal criteria are unambiguously addressed in >60% of the 53 jurisdictions. Discussion Laws can be barriers to or enablers of HIEs. However, jurisdictions are not addressing many significant issues identified by researchers. Consequently, there is a substantial risk that existing legal frameworks are not adequately supporting HIEs. Conclusion The current evidence base is insufficient for comparative assessments or impact rankings of the various factors. However, the detailed Centers for Disease Control and Prevention dataset of HIE laws could enable investigations into the types of laws that promote or impede HIEs.
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Affiliation(s)
- Cason D Schmit
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Sarah A Wetter
- Sandra Day O'Connor College of Law, Arizona State University, Phoenix, AZ, USA
| | - Bita A Kash
- Center for Health Organization Transformation, Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, USA
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IT-Enabled Clinical Decision Support: An Empirical Study on Antecedents and Mechanisms. JOURNAL OF HEALTHCARE ENGINEERING 2019; 2018:6945498. [PMID: 30651945 PMCID: PMC6311880 DOI: 10.1155/2018/6945498] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 11/21/2018] [Indexed: 11/18/2022]
Abstract
Modern hospitals increasingly make use of innovations and information technology (IT) to improve workflow and patient's clinical journey. Typical innovative solutions include patient records and clinical decision support systems to enhance the process of decision making by doctors and other healthcare practitioners. However, currently, it remains unclear how hospitals could facilitate and enable such a decision support capability in clinical practice. We ground our work on the resource-based view of the firm and put forth the notion of IT-enabled capabilities which emphasizes critical IT investment and capability development areas that hospitals could exploit in their quest to improve clinical decision support. We develop a research model that explains how “health information exchange” and enhanced “information capability” collectively drive a hospital's “clinical decision support capability.” We used partial least squares path modeling on large-scale cross-sectional data from 720 European hospitals. Outcomes suggest that health information exchange positively impacts information capability. In turn, information capability complementary partially mediates the relationship between information exchange and clinical decision support. Hence, this research contributes to the literature on clinical decision support and provides valuable insights into how to support such innovative technologies and capabilities in clinical practice. We conclude with a discussion and conclusion. Also, we outline the inherent limitations of this study and outline directions for future research.
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Everson J, Cross DA. Mind the gap: the potential of alternative health information exchange. THE AMERICAN JOURNAL OF MANAGED CARE 2019; 25:32-38. [PMID: 30667609 PMCID: PMC7336522] [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 determine the proportion of patient transitions that could be connected through 3 proprietary alternatives to open, community-based health information exchange (HIE): HIE between physicians who are part of the same integrated system, use the same electronic health record (EHR), or use an EHR that participates in an EHR vendor alliance. STUDY DESIGN Cross-sectional analysis of Medicare patient transitions and physician EHR adoption and organizational affiliation from SK&A. METHODS We characterized the percentage of transitions that could be covered by each HIE approach and the degree of redundancy. We then assessed whether coverage opportunities differed by provider type and used multivariate linear regression to estimate the association between physician characteristics and proportion of transitions uncovered by any proprietary approach (ie, requiring an open HIE approach). RESULTS Given current EHR adoption and organizational affiliations, 33% of transitions could be covered by proprietary HIE. For the average physician, open methods of HIE would still be needed for 45% of patients treated by other physicians. Physicians who did not use a market-leading EHR, were not members of a large integrated system, and shared patients with a broader network of physicians have the greatest need for open HIE. CONCLUSIONS Proprietary approaches to HIE do not eliminate the need for open HIE and may further disadvantage providers in small healthcare organizations using less common EHRs. Ongoing support and innovative value creation within open HIE will likely remain necessary to support HIE by independent physicians. Public efforts to promote interoperability should seek to integrate proprietary models with open HIE.
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Affiliation(s)
- Jordan Everson
- Department of Health Policy and Department of Biomedical Informatics, Vanderbilt University, 2525 West End Ave, Ste 1275, Nashville, TN 37203.
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Walker DM. Does participation in health information exchange improve hospital efficiency? Health Care Manag Sci 2018; 21:426-438. [PMID: 28236178 PMCID: PMC5568978 DOI: 10.1007/s10729-017-9396-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 02/13/2017] [Indexed: 10/20/2022]
Abstract
The federal government allocated nearly $30 billion to spur the development of information technology infrastructure capable of supporting the exchange of interoperable clinical data, leading to growth in hospital participation in health information exchange (HIE) networks. HIEs have the potential to improve care coordination across healthcare providers, leading ultimately to increased productivity of health services for hospitals. However, the impact of HIE participation on hospital efficiency remains unclear. This dynamic prompts the question asked by this study: does HIE participation improve hospital efficiency. This study estimates the effect of HIE participation on efficiency using a national sample of 1017 hospitals from 2009 to 2012. Using a two-stage analytic design, efficiency indices were determined using the Malmquist algorithm and then regressed on a set of hospital characteristics. Results suggest that any participation in HIE can improve both technical efficiency change and total factor productivity (TFP). A second model examining total years of HIE participation shows a benefit of one and three years of participation on TFP. These results suggest that hospital investment in HIE participation may be a useful strategy to improve hospital operational performance, and that policy should continue to support increased participation and use of HIE. More research is needed to identify the exact mechanisms through which HIE participation can improve hospital efficiency.
