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Sarkar IN. Transforming Health Data to Actionable Information: Recent Progress and Future Opportunities in Health Information Exchange. Yearb Med Inform 2022; 31:203-214. [PMID: 36463879 PMCID: PMC9719753 DOI: 10.1055/s-0042-1742519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES Provide a systematic review of literature pertaining to health information exchange (HIE) since 2018. Summarize HIE-associated literature for most frequently occurring topics, as well as within the context of the COVID-19 pandemic and health equity. Finally, provide recommendations for how HIE can advance the vision of a digital healthcare ecosystem. METHODS A computer program was developed to mediate a literature search of primary literature indexed in MEDLINE that was: (1) indexed with "Health Information Exchange" MeSH descriptor as a major topic; and (2) published between January 2018 and December 2021. Frequency of MeSH descriptors was then used to identify and to rank topics associated with the retrieved literature. COVID-19 literature was identified using the general COVID-19 PubMed Clinical Query filter. Health equity literature was identified using additional MeSH descriptor-based searches. The retrieved literature was then reviewed and summarized. RESULTS A total of 256 articles were retrieved and reviewed for this survey. The major thematic areas summarized were: (1) Information Dissemination; (2) Delivery of Health Care; (3) Hospitals; (4) Hospital Emergency Service; (5) COVID-19; (6) Health Disparities; and (7) Computer Security and Confidentiality. A common theme across all areas examined for this survey was the maturity of HIE to support data-driven healthcare delivery. Recommendations were developed based on opportunities identified across the reviewed literature. CONCLUSIONS HIE is an essential advance in next generation healthcare delivery. The review of the recent literature (2018-2021) indicates that successful HIE improves healthcare delivery, often resulting in improved health outcomes. There remain major opportunities for expanded use of HIE, including the active engagement of clinical and patient stakeholders. The maturity of HIE reflects the maturity of the biomedical informatics and health data science fields.
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Affiliation(s)
- Indra Neil Sarkar
- Brown University, Providence, RI, USA,Rhode Island Quality Institute, Providence, RI, USA,Correspondence to: Indra Neil Sarkar, PhD, MLIS, FACMI, ACHIP Brown UniversityBox G-R Providence, RI 02912USA+1 401 863 2428
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Haque SN, Territo H, Bailey R, Massoudi B, Loomis R, Burstein G. Quantifying benefits of using health information exchange to support public health STI reporting and treatment in Western New York. Health Inf Manag 2017; 48:42-47. [PMID: 29020835 DOI: 10.1177/1833358317732024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE: To calculate average savings of using health information exchange (HIE) for demographic and treatment requests for chlamydia and gonorrhoea in Western New York, specifically the Erie County Department of Health and its catchment area. METHOD: We conducted a mixed-method case study. Qualitative methods included interviews, document review, and workflow mapping, which were used as the inputs to identify time savings. Case rates, time savings, and salary averages were used to calculate average savings. RESULTS: The avoided demographic information requests resulted in time and money savings (range of USD$2312-USD$4624 for chlamydia and USD$809-USD$1512 for gonorrhoea) as did avoided treatment requests (range of USD$671-USD$2803 for chlamydia and USD$981-USD$1635 for gonorrhoea). DISCUSSION: HIE supported sexually transmitted infection (STI) treatment by making it easier for public health staff to identify and act upon STI diagnoses. Availability of information online resulted in less reliance on provider offices for demographic and treatment information. CONCLUSION: Results indicated that using HIE to support treatment and management of STIs can save public health staff time spent on obtaining demographic and treatment information. Other public health departments could use HIE for this and other types of disease surveillance activities. Considering public health needs in HIE development and use can improve efficiency of public health services and enhance effectiveness of activities.
