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Rajamani S, Chakoian H, Bieringer A, Lintelmann A, Sanders J, Ostadkar R, Saupe A, Grilli G, White K, Solarz S, Melton GB. Development and implementation of an interoperability tool across state public health agency's disease surveillance and immunization information systems. JAMIA Open 2023; 6:ooad055. [PMID: 37545982 PMCID: PMC10400481 DOI: 10.1093/jamiaopen/ooad055] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/13/2023] [Accepted: 07/20/2023] [Indexed: 08/08/2023] Open
Abstract
Public health information systems have historically been siloed with limited interoperability. The State of Minnesota's disease surveillance system (Minnesota Electronic Disease Surveillance System: MEDSS, ∼12 million total reportable events) and immunization information system (Minnesota Immunization Information Connection: MIIC, ∼130 million total immunizations) lacked interoperability between them and data exchange was fully manual. An interoperability tool based on national standards (HL7 and SOAP/web services) for query and response was developed for electronic vaccination data exchange from MIIC into MEDSS by soliciting stakeholder requirements (n = 39) and mapping MIIC vaccine codes (n = 294) to corresponding MEDSS product codes (n = 48). The tool was implemented in March 2022 and incorporates MIIC data into a new vaccination form in MEDSS with mapping of 30 data elements including MIIC demographics, vaccination history, and vaccine forecast. The tool was evaluated using mixed methods (quantitative analysis of user time, clicks, queries; qualitative review with users). Comparison of key tasks demonstrated efficiencies including vaccination data access (before: 50 clicks, >2 min; after: 4 clicks, 8 s) which translated directly to staff effort (before: 5 h/week; after: ∼17 min/week). This case study demonstrates the contribution of improving public health systems interoperability, ultimately with the goal of enhanced data-driven decision-making and public health surveillance.
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Affiliation(s)
- Sripriya Rajamani
- Corresponding Author: Sripriya Rajamani, MBBS, PhD, MPH, FAMIA, Informatics Program, Population Health and Systems Cooperative, School of Nursing, University of Minnesota, 308 Harvard St, SE Minneapolis, MN 55455, USA;
| | - Hanna Chakoian
- Infectious Disease Epidemiology, Prevention and Control Division, Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - Aaron Bieringer
- Infectious Disease Epidemiology, Prevention and Control Division, Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - Anna Lintelmann
- Infectious Disease Epidemiology, Prevention and Control Division, Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - Jeffrey Sanders
- Infectious Disease Epidemiology, Prevention and Control Division, Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - Rachel Ostadkar
- Infectious Disease Epidemiology, Prevention and Control Division, Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - Amy Saupe
- Infectious Disease Epidemiology, Prevention and Control Division, Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - Genny Grilli
- Infectious Disease Epidemiology, Prevention and Control Division, Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - Katie White
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sarah Solarz
- Infectious Disease Epidemiology, Prevention and Control Division, Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - Genevieve B Melton
- Institute for Health Informatics, Office of Academic Clinical Affairs, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Surgery, University of Minnesota Medical School, University of Minnesota, Minneapolis, Minnesota, USA
- Center for Learning Health System Sciences, University of Minnesota Medical School and School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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Rajamani S, Kayser A, Ruprecht A, Cassman J, Polzer M, Homan T, Reid A, Hanson M, Emerson E, Dahlberg Schmit A, Solarz S. Electronic case reporting (eCR) of COVID-19 to public health: implementation perspectives from the Minnesota Department of Health. J Am Med Inform Assoc 2022; 29:1958-1966. [PMID: 35904765 PMCID: PMC9384568 DOI: 10.1093/jamia/ocac133] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/05/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Electronic case reporting (eCR) is the automated generation and transmission of case reports from electronic health records to public health for review and action. These reports (electronic initial case reports: eICRs) adhere to recommended exchange and terminology standards. eCR is a partnership of the Centers for Disease Control and Prevention (CDC), Association of Public Health Laboratories (APHL) and Council of State and Territorial Epidemiologists (CSTE). The Minnesota Department of Health (MDH) received eICRs for COVID-19 from April 2020 (3 sites, manual process), automated eCR implementation in August 2020 (7 sites), and on-boarded ∼1780 clinical units in 460 sites across 6 integrated healthcare systems (through March 2022). Approximately 20 000 eICRs/month were reported to MDH during high-volume timeframes. With increasing provider/health system implementation, the proportion of COVID-19 cases with an eICR increased to 30% (March 2022). Evaluation of data quality for select demographic variables (gender, race, ethnicity, email, phone, language) across the 6 reporting health systems revealed a high proportion of completeness (>80%) for half of variables and less complete data for rest (ethnicity, email, language) along with low ethnicity data (<50%) for one health system. Presently eCR implementation at MDH includes only one EHR vendor. Next steps will focus on onboarding other EHRs, additional eICR data extraction/utilization, detailed analysis, outreach to address data quality issues, and expanding to other reportable conditions.