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Affiliation(s)
- Daniel M Walker
- The Ohio State University, College of Medicine, 2231 North High St., Rm, Columbus, OH, 266, USA.
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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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17
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Abstract
OBJECTIVE To summarize the recent literature and research and present a selection of the best papers published in 2017 in the field of Health Information Management (HIM) and Health Informatics. METHODS A systematic review of the literature was performed by the two HIM section editors of the International Medical Informatics Association (IMIA) Yearbook with the help of a medical librarian. We searched bibliographic databases for HIM-related papers using both MeSH descriptors and keywords in titles and abstracts. A shortlist of 15 candidate best papers was first selected by section editors before being peer-reviewed by independent external reviewers. RESULTS Health Information Exchange was a major theme within candidate best papers. The four papers ultimately selected as 'Best Papers' represent themes that include health information exchange, governance and policy issues, results of health information exchange, and methods of integrating information from multiple sources. Other articles within the candidate best papers include these themes as well as those focusing on authentication and de-identification and usability of information systems. CONCLUSIONS The papers discussed in the HIM section of IMIA Yearbook reflect the overall theme of the 2018 edition of the Yearbook, i.e., the tension between privacy and access to information. While most of the papers focused on health information exchange, which reflects the "access" side of the equation, most of the others addressed privacy issues. This synopsis discusses these key issues at the intersection of HIM and informatics.
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Affiliation(s)
| | - Eta S. Berner
- Graduate Programs in Health Informatics, Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
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18
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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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Lin SC, Adler-Milstein J. The relationship between hospital and ehr vendor market dynamics on health information organization presence and participation. BMC Med Inform Decis Mak 2018; 18:28. [PMID: 29739410 PMCID: PMC5941339 DOI: 10.1186/s12911-018-0605-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 04/27/2018] [Indexed: 11/30/2022] Open
Abstract
Background Health Information Organizations (HIOs) are third party organizations that facilitate electronic health information exchange (HIE) between providers in a geographic area. Despite benefits from HIE, HIOs have struggled to form and subsequently gain broad provider participation. We sought to assess whether market-level hospital and EHR vendor dynamics are associated with presence and level of hospital participation in HIOs. Methods 2014 data on 4523 hospitals and their EHR vendors were aggregated to the market level. We used multivariate OLS regression to analyze the relationship between hospital and vendor dynamics and (1) probability of HIO presence and (2) percent of hospitals participating in an HIO. Results 298 of 469 markets (64%) had HIO presence, and in those markets, 47% of hospitals participated in an HIO on average. In multivariate analysis, four characteristics were associated with HIO presence. Markets with more hospitals, markets with more EHR vendors, and markets with an EHR vendor-led HIE approach were more likely to have an HIO. Compared to markets with low hospital competition, markets with high hospital competition had a 25 percentage point lower probability of HIO presence. Two characteristics were associated with level of hospital HIO participation. Markets with more hospitals as well as markets with high vendor competition (compared to low competition) had lower participation. Conclusion Both hospital and EHR vendor dynamics are associated with whether a market has an HIO as well as the level of hospital participation in HIOs. Electronic supplementary material The online version of this article (10.1186/s12911-018-0605-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sunny C Lin
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Julia Adler-Milstein
- Department of Medicine, Center for Clinical Informatics and Improvement Research, University of California, San Francisco, CA, USA
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20
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Geography of community health information organization activity in the United States: Implications for the effectiveness of health information exchange. Health Care Manage Rev 2018; 42:132-141. [PMID: 26982490 DOI: 10.1097/hmr.0000000000000103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The United States has invested nearly a billion dollars in creating community health information organizations (HIOs) to foster health information exchange. Community HIOs provide exchange services to health care organizations within a distinct geographic area. While geography is a key organizing principle for community HIOs, it is unclear if geography is an effective method for organization or what challenges are created by a geography-based approach to health information exchange. PURPOSE This study describes the extent of reported community HIO coverage in the United States and explores the practical and policy implications of overlaps and gaps in HIO service areas. Furthermore, because self-reported service areas may not accurately reflect the true extent of HIOs activities, this study maps the actual markets for health services included in each HIO. METHODOLOGY An inventory of operational community HIOs that included self-reported geographic markets and participating organizations was face-validated using a crowd-sourcing approach. Aggregation of the participating hospitals' individual health care markets provided the total geographic market served by each community HIO. Mapping and overlay analyses using geographic information system methods described the extent of community HIO activity in the United States. FINDINGS Evidence suggests that community HIOs may be inefficiently distributed. Parts of the United States have multiple, overlapping HIOs, while others do not have any providing health information exchange services. In markets served by multiple community HIOs, 45% of hospitals were participants of only one HIO. PRACTICE IMPLICATIONS The current geography of community HIO activity does not provide comprehensive patient information to providers, nor community-wide information for public health agencies. The discord between the self-reported and market geography of community HIOs raises concerns about the potential effectiveness of health information exchange, illustrates the limitations of geography as an organizing principle, and indicates operational challenges facing those leading and working with community HIOs.