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Affiliation(s)
| | - Heather Territo
- 2 Erie County Department of Health, Buffalo, NY, USA.,3 Women and Children's Hospital of Buffalo, USA
| | | | | | | | - Gale Burstein
- 2 Erie County Department of Health, Buffalo, NY, USA.,5 Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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Heath M, Appan R, Gudigantala N. Exploring Health Information Exchange (HIE) Through Collaboration Framework: Normative Guidelines for IT Leadership of Healthcare Organizations. INFORMATION SYSTEMS MANAGEMENT 2017. [DOI: 10.1080/10580530.2017.1288524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Michele Heath
- Monte Ahuja College of Business, Cleveland State University, Cleveland, Ohio, USA
| | - Radha Appan
- Monte Ahuja College of Business, Cleveland State University, Cleveland, Ohio, USA
| | - Naveen Gudigantala
- Robert B. Pamplin Jr. School of Business Administration, University of Portland, Portland, Oregon, USA
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Shah GH, Vest JR, Lovelace K, McCullough JM. Local Health Departments' Partners and Challenges in Electronic Exchange of Health Information. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 22 Suppl 6, Public Health Informatics:S44-S50. [PMID: 27684617 PMCID: PMC5049940 DOI: 10.1097/phh.0000000000000442] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Unprecedented amounts of data are produced by the health care and other sectors, presenting opportunities for local health departments (LHDs) to access these data. LHDs will need to participate in health information exchange (HIE) with a number of partners in order to benefit from these data resources. LHDs' participation in HIEs with specific partners has not been studied. OBJECTIVES To describe the level of and challenges in LHD participation in HIE with other partners, and variation by LHD population size and governance type. DATA AND METHODS This research uses data from the 2015 Informatics Capacity and Needs Assessment Survey, with a target population of all LHDs in the United States. A representative sample of 650 LHDs was drawn using a stratified random sampling design. A total of 324 completed responses were received with a 50% response rate. Survey data were cleaned, and bivariate comparisons were conducted using χ and Somer's D. RESULTS Substantial variation existed in LHDs' participation in HIE by type of exchange partner. Although 71% participated in HIE with the state departments of health, only 12% with jail/correctional health, 14% with health or county-based purchasing plans, and 15% with home health agencies. Compared with large LHDs (jurisdiction populations of ≥500 000), smaller LHDs were more likely to participate in HIE with state departments of health, but less likely with other exchange partners. The challenges to HIE participation were technological, and organizational/interorganizational in nature and variation existed by LHDs' population size and governance structure with respect to state authority. CONCLUSIONS Local public health agencies more commonly participate in HIE with some partners, but may need to improve HIE with many others. National strategies targeting an increase in HIE of LHDs may use our findings to focus those initiatives.
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Affiliation(s)
- Gulzar H. Shah
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Dr Shah); Indiana University Richard M. Fairbanks School of Public Health at IUPUI, and Regenstrief Institute, Indianapolis, Indiana (Dr Vest); Department of Public Health Education, UNCG, Greensboro, North Carolina (Dr Lovelace); and School for the Science of Health Care Delivery, Arizona State University, Tempe, Arizona (Dr McCullough)
| | - Joshua R. Vest
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Dr Shah); Indiana University Richard M. Fairbanks School of Public Health at IUPUI, and Regenstrief Institute, Indianapolis, Indiana (Dr Vest); Department of Public Health Education, UNCG, Greensboro, North Carolina (Dr Lovelace); and School for the Science of Health Care Delivery, Arizona State University, Tempe, Arizona (Dr McCullough)
| | - Kay Lovelace
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Dr Shah); Indiana University Richard M. Fairbanks School of Public Health at IUPUI, and Regenstrief Institute, Indianapolis, Indiana (Dr Vest); Department of Public Health Education, UNCG, Greensboro, North Carolina (Dr Lovelace); and School for the Science of Health Care Delivery, Arizona State University, Tempe, Arizona (Dr McCullough)
| | - J. Mac McCullough