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Affiliation(s)
- Sripriya Rajamani
- Informatics Program, School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
- Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA
- Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - Ann Kayser
- Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - Ali Ruprecht
- Minnesota Department of Health, Saint Paul, Minnesota, USA
| | | | - Megan Polzer
- Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - Teri Homan
- Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - Ann Reid
- Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - Melinda Hanson
- Minnesota Department of Health, Saint Paul, Minnesota, USA
| | - Emily Emerson
- Minnesota Department of Health, Saint Paul, Minnesota, USA
| | | | - Sarah Solarz
- Minnesota Department of Health, Saint Paul, Minnesota, USA
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Dixon BE, Zhang Z, Arno JN, Revere D, Joseph Gibson P, Grannis SJ. Improving Notifiable Disease Case Reporting Through Electronic Information Exchange-Facilitated Decision Support: A Controlled Before-and-After Trial. Public Health Rep 2020; 135:401-410. [PMID: 32250707 DOI: 10.1177/0033354920914318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Outbreak detection and disease control may be improved by simplified, semi-automated reporting of notifiable diseases to public health authorities. The objective of this study was to determine the effect of an electronic, prepopulated notifiable disease report form on case reporting rates by ambulatory care clinics to public health authorities. METHODS We conducted a 2-year (2012-2014) controlled before-and-after trial of a health information exchange (HIE) intervention in Indiana designed to prepopulate notifiable disease reporting forms to providers. We analyzed data collected from electronic prepopulated reports and "usual care" (paper, fax) reports submitted to a local health department for 7 conditions by using a difference-in-differences model. Primary outcomes were changes in reporting rates, completeness, and timeliness between intervention and control clinics. RESULTS Provider reporting rates for chlamydia and gonorrhea in intervention clinics increased significantly from 56.9% and 55.6%, respectively, during the baseline period (2012) to 66.4% and 58.3%, respectively, during the intervention period (2013-2014); they decreased from 28.8% and 27.5%, respectively, to 21.7% and 20.6%, respectively, in control clinics (P < .001). Completeness improved from baseline to intervention for 4 of 15 fields in reports from intervention clinics (P < .001), although mean completeness improved for 11 fields in both intervention and control clinics. Timeliness improved for both intervention and control clinics; however, reports from control clinics were timelier (mean, 7.9 days) than reports from intervention clinics (mean, 9.7 days). CONCLUSIONS Electronic, prepopulated case reporting forms integrated into providers' workflow, enabled by an HIE network, can be effective in increasing notifiable disease reporting rates and completeness of information. However, it was difficult to assess the effect of using the forms for diseases with low prevalence (eg, salmonellosis, histoplasmosis).