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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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Patel V, McNamara L, Dullabh P, Sawchuk ME, Swain M. Variation in interoperability across clinical laboratories nationwide. Int J Med Inform 2017; 108:175-184. [PMID: 29132625 DOI: 10.1016/j.ijmedinf.2017.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 07/11/2017] [Accepted: 09/19/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To characterize nationwide variation and factors associated with clinical laboratories': (1) capabilities to send structured test results electronically to ordering practitioners' EHR systems; and (2) their levels of exchange activity, as measured by whether they sent more than three-quarters of their test results as structured data to ordering practitioners' EHR systems. MATERIALS AND METHODS A national survey of all independent and hospital laboratories was conducted in 2013. Using an analytic weighted sample of 9382 clinical laboratories, a series of logistic regression analyses were conducted to identify organizational and area characteristics associated with clinical laboratories' exchange capability and activity. RESULTS Hospital-based clinical laboratories (71%) and larger clinical laboratories (80%) had significantly higher levels of capability compared to independent (58%) and smaller laboratories (48%), respectively; though all had similar levels of exchange activity, with 30% of clinical laboratories sending 75% or more of their test results electronically. In multivariate analyses, hospital and the largest laboratories had 1.87 and 4.40 higher odds, respectively, of possessing the capability to send results electronically compared to independent laboratories (p<0.001). Laboratories located in areas with a higher share of potential exchange partners had a small but significantly greater capability to send results electronically and higher levels of exchange activity(p<0.05). CONCLUSION Clinical laboratories' capability to exchange varied by size and type; however, all clinical laboratories had relatively low levels of exchange activity. The role of exchange partners potentially played a small but significant role in driving exchange capability and activity.
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Affiliation(s)
- Vaishali Patel
- Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services, Washington, DC, United States.
| | | | | | - Megan E Sawchuk
- Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Atlanta, GA, United States
| | - Matthew Swain
- Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services, Washington, DC, United States
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Vest JR, Greenberger MF, Garnatz A. Diverging views on health information exchange organizations. Learn Health Syst 2017; 1:e10031. [PMID: 31245563 PMCID: PMC6508502 DOI: 10.1002/lrh2.10031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/21/2017] [Accepted: 05/13/2017] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Health information exchange (HIE) capabilities meet the demands for a more effective, efficient, and safer health care system. However, organizations and individual providers have pursued different strategies to meet their respective needs for HIE capabilities. Because effective information sharing is necessary to a learning health system, this study sought to explore the perceptions of different approaches' effect on key features of an effective health care system. METHODS An anonymous web-based survey was sent to a convenience sample of the membership of the Healthcare Information and Management Systems Society and the Strategic Health Information Exchange Collaborative with knowledge of HIE (n=68). A series of 7-point Likert-type items measured perceptions of enterprise health information exchanges (eHIEs) and community health information organizations (cHIOs) in the areas of effect on exchange participation, effect on market dynamics, relationship to DIRECT Secure Messaging and vendor-mediated exchange, and effect on quality. Also, respondents were asked to rate 13 qualities and services as "more about eHIE" or "more about cHIO." RESULTS Respondents tended to agree on the importance of cHIO and eHIE. Community benefits and support for public health agencies were concepts more often applied to cHIOs. DISCUSSION This study affirmed much of the conventional wisdom and anecdotal comments about perceptions of cHIOs and eHIEs. Although the respondents viewed cHIOs and eHIEs differently in terms of broader societal benefit and strategic advantage, nonetheless consistent agreement appeared in areas of importance in relationship to other information sharing strategies and overall effect on the quality of care.
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Affiliation(s)
- Joshua R. Vest
- Indiana University Richard M Fairbanks School of Public Health–IndianapolisCenter for Health PolicyIndianapolisIndiana
| | | | - Audrey Garnatz
- Health Information and Management Systems Society (HIMSS)ChicagoIllinois
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Petrova M, Barclay M, Barclay SS, Barclay SIG. Between "the best way to deliver patient care" and "chaos and low clinical value": General Practitioners' and Practice Managers' views on data sharing. Int J Med Inform 2017; 104:74-83. [PMID: 28599819 DOI: 10.1016/j.ijmedinf.2017.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 05/08/2017] [Accepted: 05/13/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE In the UK, General Practitioners and Practice Managers are key to enabling health information exchange (typically referred to as 'data sharing'). This study aimed to survey GPs and PMs for familiarity, engagement with and perceptions of patient data sharing. METHODS Cross-sectional survey. All 107 general practices in England's second largest Clinical Commissioning Group, Cambridgeshire & Peterborough CCG. Descriptive statistics; hierarchical logistic regression; thematic analysis. RESULTS 405 (64%) responses were received - from 338 (62%) GPs and 67 (71%) PMs. Familiarity and engagement were highest for local frail elderly and end of life care projects (>76% had used). The greatest difference in use concerned the now suspended national care.data initiative: PMs had odds of reporting use 75 times higher than GP partners (95% CI 27-211). Patient confusion was the most pronounced challenge and improved coordination the most pronounced expected benefit. Frequency of discussions with patients varied with IT competence (OR 4.2 for most competent users relative to least, 95% CI 1.7-10.7) and clinical system (OR 0.3, 95% CI 0.1-0.5). Patient reservations were reported more frequently by respondents who rated their IT competence as highest (OR 3.3, 95% CI 1.5-7.6), perceived more data sharing challenges (OR for a 1-point increase in challenges perception score 3.4, 95% CI 2.1-5.6) and by PMs (relative to GP partners, OR 18.0, 95% CI 7.9-41.3). CONCLUSIONS Familiarity with and use of data sharing projects was high among GPs and PMs. Both their individual and organisational characteristics were associated with the reported frequency of discussions and patients' responses. Improved awareness of the impact of provider characteristics and attitudes on patients' decisions about data sharing may enhance the equity and autonomy of those decisions.