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Dr Shah); Indiana University Richard M. Fairbanks School of Public Health at IUPUI, and Regenstrief Institute, Indianapolis, Indiana (Dr Vest); Department of Public Health Education, UNCG, Greensboro, North Carolina (Dr Lovelace); and School for the Science of Health Care Delivery, Arizona State University, Tempe, Arizona (Dr McCullough)
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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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Socias C, Liang Y, Delclos G, Graves J, Hendrikson E, Cooper S. The Feasibility of Using Electronic Health Records to Describe Demographic and Clinical Indicators of Migrant and Seasonal Farmworkers. J Agromedicine 2016; 21:71-81. [PMID: 26479964 PMCID: PMC4744472 DOI: 10.1080/1059924x.2015.1074633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Few extensive, national clinical databases exist on the health of migrant and seasonal farmworkers (MSFWs). Electronic health records (EHRs) are increasingly utilized by Federally Qualified Health Centers (FQHCs) and have the potential to improve clinical care and complement current surveillance and epidemiologic studies of underserved working populations, such as MSFWs. The aim of this feasibility study was to describe the demographics and baseline clinical indicators of patients at an FQHC by MSFW status. The authors described 2012 patient demographics, social history, medical indicators, and diagnoses by MSFW status from the de-identified EHR database of a large, multisite Colorado Migrant Health Center (MHC). Included in the study were 41,817 patients from 2012: 553 (1.3%) MSFWs, 20,665 (49.4%) non-MSFWs, and 20,599 (49.3%) who had no information in the MSFW field. MSFWs were more often male, married, employed, Hispanic, and Spanish-speaking compared with non-MSFWs. The most frequent diagnoses for all patients were hypertension, overweight/obesity, lipid disorder, type 2 diabetes, or a back disorder. Although there were significant missing values, this feasibility study was able to analyze medical data in a timely manner and show that Meaningful Use requirements can improve the usability of EHR data for epidemiologic research of MSFWs and other patients at FQHCs. The results of this study were consistent with current literature available for MSFWs. By reaching this vulnerable working population, EHRs may be a key data source for occupational injury and illness surveillance and research.
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Affiliation(s)
- Christina Socias
- The University of Texas Health Sciences Center, School of Public Health, Houston, Texas
| | - Yuanyuan Liang
- The University of Texas Health Sciences Center, School of Public Health, Houston, Texas
| | - George Delclos
- The University of Texas Health Sciences Center, School of Public Health, Houston, Texas
| | - Julie Graves
- American University of the Caribbean, Cupecoy, Dutch Lowlands, St. Maarten
| | | | - Sharon Cooper
- The University of Texas Health Sciences Center, School of Public Health, Houston, Texas
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Zech J, Husk G, Moore T, Kuperman GJ, Shapiro JS. Identifying homelessness using health information exchange data. J Am Med Inform Assoc 2015; 22:682-7. [PMID: 25670759 DOI: 10.1093/jamia/ocu005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 10/20/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Homeless patients experience poor health outcomes and consume a disproportionate amount of health care resources compared with domiciled patients. There is increasing interest in the federal government in providing care coordination for homeless patients, which will require a systematic way of identifying these individuals. OBJECTIVE We analyzed address data from Healthix, a New York City-based health information exchange, to identify patterns that could indicate homelessness. METHODS Patients were categorized as likely to be homeless if they registered with the address of a hospital, homeless shelter, place of worship, or an address containing a keyword synonymous with "homelessness." RESULTS We identified 78,460 out of 7,854,927 Healthix patients (1%) as likely to have been homeless over the study period of September 30, 2008 to July 19, 2013. We found that registration practices for these patients varied widely across sites. CONCLUSIONS The use of health information exchange data enabled us to identify a large number of patients likely to be homeless and to observe the wide variation in registration practices for homeless patients within and across sites. Consideration of these results may suggest a way to improve the quality of record matching for homeless patients. Validation of these results is necessary to confirm the homeless status of identified individuals. Ultimately, creating a standardized and structured field to record a patient's housing status may be a preferable approach.