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Affiliation(s)
- Brian E Dixon
- 10668 Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA.,50826 Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA.,12250 Center for Health Information and Communication, Health Services Research & Development Service, Department of Veterans Affairs, Indianapolis, IN, USA
| | - Zuoyi Zhang
- 50826 Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Janet N Arno
- 12250 School of Medicine, Indiana University, Indianapolis, IN, USA.,4059 Marion County Public Health Department, Indianapolis, IN, USA
| | - Debra Revere
- 7284 School of Public Health, University of Washington, Seattle, WA, USA
| | - P Joseph Gibson
- 4059 Marion County Public Health Department, Indianapolis, IN, USA
| | - Shaun J Grannis
- 50826 Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA.,12250 School of Medicine, Indiana University, Indianapolis, IN, USA
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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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Dixon BE, Zhang Z, Lai PTS, Kirbiyik U, Williams J, Hills R, Revere D, Gibson PJ, Grannis SJ. Completeness and timeliness of notifiable disease reporting: a comparison of laboratory and provider reports submitted to a large county health department. BMC Med Inform Decis Mak 2017. [PMID: 28645285 PMCID: PMC5481902 DOI: 10.1186/s12911-017-0491-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background Most public health agencies expect reporting of diseases to be initiated by hospital, laboratory or clinic staff even though so-called passive approaches are known to be burdensome for reporters and produce incomplete as well as delayed reports, which can hinder assessment of disease and delay recognition of outbreaks. In this study, we analyze patterns of reporting as well as data completeness and timeliness for traditional, passive reporting of notifiable disease by two distinct sources of information: hospital and clinic staff versus clinical laboratory staff. Reports were submitted via fax machine as well as electronic health information exchange interfaces. Methods Data were extracted from all submitted notifiable disease reports for seven representative diseases. Reporting rates are the proportion of known cases having a corresponding case report from a provider, a faxed laboratory report or an electronic laboratory report. Reporting rates were stratified by disease and compared using McNemar’s test. For key data fields on the reports, completeness was calculated as the proportion of non-blank fields. Timeliness was measured as the difference between date of laboratory confirmed diagnosis and the date the report was received by the health department. Differences in completeness and timeliness by data source were evaluated using a generalized linear model with Pearson’s goodness of fit statistic. Results We assessed 13,269 reports representing 9034 unique cases. Reporting rates varied by disease with overall rates of 19.1% for providers and 84.4% for laboratories (p < 0.001). All but three of 15 data fields in provider reports were more often complete than those fields within laboratory reports (p <0.001). Laboratory reports, whether faxed or electronically sent, were received, on average, 2.2 days after diagnosis versus a week for provider reports (p <0.001). Conclusions Despite growth in the use of electronic methods to enhance notifiable disease reporting, there still exists much room for improvement.
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Affiliation(s)
- Brian E Dixon
- Indiana University, Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, RG 5000, Indianapolis, IN, 46202, USA. .,Regenstrief Institute, Center for Biomedical Informatics, 1101 W 10th St, Indianapolis, IN, USA. .,Department of Veterans Affairs, Health Services Research & Development Service, Center for Health Information and Communication, 1481 W. 10th St, 11H, Indianapolis, IN, USA. .,Department of BioHealth Informatics, School of Informatics and Computing, Indiana University, 535 W Michigan St, Indianapolis, IN, 46202, USA.