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Affiliation(s)
- Mila Petrova
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | - Matthew Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sam S Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen I G Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Everson J. The implications and impact of 3 approaches to health information exchange: community, enterprise, and vendor-mediated health information exchange. Learn Health Syst 2017; 1:e10021. [PMID: 31245558 PMCID: PMC6508570 DOI: 10.1002/lrh2.10021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/24/2016] [Accepted: 12/01/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Electronic health information exchange (HIE) is considered essential to establishing a learning health system, reducing medical errors, and improving efficiency, but establishment of widespread, high functioning HIE has been challenging. Healthcare organizations now have considerable flexibility in selecting among several HIE strategies, most prominently community HIE, enterprise HIE (led by a healthcare organization), and electronic health record vendor-mediated HIE. Each of these strategies is characterized by different conveners, capabilities, and motivations and may have different abilities to facilitate improved patient care. METHODS I reviewed the available scholarly literature to draw conceptual distinctions between these types of HIE, to assess the current evidence on each type of HIE, and to indicate important areas of future research. RESULTS While community HIE seems to offer the most open approach to HIE allowing for high levels of connectivity, both enterprise HIE and vendor-mediated HIE face lower barriers to formation and sustainability. Most existing evidence is focused on community HIE and points towards low overall use, challenges to usability, and ambiguous impact. To better guide organizational leaders and policymakers in the expansion of beneficial HIE and anticipate future trends, future research should work to better capture the prevalence of other forms of HIE, and to adopt common methods to allow comparisons of rate of use, usability, and impact on patient care across studies and types of HIE. CONCLUSIONS Healthcare organizations' choice of HIE strategy influences the set of partners the organization is connected to and may influence the benefit that efforts supported by HIE can offer to patients. Current research is not fully capturing the diversity of approaches to HIE and their potentially varying impact on providers and patients.
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Affiliation(s)
- Jordan Everson
- Department of Health Management and Policy, School of Public HealthUniversity of MichiganAnn ArborMichigan
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System dynamics simulation modeling of health information exchange (HIE) adoption and policy intervention: A case study in the State of Maryland. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.orhc.2017.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Esmaeilzadeh P, Sambasivan M. Health Information Exchange (HIE): A literature review, assimilation pattern and a proposed classification for a new policy approach. J Biomed Inform 2016; 64:74-86. [PMID: 27645322 DOI: 10.1016/j.jbi.2016.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 08/12/2016] [Accepted: 09/15/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Literature shows existence of barriers to Healthcare Information Exchange (HIE) assimilation process. A number of studies have considered assimilation of HIE as a whole phenomenon without regard to its multifaceted nature. Thus, the pattern of HIE assimilation in healthcare providers has not been clearly studied due to the effects of contingency factors on different assimilation phases. This study is aimed at defining HIE assimilation phases, recognizing assimilation pattern, and proposing a classification to highlight unique issues associated with HIE assimilation. METHODS A literature review of existing studies related to HIE efforts from 2005 was undertaken. Four electronic research databases (PubMed, Web of Science, CINAHL, and Academic Search Premiere) were searched for articles addressing different phases of HIE assimilation process. RESULTS Two hundred and fifty-four articles were initially selected. Out of 254, 44 studies met the inclusion criteria and were reviewed. The assimilation of HIE is a complicated and a multi-staged process. Our findings indicated that HIE assimilation process consisted of four main phases: initiation, organizational adoption decision, implementation and institutionalization. The data helped us recognize the assimilation pattern of HIE in healthcare organizations. CONCLUSIONS The results provide useful theoretical implications for research by defining HIE assimilation pattern. The findings of the study also have practical implications for policy makers. The findings show the importance of raising national awareness of HIE potential benefits, financial incentive programs, use of standard guidelines, implementation of certified technology, technical assistance, training programs and trust between healthcare providers. The study highlights deficiencies in the current policy using the literature and identifies the "pattern" as an indication for a new policy approach.