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Affiliation(s)
- John Zech
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Gregg Husk
- Department of Emergency Medicine, Mount Sinai Beth Israel, New York, NY, 10003, USA
| | | | | | - Jason S Shapiro
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA,
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Mamiya H, Schwartzman K, Verma A, Jauvin C, Behr M, Buckeridge D. Towards probabilistic decision support in public health practice: predicting recent transmission of tuberculosis from patient attributes. J Biomed Inform 2014; 53:237-42. [PMID: 25460204 DOI: 10.1016/j.jbi.2014.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 11/04/2014] [Accepted: 11/11/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Investigating the contacts of a newly diagnosed tuberculosis (TB) case to prevent TB transmission is a core public health activity. In the context of limited resources, it is often necessary to prioritize investigation when multiple cases are reported. Public health personnel currently prioritize contact investigation intuitively based on past experience. Decision-support software using patient attributes to predict the probability of a TB case being involved in recent transmission could aid in this prioritization, but a prediction model is needed to drive such software. METHODS We developed a logistic regression model using the clinical and demographic information of TB cases reported to Montreal Public Health between 1997 and 2007. The reference standard for transmission was DNA fingerprint analysis. We measured the predictive performance, in terms of sensitivity, specificity, negative predictive value, positive predictive value, the Receiver Operating Characteristic (ROC) curve and the Area Under the ROC (AUC). RESULTS Among 1552 TB cases enrolled in the study, 314 (20.2%) were involved in recent transmission. The AUC of the model was 0.65 (95% confidence interval: 0.61-0.68), which is significantly better than random prediction. The maximized values of sensitivity and specificity on the ROC were 0.53 and 0.67, respectively. CONCLUSIONS The characteristics of a TB patient reported to public health can be used to predict whether the newly diagnosed case is associated with recent transmission as opposed to reactivation of latent infection.
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Affiliation(s)
- Hiroshi Mamiya
- McGill Clinical and Health Informatics, McGill University, 1140 Avenue Pine, Montréal, Québec H3A 1A3, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada.
| | - Kevin Schwartzman
- Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, 3650 Rue Saint-Urbain, Montreal, Quebec H2X 2P4, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada; McGill International TB Centre, McGill University Health Centre, 1650 Cedar Avenue, Room A5.156, Montreal, Quebec, H3G 1A4, Canada
| | - Aman Verma
- McGill Clinical and Health Informatics, McGill University, 1140 Avenue Pine, Montréal, Québec H3A 1A3, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada
| | - Christian Jauvin
- McGill Clinical and Health Informatics, McGill University, 1140 Avenue Pine, Montréal, Québec H3A 1A3, Canada
| | - Marcel Behr
- McGill University Health Centre, 1650 Cedar Avenue, Room A5.156, Montreal, H3G 1A4, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada; McGill International TB Centre, McGill University Health Centre, 1650 Cedar Avenue, Room A5.156, Montreal, Quebec, H3G 1A4, Canada
| | - David Buckeridge
- McGill Clinical and Health Informatics, McGill University, 1140 Avenue Pine, Montréal, Québec H3A 1A3, Canada; Agence Sociosanitaire de Montréal, Direction de la santé publique, 1301 Rue Sherbrooke Est, Montreal, Quebec H2L 1M3, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2, Canada
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Kierkegaard P, Kaushal R, Vest JR. Applications of health information exchange information to public health practice. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2014; 2014:795-804. [PMID: 25954386 PMCID: PMC4419901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Increased information availability, timeliness, and comprehensiveness through health information exchange (HIE) can support public health practice. The potential benefits to disease monitoring, disaster response, and other public health activities served as an important justification for the US' investments in HIE. After several years of HIE implementation and funding, we sought to determine if any of the anticipated benefits of exchange participation were accruing to state and local public health practitioners participating in five different exchanges. Using qualitative interviews and template analyses, we identified public health efforts and activities that were improved by participation in HIE. HIE supported public health activities consistent with expectations in the literature. However, no single department realized all the potential benefits of HIE identified. These findings suggest ways to improve HIE usage in public health.