| | - Zuoyi Zhang
- Regenstrief Institute, Center for Biomedical Informatics, 1101 W 10th St, Indianapolis, IN, USA
| | - Patrick T S Lai
- Regenstrief Institute, Center for Biomedical Informatics, 1101 W 10th St, Indianapolis, IN, USA.,Department of BioHealth Informatics, School of Informatics and Computing, Indiana University, 535 W Michigan St, Indianapolis, IN, 46202, USA
| | - Uzay Kirbiyik
- Indiana University, Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, RG 5000, Indianapolis, IN, 46202, USA.,Regenstrief Institute, Center for Biomedical Informatics, 1101 W 10th St, Indianapolis, IN, USA
| | - Jennifer Williams
- Regenstrief Institute, Center for Biomedical Informatics, 1101 W 10th St, Indianapolis, IN, USA
| | - Rebecca Hills
- University of Washington, School of Public Health, 1107 NE 45th St, Suite 400, Box 354809, Seattle, WA, 98195-4809, USA
| | - Debra Revere
- University of Washington, School of Public Health, 1107 NE 45th St, Suite 400, Box 354809, Seattle, WA, 98195-4809, USA
| | - P Joseph Gibson
- Marion County Public Health Department, 3838 N Rural St, Indianapolis, IN, 46205, USA
| | - Shaun J Grannis
- Regenstrief Institute, Center for Biomedical Informatics, 1101 W 10th St, Indianapolis, IN, USA.,Indiana University, School of Medicine, 3410 10th St, #6200, Indianapolis, IN, USA
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Revere D, Hills RH, Dixon BE, Gibson PJ, Grannis SJ. Notifiable condition reporting practices: implications for public health agency participation in a health information exchange. BMC Public Health 2017; 17:247. [PMID: 28284190 PMCID: PMC5346201 DOI: 10.1186/s12889-017-4156-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 03/02/2017] [Indexed: 11/10/2022] Open
Abstract
Background The future of notifiable condition reporting in the United States is undergoing a transformation with the increasing development of Health Information Exchanges which support electronic data-sharing and -transfer networks and the wider adoption of electronic laboratory reporting. Communicable disease report forms originating in clinics are an important source of surveillance data for public health agencies. However, problems of poor data quality and delayed submission of reports to public health agencies are common. In addition, studies of barriers and facilitators to reporting have assumed that the primary reporter is the treating physician, although the extent to which a provider is involved in the reporting workflow is unclear. We sought to better understand the barriers to and burden of notifiable condition reporting from the perspectives of the three primary groups involved in reporting workflow: providers, clinic staff who bear the principal responsibility for reporting, and the public health workers who receive and process reports from clinics. In addition, we sought to situate these findings within the context of the future of notifiable disease reporting and the potential impacts of electronic lab and medical records on the surveillance system. Methods Seven ambulatory care clinics and 3 public health agencies that are part of a Health Information Exchange in the state of Indiana, USA, participated in the study. Data were obtained from a survey of clinic physicians (N = 29), interviews with clinic reporters (N = 11), and interviews with public health workers (N = 9). Survey data were summarized descriptively and interview transcripts underwent qualitative analysis. Results In both clinics and public health agencies, the laboratory report initiates reporting workflow. Provider involvement with reporting primarily revolves around ordering medications to treat a condition confirmed by the lab result. In clinics, reporting is typically the responsibility of clinic reporters who vary in frequency of reporting. We found an association between frequency of reporting, reporting knowledge and perceptions of reporting burden. In both clinics and public health agencies, interruptions and delays in reporting workflow are encountered due to inaccurate or missing information and impact reporting timeliness, data quality and report completeness. Both providers and clinic reporters lack clarity regarding how data submitted by their reports are used by public health agencies. It is possible that the value of reporting may be diminished when those responsible do not perceive receiving benefit in return. This may account for the low awareness of or recollection of public health communications with clinics that we observed. Despite the high likelihood that public health advisories and guidance are based, in part, on data submitted by clinics, a direct concordance may not be recognized. Conclusions Unlike most studies of notifiable condition reporting, this study included the clinic reporters who bear primary responsibility for completing and submitting reports to public health agencies. A primary barrier to this reporting is timely and easy access to data. It is possible that expanded adoption of electronic health record and laboratory reporting systems will improve access to this data and reduce reporting the burden. However, a complete reliance on automatic electronic extraction of data requires caution and necessitates continued interfacing with clinic reporters for the foreseeable future—particularly for notifiable conditions that are high-impact, uncommon, prone to false positive readings by labs, or are hard to verify. An important finding of this study is the association between frequency of reporting, reporting knowledge and perceptions of reporting burden. Increased automation could result in even lower reporting knowledge and familiarity with reporting requirements which could actually increase reporters’ perception of notifiable condition reporting as burdensome. Another finding was of uncertainty regarding how data sent to public health agencies is used or provides clinical benefit. A strong recommendation generated by these findings is that, given their central role in reporting, clinic reporters are a significant target audience for public health outreach and education that aims to alleviate perceived reporting burden and improve reporting knowledge. In particular, communicating the benefits of public health’s use of the data may reduce a perceived lack of information reciprocity between clinical and public health organizations. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4156-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Debra Revere
- School of Public Health, University of Washington, 1107 NE 45th St., Suite 400, PO Box 354809, Seattle, WA, 98105, USA.