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Affiliation(s)
- Pouyan Esmaeilzadeh
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL 33199, United States.
| | - Murali Sambasivan
- Taylor's Business School, Taylor's University Lakeside Campus, Malaysia; Victoria University, Melbourne, Australia.
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28
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Vest JR, Kash BA. Differing Strategies to Meet Information-Sharing Needs: Publicly Supported Community Health Information Exchanges Versus Health Systems' Enterprise Health Information Exchanges. Milbank Q 2016; 94:77-108. [PMID: 26994710 DOI: 10.1111/1468-0009.12180] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
POLICY POINTS Community health information exchanges have the characteristics of a public good, and they support population health initiatives at the state and national levels. However, current policy equally incentivizes health systems to create their own information exchanges covering more narrowly defined populations. Noninteroperable electronic health records and vendors' expensive custom interfaces are hindering health information exchanges. Moreover, vendors are imposing the costs of interoperability on health systems and community health information exchanges. Health systems are creating networks of targeted physicians and facilities by funding connections to their own enterprise health information exchanges. These private networks may change referral patterns and foster more integration with outpatient providers. CONTEXT The United States has invested billions of dollars to encourage the adoption of and implement the information technologies necessary for health information exchange (HIE), enabling providers to efficiently and effectively share patient information with other providers. Health care providers now have multiple options for obtaining and sharing patient information. Community HIEs facilitate information sharing for a broad group of providers within a region. Enterprise HIEs are operated by health systems and share information among affiliated hospitals and providers. We sought to identify why hospitals and health systems choose either to participate in community HIEs or to establish enterprise HIEs. METHODS We conducted semistructured interviews with 40 policymakers, community and enterprise HIE leaders, and health care executives from 19 different organizations. Our qualitative analysis used a general inductive and comparative approach to identify factors influencing participation in, and the success of, each approach to HIE. FINDINGS Enterprise HIEs support health systems' strategic goals through the control of an information technology network consisting of desired trading partners. Community HIEs support obtaining patient information from the broadest set of providers, but with more dispersed benefits to all participants, the community, and patients. Although not an either/or decision, community and enterprise HIEs compete for finite organizational resources like time, skilled staff, and money. Both approaches face challenges due to vendor costs and less-than-interoperable technology. CONCLUSIONS Both community and enterprise HIEs support aggregating clinical data and following patients across settings. Although they can be complementary, community and enterprise HIEs nonetheless compete for providers' attention and organizational resources. Health policymakers might try to encourage the type of widespread information exchange pursued by community HIEs, but the business case for enterprise HIEs clearly is stronger. The sustainability of a community HIE, potentially a public good, may necessitate ongoing public funding and supportive regulation.
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Affiliation(s)
- Joshua R Vest
- Indiana University Richard M. Fairbanks School of Public Health at IUPUI
| | - Bita A Kash
- National Science Foundation Center for Health Organization Transformation and Texas A&M Health Sciences Center
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Everson J, Adler-Milstein J. Engagement In Hospital Health Information Exchange Is Associated With Vendor Marketplace Dominance. Health Aff (Millwood) 2016; 35:1286-93. [DOI: 10.1377/hlthaff.2015.1215] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Jordan Everson
- Jordan Everson ( ) is a doctoral candidate in health management and policy at the University of Michigan, in Ann Arbor
| | - Julia Adler-Milstein
- Julia Adler-Milstein is an assistant professor in the School of Information, University of Michigan, with a joint appointment in the Department of Health Management and Policy, School of Public Health
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Flott K, Callahan R, Darzi A, Mayer E. A Patient-Centered Framework for Evaluating Digital Maturity of Health Services: A Systematic Review. J Med Internet Res 2016; 18:e75. [PMID: 27080852 PMCID: PMC4850277 DOI: 10.2196/jmir.5047] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/25/2015] [Accepted: 12/03/2015] [Indexed: 11/26/2022] Open
Abstract
Background Digital maturity is the extent to which digital technologies are used as enablers to deliver a high-quality health service. Extensive literature exists about how to assess the components of digital maturity, but it has not been used to design a comprehensive framework for evaluation. Consequently, the measurement systems that do exist are limited to evaluating digital programs within one service or care setting, meaning that digital maturity evaluation is not accounting for the needs of patients across their care pathways. Objective The objective of our study was to identify the best methods and metrics for evaluating digital maturity and to create a novel, evidence-based tool for evaluating digital maturity across patient care pathways. Methods We systematically reviewed the literature to find the best methods and metrics for evaluating digital maturity. We searched the PubMed database for all papers relevant to digital maturity evaluation. Papers were selected if they provided insight into how to appraise digital systems within the health service and if they indicated the factors that constitute or facilitate digital maturity. Papers were analyzed to identify methodology for evaluating digital maturity and indicators of digitally mature systems. We then used the resulting information about methodology to design an evaluation framework. Following that, the indicators of digital maturity were extracted and grouped into increasing levels of maturity and operationalized as metrics within the evaluation framework. Results We identified 28 papers as relevant to evaluating digital maturity, from which we derived 5 themes. The first theme concerned general evaluation methodology for constructing the framework (7 papers). The following 4 themes were the increasing levels of digital maturity: resources and ability (6 papers), usage (7 papers), interoperability (3 papers), and impact (5 papers). The framework includes metrics for each of these levels at each stage of the typical patient care pathway. Conclusions The framework uses a patient-centric model that departs from traditional service-specific measurements and allows for novel insights into how digital programs benefit patients across the health system. Trial Registration N/A
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Affiliation(s)
- Kelsey Flott
- Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, United Kingdom.
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Abstract
Policy makers and practitioners argue that electronic exchange of clinical data across the healthcare system is a key component of improving health service delivery in the United States. Provider administrators, however, question the strategic value of participation in health information exchanges (HIEs) and remain reluctant to participate. Existing research fails to adequately illuminate the potential value derived from HIEs by participating organizations. This paper addresses this gap by developing a conceptual model informed by the complementary theoretical perspectives of the relational view and systems theory to specify both a provider organizationʼs internal conditions and the HIE structure necessary for both financial accrual and quality improvement. This two-sided model can assist policymakers as they attempt to encourage HIE development, as well as provider and HIE leadership that seek to benefit from HIEs. The propositions developed from this model can also help guide researchers as they evaluate the impact of HIEs.
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The Promise of Information and Communication Technology in Healthcare: Extracting Value From the Chaos. Am J Med Sci 2016; 351:59-68. [DOI: 10.1016/j.amjms.2015.10.015] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/08/2015] [Indexed: 11/30/2022]
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Cross DA, Lin SC, Adler-Milstein J. Assessing payer perspectives on health information exchange. J Am Med Inform Assoc 2015; 23:297-303. [PMID: 26142424 PMCID: PMC4784554 DOI: 10.1093/jamia/ocv072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 05/17/2015] [Indexed: 11/18/2022] Open
Abstract
Objective To identify factors that impede payer engagement in a health information exchange (HIE), along with organizational and policy strategies that might effectively address the impediments. Materials and Methods Qualitative analysis of semi-structured interviews with leaders from 17 varied payer organizations from across the country (e.g., large, national payers; state Blues plans; local Medicaid managed care plans). Results We found a large gap between payers’ vision of what optimal HIE should be and the current approach to HIE in the United States. Notably, payers sought to be active participants in HIE efforts – both providing claims data and accessing clinical data to support payer HIE use cases. Instead, payers were often asked by HIE efforts only to provide financial support without the option to participate in data exchange, or, when given the option, their data needs were secondary to those of providers. Discussion Efforts to engage payers in pursuit of more robust and sustainable HIE need to better align their value proposition with payer HIE use cases. This will require addressing provider concerns about payer access to clinical data. Policymakers should focus on creating the conditions for broader payer engagement by removing common obstacles, such as low provider engagement in HIE. Conclusion Despite variation in the extent to which payers engaged with current HIE efforts, there was agreement on the vision of optimal HIE and the facilitators of greater payer engagement. Specific actions by those leading HIE efforts, complemented by policy efforts nationally, could greatly increase payer engagement and enhance HIE sustainability.
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Affiliation(s)
- Dori A Cross
- School of Public Health (Health Management and Policy), University of Michigan, Ann Arbor, MI, USA
| | - Sunny C Lin
- School of Public Health (Health Management and Policy), University of Michigan, Ann Arbor, MI, USA
| | - Julia Adler-Milstein
- School of Public Health (Health Management and Policy), University of Michigan, Ann Arbor, MI, USA
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Juhr M, Haux R, Suzuki T, Takabayashi K. Overview of recent trans-institutional health network projects in Japan and Germany. J Med Syst 2015; 39:50. [PMID: 25732082 DOI: 10.1007/s10916-015-0234-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/11/2015] [Indexed: 11/28/2022]
Abstract
Worldwide populations are aging and countries have to prepare for the effects of demographic change in health care. Health information exchange (HIE), which is the process of moving patient information across health care providers electronically, can help overcome health data fragmentation and open opportunities to improve patient care in terms of quality, economy and efficiency. Since Japan and Germany are among the first countries strongly impacted by demographic changes of aging populations, we report on current developments about health information systems carrying out HIE based on case studies in both countries. Four projects that address the improvement of HIE within a defined region have been selected and investigated: the German project of the Lower Saxony Bank of Health and the Japanese projects Chiba ITnet, Nagasaki AjisaiNet and the National Disaster and Backup System of Japan. The project descriptions are based on relevant English publications, on-site visits and interviews with developers and users. The projects are introduced in terms of their basic architecture and implementation, their present status and future objectives. The projects' developments are still in progress and all have to cope with significant challenges before they will be able to provide a fully working trans-institutional health network solution.