| | | | | | - P Joseph Gibson
- Marion County Public Health Department, Indianapolis, IN, USA
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Dixon BE, Barboza K, Jensen AE, Bennett KJ, Sherman SE, Schwartz MD. Measuring Practicing Clinicians' Information Literacy. An Exploratory Analysis in the Context of Panel Management. Appl Clin Inform 2017; 8:149-161. [PMID: 28197620 PMCID: PMC5373760 DOI: 10.4338/aci-2016-06-ra-0083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 12/05/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND As healthcare moves towards technology-driven population health management, clinicians must adopt complex digital platforms to access health information and document care. OBJECTIVES This study explored information literacy, a set of skills required to effectively navigate population health information systems, among primary care providers in one Veterans' Affairs (VA) medical center. METHODS Information literacy was assessed during an 8-month randomized trial that tested a population health (panel) management intervention. Providers were asked about their use and comfort with two VA digital tools for panel management at baseline, 16 weeks, and post-intervention. An 8-item scale (range 0-40) was used to measure information literacy (Cronbach's α=0.84). Scores between study arms and provider types were compared using paired t-tests and ANOVAs. Associations between self-reported digital tool use and information literacy were measured via Pearson's correlations. RESULTS Providers showed moderate levels of information literacy (M= 27.4, SD 6.5). There were no significant differences in mean information literacy between physicians (M=26.4, SD 6.7) and nurses (M=30.5, SD 5.2, p=0.57 for difference), or between intervention (M=28.4, SD 6.5) and control groups (M=25.1, SD 6.2, p=0.12 for difference). Information literacy was correlated with higher rates of self-reported information system usage (r=0.547, p=0.001). Clinicians identified data access, accuracy, and interpretability as potential information literacy barriers. CONCLUSIONS While exploratory in nature, cautioning generalizability, the study suggests that measuring and improving clinicians' information literacy may play a significant role in the implementation and use of digital information tools, as these tools are rapidly being deployed to enhance communication among care teams, improve health care outcomes, and reduce overall costs.
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Affiliation(s)
- Brian E Dixon
- Brian E. Dixon, MPA, PhD, Regenstrief Institute, 1101 W. 10th St., RF 336, Indianapolis, Indiana 46202,
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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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Dixon BE, Kharrazi H, Lehmann HP. Public Health and Epidemiology Informatics: Recent Research and Trends in the United States. Yearb Med Inform 2015; 10:199-206. [PMID: 26293869 PMCID: PMC4587030 DOI: 10.15265/iy-2015-012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To survey advances in public health and epidemiology informatics over the past three years. METHODS We conducted a review of English-language research works conducted in the domain of public health informatics (PHI), and published in MEDLINE between January 2012 and December 2014, where information and communication technology (ICT) was a primary subject, or a main component of the study methodology. Selected articles were synthesized using a thematic analysis using the Essential Services of Public Health as a typology. RESULTS Based on themes that emerged, we organized the advances into a model where applications that support the Essential Services are, in turn, supported by a socio-technical infrastructure that relies on government policies and ethical principles. That infrastructure, in turn, depends upon education and training of the public health workforce, development that creates novel or adapts existing infrastructure, and research that evaluates the success of the infrastructure. Finally, the persistence and growth of infrastructure depends on financial sustainability. CONCLUSIONS Public health informatics is a field that is growing in breadth, depth, and complexity. Several Essential Services have benefited from informatics, notably, "Monitor Health," "Diagnose & Investigate," and "Evaluate." Yet many Essential Services still have not yet benefited from advances such as maturing electronic health record systems, interoperability amongst health information systems, analytics for population health management, use of social media among consumers, and educational certification in clinical informatics. There is much work to be done to further advance the science of PHI as well as its impact on public health practice.