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Affiliation(s)
- Maren Juhr
- Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig and Hannover Medical School, Muehlenpfordtstr. 23, 38106, Braunschweig, Germany,
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35
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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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Zaidan AA, Zaidan BB, Kadhem Z, Larbani M, Lakulu MB, Hashim M. Challenges, Alternatives, and Paths to Sustainability: Better Public Health Promotion Using Social Networking Pages as Key Tools. J Med Syst 2015; 39:7. [DOI: 10.1007/s10916-015-0201-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 01/13/2015] [Indexed: 12/19/2022]
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Fleischman W, Lowry T, Shapiro J. The visit-data warehouse: enabling novel secondary use of health information exchange data. EGEMS (WASHINGTON, DC) 2014; 2:1099. [PMID: 25848595 PMCID: PMC4371519 DOI: 10.13063/2327-9214.1099] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION/OBJECTIVES Health Information Exchange (HIE) efforts face challenges with data quality and performance, and this becomes especially problematic when data is leveraged for uses beyond primary clinical use. We describe a secondary data infrastructure focusing on patient-encounter, nonclinical data that was built on top of a functioning HIE platform to support novel secondary data uses and prevent potentially negative impacts these uses might have otherwise had on HIE system performance. BACKGROUND HIE efforts have generally formed for the primary clinical use of individual clinical providers searching for data on individual patients under their care, but many secondary uses have been proposed and are being piloted to support care management, quality improvement, and public health. DESCRIPTION OF THE HIE AND BASE INFRASTRUCTURE This infrastructure review describes a module built into the Healthix HIE. Healthix, based in the New York metropolitan region, comprises 107 participating organizations with 29,946 acute-care beds in 383 facilities, and includes more than 9.2 million unique patients. The primary infrastructure is based on the InterSystems proprietary Caché data model distributed across servers in multiple locations, and uses a master patient index to link individual patients' records across multiple sites. We built a parallel platform, the "visit data warehouse," of patient encounter data (demographics, date, time, and type of visit) using a relational database model to allow accessibility using standard database tools and flexibility for developing secondary data use cases. These four secondary use cases include the following: (1) tracking encounter-based metrics in a newly established geriatric emergency department (ED), (2) creating a dashboard to provide a visual display as well as a tabular output of near-real-time de-identified encounter data from the data warehouse, (3) tracking frequent ED users as part of a regional-approach to case management intervention, and (4) improving an existing quality improvement program that analyzes patients with return visits to EDs within 72 hours of discharge. RESULTS/LESSONS LEARNED Setting up a separate, near-real-time, encounters-based relational database to complement an HIE built on a hierarchical database is feasible, and may be necessary to support many secondary uses of HIE data. As of November 2014, the visit-data warehouse (VDW) built by Healthix is undergoing technical validation testing and updates on an hourly basis. We had to address data integrity issues with both nonstandard and missing HL7 messages because of varied HL7 implementation across the HIE. Also, given our HIEs federated structure, some sites expressed concerns regarding data centralization for the VDW. An established and stable HIE governance structure was critical in overcoming this initial reluctance. CONCLUSIONS As secondary use of HIE data becomes more prevalent, it may be increasingly necessary to build separate infrastructure to support secondary use without compromising performance. More research is needed to determine optimal ways of building such infrastructure and validating its use for secondary purposes.
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Affiliation(s)
- William Fleischman
- Icahn School of Medicine at Mount Sinai ; Robert Wood Johnson Foundation Clinical Scholars Program ; Yale University School of Medicine
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Kierkegaard P, Kaushal R, Vest J. How could health information exchange better meet the needs of care practitioners? Appl Clin Inform 2014; 5:861-77. [PMID: 25589903 PMCID: PMC4287667 DOI: 10.4338/aci-2014-06-ra-0055] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/24/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Health information exchange (HIE) has the potential to improve the quality of healthcare by enabling providers with better access to patient information from multiple sources at the point of care. However, HIE efforts have historically been difficult to establish in the US and the failure rates of organizations created to foster HIE have been high. OBJECTIVES We sought to better understand how RHIO-based HIE systems were used in practice and the challenges care practitioners face using them. The objective of our study were to so investigate how HIE can better meet the needs of care practitioners. METHODS We performed a multiple-case study using qualitative methods in three communities in New York State. We conducted interviews onsite and by telephone with HIE users and non-users and observed the workflows of healthcare professionals at multiple healthcare organizations participating in a local HIE effort in New York State. RESULTS The empirical data analysis suggests that challenges still remain in increasing provider usage, optimizing HIE implementations and connecting HIE systems across geographic regions. Important determinants of system usage and perceived value includes users experienced level of available information and the fit of use for physician workflows. CONCLUSIONS Challenges still remain in increasing provider adoption, optimizing HIE implementations, and demonstrating value. The inability to find information reduced usage of HIE. Healthcare organizations, HIE facilitating organizations, and states can help support HIE adoption by ensuring patient information is accessible to providers through increasing patient consents, fostering broader participation, and by ensuring systems are usable.
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Affiliation(s)
- P. Kierkegaard
- University of Copenhagen, Department of Computer Science, København S, Denmark
| | - R. Kaushal
- Department of Healthcare Policy and Research, Center for Healthcare Informatics and Policy, Weill Cornell Medical College, New York, USA, Health Information Technology Evalution Collaborative (HITEC), New York, USA
| | - J.R. Vest
- Weill Cornell Medical College, Department of Healthcare Policy and Research, New York, New York, United States
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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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Vest JR, Kern LM, Silver MD, Kaushal R. The potential for community-based health information exchange systems to reduce hospital readmissions. J Am Med Inform Assoc 2014; 22:435-42. [DOI: 10.1136/amiajnl-2014-002760] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Abstract
Background Hospital readmissions are common, costly, and offer opportunities for utilization reduction. Electronic health information exchange (HIE) systems may help prevent readmissions by improving access to clinical data by ambulatory providers after discharge from the hospital.