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Affiliation(s)
| | | | - H P Lehmann
- Harold Lehmann, 2024 E Monument St, Baltimore MD 21209, Tel. +1 410 502 7569, E-mail:
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What's Past is Prologue: A Scoping Review of Recent Public Health and Global Health Informatics Literature. Online J Public Health Inform 2015; 7:e216. [PMID: 26392846 PMCID: PMC4576440 DOI: 10.5210/ojphi.v7i2.5931] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To categorize and describe the public health informatics (PHI) and global health informatics (GHI) literature between 2012 and 2014. METHODS We conducted a semi-systematic review of articles published between January 2012 and September 2014 where information and communications technologies (ICT) was a primary subject of the study or a main component of the study methodology. Additional inclusion and exclusion criteria were used to filter PHI and GHI articles from the larger biomedical informatics domain. Articles were identified using MEDLINE as well as personal bibliographies from members of the American Medical Informatics Association PHI and GHI working groups. RESULTS A total of 85 PHI articles and 282 GHI articles were identified. While systems in PHI continue to support surveillance activities, we identified a shift towards support for prevention, environmental health, and public health care services. Furthermore, articles from the U.S. reveal a shift towards PHI applications at state and local levels. GHI articles focused on telemedicine, mHealth and eHealth applications. The development of adequate infrastructure to support ICT remains a challenge, although we identified a small but growing set of articles that measure the impact of ICT on clinical outcomes. DISCUSSION There is evidence of growth with respect to both implementation of information systems within the public health enterprise as well as a widening of scope within each informatics discipline. Yet the articles also illuminate the need for more primary research studies on what works and what does not as both searches yielded small numbers of primary, empirical articles. CONCLUSION While the body of knowledge around PHI and GHI continues to mature, additional studies of higher quality are needed to generate the robust evidence base needed to support continued investment in ICT by governmental health agencies.
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Hebden JN. Slow adoption of automated infection prevention surveillance: are human factors contributing? Am J Infect Control 2015; 43:559-62. [PMID: 25798777 DOI: 10.1016/j.ajic.2015.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 02/05/2015] [Accepted: 02/05/2015] [Indexed: 10/23/2022]
Abstract
Although automated surveillance technology has been evolving for decades, adoption of these technologies is in a nascent state. The current trajectory of public reporting, continued emergence of multidrug-resistant organisms, and mandated antimicrobial stewardship initiatives will result in an increased surveillance workload for ICPs. The use of traditional surveillance methods will be inefficient in meeting the demands for more data and are potentially flawed by subjective interpretation. An examination is offered of the slow adoption of automated surveillance technology from a system perspective with the inherent ambiguities that may operate within the ICP work structure. Formal qualitative research is needed to assess the human factors associated with lack of acceptance of automated surveillance systems. Identification of these factors will allow the National Healthcare Safety Network and professional organizations to offer educational programs and mentoring to the ICP community that target knowledge deficits and the embedded culture that embraces the status quo. With the current focus on fully electronic surveillance systems that perform surveillance in its entirety without case review, effective use of the data will be dependent on ICP skills and their understanding of the strengths and limitations of output from algorithmic detection models.