Objective We sought to determine the association between HIE system usage and 30-day same-cause hospital readmissions among patients who consented and participated in an operational community-wide HIE during a 6-month period in 2009–2010.
Methods We identified a retrospective cohort of hospital readmissions among adult patients in the Rochester, New York area. We analyzed claims files from two health plans that insure more than 60% of the area population. To be included in the dataset, patients needed to be continuously enrolled in the health plan with at least one encounter with a participating provider in the 6 months following consent to be included in the HIE system. Each patient appeared in the dataset only once and each discharge could be followed for at least 30 days.
Results We found that accessing patient information in the HIE system in the 30 days after discharge was associated with a 57% lower adjusted odds of readmission (OR 0.43; 95% CI 0.27 to 0.70). The estimated annual savings in the sample from averted readmissions associated with HIE usage was $605 000.
Conclusions These findings indicate that usage of an electronic HIE system in the ambulatory setting within 30 days after hospital discharge may effectively prevent hospital readmissions, thereby supporting the need for ongoing HIE efforts.
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Affiliation(s)
- Joshua R Vest
- Center for Healthcare Informatics & Policy, Weill Cornell Medical College, New York, New York, USA
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
- Health Information Technology Evaluation Collaborative, New York, New York, USA
| | - Lisa M Kern
- Center for Healthcare Informatics & Policy, Weill Cornell Medical College, New York, New York, USA
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
- Health Information Technology Evaluation Collaborative, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Michael D Silver
- Center for Healthcare Informatics & Policy, Weill Cornell Medical College, New York, New York, USA
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
- Health Information Technology Evaluation Collaborative, New York, New York, USA
| | - Rainu Kaushal
- Center for Healthcare Informatics & Policy, Weill Cornell Medical College, New York, New York, USA
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
- Health Information Technology Evaluation Collaborative, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Pediatrics, Weill Cornell Medical College, New York, New York, USA
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Richardson JE, Malhotra S, Kaushal R. A case report in health information exchange for inter-organizational patient transfers. Appl Clin Inform 2014; 5:642-50. [PMID: 25298805 DOI: 10.4338/aci-2014-02-cr-0016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 06/02/2014] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To provide a case report of barriers and promoters to implementing a health information exchange (HIE) tool that supports patient transfers between hospitals and skilled nursing facilities. METHODS A multi-disciplinary team conducted semi-structured telephone and in-person interviews in a purposive sample of HIE organizational informants and providers in New York City who implemented HIE to share patient transfer information. The researchers conducted grounded theory analysis to identify themes of barriers and promoters and took steps to improve the trustworthiness of the results including vetting from a knowledgeable study participant. RESULTS Between May and October 2011, researchers recruited 18 participants: informaticians, healthcare administrators, software engineers, and providers from a skilled nursing facility. Subjects perceived the HIE tool's development a success in that it brought together stakeholders who had traditionally not partnered for informatics work, and that they could successfully share patient transfer information between a hospital and a skilled nursing facility. Perceived barriers included lack of hospital stakeholder buy-in and misalignment with clinical workflows that inhibited use of HIE-based patient transfer data. Participants described barriers and promoters in themes related to organizational, technical, and user-oriented issues. The investigation revealed that stakeholders could develop and implement health information technology that technically enables clinicians in both hospitals and skilled nursing facilities to exchange real-time information in support of patient transfers. User level barriers, particularly in the emergency department, should give pause to developers and implementers who plan to use HIE in support of patient transfers. CONCLUSIONS Participants' experiences demonstrate how stakeholders may succeed in developing and piloting an electronic transfer form that relies on HIE to aggregate, communicate, and display relevant patient transfer data across health care organizations. Their experiences also provide insights for others seeking to develop HIE applications to improve patient transfers between emergency departments and skilled nursing facilities.
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Affiliation(s)
- J E Richardson
- Department of Healthcare Policy and Research, Center for Healthcare Informatics and Policy, Weill Cornell Medical College , New York , USA Health Information Technology Evaluation Collaborative (HITEC) , New York, USA
| | - S Malhotra
- Weill Cornell Physicians Organization , New York, NY
| | - R Kaushal
- Department of Healthcare Policy and Research, Center for Healthcare Informatics and Policy, Weill Cornell Medical College , New York , USA Health Information Technology Evaluation Collaborative (HITEC) , New York, USA
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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, Campion TR, Kern LM, Kaushal R. Public and private sector roles in health information technology policy: Insights from the implementation and operation of exchange efforts in the United States. HEALTH POLICY AND TECHNOLOGY 2014. [DOI: 10.1016/j.hlpt.2014.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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