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Revere D, Dixon BE, Hills R, Williams JL, Grannis SJ. Leveraging health information exchange to improve population health reporting processes: lessons in using a collaborative-participatory design process. ACTA ACUST UNITED AC 2014; 2:1082. [PMID: 25848615 PMCID: PMC4371487 DOI: 10.13063/2327-9214.1082] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: Surveillance, or the systematic monitoring of disease within a population, is a cornerstone function of public health. Despite significant investment in information technologies (IT) to improve the public’s health, health care providers continue to rely on manual, spontaneous reporting processes that can result in incomplete and delayed surveillance activities. Background: Participatory design principles advocate including real users and stakeholders when designing an information system to ensure high ecological validity of the product, incorporate relevance and context into the design, reduce misconceptions designers can make due to insufficient domain expertise, and ultimately reduce barriers to adoption of the system. This paper focuses on the collaborative and informal participatory design process used to develop enhanced, IT-enabled reporting processes that leverage available electronic health records in a health information exchange to prepopulate notifiable-conditions report forms used by public health authorities. Methods: Over nine months, public health stakeholders, technical staff, and informatics researchers were engaged in a multiphase participatory design process that included public health stakeholder focus groups, investigator-engineering team meetings, public health survey and census regarding high-priority data elements, and codesign of exploratory prototypes and final form mock-ups. Findings: A number of state-mandated report fields that are not highly used or desirable for disease investigation were eliminated, which allowed engineers to repurpose form space for desired and high-priority data elements and improve the usability of the forms. Our participatory design process ensured that IT development was driven by end user expertise and needs, resulting in significant improvements to the layout and functionality of the reporting forms. Discussion: In addition to informing report form development, engaging with public health end users and stakeholders through the participatory design process provided new insights into public health workflow and allowed the team to quickly triage user requests while managing user expectations within the realm of engineering possibilities. Conclusion: Engaging public health, engineering staff, and investigators in a shared codesigning process ensured that the new forms will not only meet real-life needs but will also support development of a product that will be adopted and, ultimately, improve communicable and infectious disease reporting by clinicians to public health.
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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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Dixon BE, Vreeman DJ, Grannis SJ. The long road to semantic interoperability in support of public health: experiences from two states. J Biomed Inform 2014; 49:3-8. [PMID: 24680985 PMCID: PMC4083703 DOI: 10.1016/j.jbi.2014.03.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 03/13/2014] [Accepted: 03/16/2014] [Indexed: 01/17/2023]
Abstract
Proliferation of health information technologies creates opportunities to improve clinical and public health, including high quality, safer care and lower costs. To maximize such potential benefits, health information technologies must readily and reliably exchange information with other systems. However, evidence from public health surveillance programs in two states suggests that operational clinical information systems often fail to use available standards, a barrier to semantic interoperability. Furthermore, analysis of existing policies incentivizing semantic interoperability suggests they have limited impact and are fragmented. In this essay, we discuss three approaches for increasing semantic interoperability to support national goals for using health information technologies. A clear, comprehensive strategy requiring collaborative efforts by clinical and public health stakeholders is suggested as a guide for the long road towards better population health data and outcomes.
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Affiliation(s)
- Brian E Dixon
- Department of BioHealth Informatics, Indiana University School of Informatics and Computing, Indianapolis, IN, USA; Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, IN, USA; Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Richard L. Roudebush VA Medical Center, 410 W. 10th St., Suite 2000, Indianapolis, IN 46202, USA.
| | - Daniel J Vreeman
- Indiana University School of Medicine Indianapolis, IN, Regenstrief Institute, Inc., Indianapolis, IN, USA
| | - Shaun J Grannis
- Indiana University School of Medicine Indianapolis, IN, Regenstrief Institute, Inc., Indianapolis, IN, USA
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Estimating increased electronic laboratory reporting volumes for meaningful use:
implications for the public health workforce. Online J Public Health Inform 2014; 5:225. [PMID: 24678378 PMCID: PMC3959912 DOI: 10.5210/ojphi.v5i3.4939] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To provide formulas for estimating notifiable disease reporting volume
from ‘meaningful use’ electronic laboratory reporting (ELR).
Methods: We analyzed two years of comprehensive ELR reporting data from 15
metropolitan hospitals and laboratories. Report volumes were divided by
population counts to derive generalizable estimators. Results: Observed volume
of notifiable disease reports in a metropolitan area were more than twice
national averages. ELR volumes varied by institution type, bed count, and by the
level of effort required of health department staff. Conclusions: Health
departments may experience a significant increase in notifiable disease
reporting following efforts to fulfill meaningful use requirements, resulting in
increases in workload that may further strain public health resources. Volume
estimators provide a method for predicting ELR transaction volumes, which may
support administrative planning in health departments.
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