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Affiliation(s)
| | - Rainu Kaushal
- Center for Healthcare Informatics & Policy, Weill Cornell Medical College, New York NY ; Department of Healthcare Policy and Research, Weill Cornell Medical College, New York NY ; Department of Medicine, Weill Cornell Medical College, New York, NY ; Department of Pediatrics, Weill Cornell Medical College, New York, NY ; NewYork-Presbyterian Hospital, New York, NY
| | - Joshua R Vest
- Center for Healthcare Informatics & Policy, Weill Cornell Medical College, New York NY ; Department of Healthcare Policy and Research, Weill Cornell Medical College, New York NY
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Massoudi BL, Marcial LH, Haque S, Bailey R, Chester K, Cunningham S, Riley A, Soper P. Beacon communities' public health initiatives: a case study analysis. EGEMS (WASHINGTON, DC) 2014; 2:1093. [PMID: 25848620 PMCID: PMC4371438 DOI: 10.13063/2327-9214.1093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The Beacon Communities for Public Health (BCPH) project was launched in 2011 to gain a better understanding of the range of activities currently being conducted in population- and public health by the Beacon Communities. The project highlighted the successes and challenges of these efforts with the aim of sharing this information broadly among the public health community. BACKGROUND The Beacon Community Program, designed to showcase technology-enabled, community-based initiatives to improve outcomes, focused on: building and strengthening health information technology (IT) infrastructure and exchange capabilities; translating investments in health IT to measureable improvements in cost, quality, and population health; and, developing innovative approaches to performance measurement, technology, and care delivery. METHODS Four multimethod case studies were conducted based on a modified sociotechnical framework to learn more about public health initiative implementation and use in the Beacon Communities. Our methodological approach included using document review and semistructured key informant interviews. NACCHO Model Practice Program criteria were used to select the public health initiatives included in the case studies. FINDINGS Despite differences among the case studies, common barriers and facilitators were found to be present in all areas of the sociotechnical framework application including structure, people, technology, tasks, overarching considerations, and sustainability. Overall, there were many more facilitators (range = 7-14) present for each Beacon compared to barriers (range = 4-6). DISCUSSION Four influential promising practices were identified through the work: forging strong and sustainable partnerships; ensuring a good task-technology fit and a flexible and iterative design; fostering technology acceptance; and, providing education and demonstrating value. CONCLUSIONS A common weakness was the lack of a framework or model for the Beacon Communities evaluation work. Sharing a framework or approach to evaluation at the beginning of implementation made the work more effective. Supporting evaluation to inform future implementations is important.
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Goldwater J, Jardim J, Khan T, Chan K. Emphasizing Public Health Within a Health Information Exchange: An Evaluation of the District of Columbia's Health Information Exchange Program. EGEMS 2014; 2:1090. [PMID: 25848617 PMCID: PMC4371436 DOI: 10.13063/2327-9214.1090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: Clinovations Government Solutions (CGS) was contracted in 2013 to conduct a mixed-methods evaluation of the District of Columbia (D.C.) Health Information Exchange (HIE) program as part of their Cooperative Agreement Grant funded by the Office of the National Coordinator in 2010. The evaluation was to focus on the progress of the HIE, how many providers and hospitals were participating in the program, and what benefits were being realized through the use of the HIE. During the course of the evaluation, the CGS team found that the use of the HIE to support public health reporting was one of its core elements. Background: The D.C. HIE is one of 56 HIE that were funded out of the Cooperative Agreement program. The HIE program was managed by the District of Columbia Department of Health Care Finance (DHCF), which also manages the District of Columbia Medicaid Program. The program was initially designed to accomplish the following: developing state-level directories and enabling technical services for HIE within and across states; ensuring an effective model for governance and accountability; coordinating an integrated approach with Medicaid and public health; and developing or updating privacy and security requirements for HIE within and across state borders. As the evaluation progressed, the CGS team discovered that the relationship between the DHCF and the District of Columbia Department of Health (DOH) had become a cornerstone of the D.C. HIE program. Methods: The CGS team used a mixed-methods approach for the evaluation, including a review of documents developed by the DHCF in its HIE program, including its original application. We also conducted 10 key informant interviews and moderated two small-group discussions using a semistructured protocol; and we developed a survey that measured the use, satisfaction, and future sustainability of the HIE for over 200 providers within the District of Columbia. Findings: While the evaluation focused on the D.C. HIE program in its entirety, the results indicated the value of utilizing the HIE for public health reporting to enhance the surveillance activities of the DOH. Specifically, the DHCF and DOH collaboration resulted in using the HIE to electronically capture and report immunization data; and in requiring electronic lab reporting and results as part of the Meaningful Use Requirement—which can assist in detecting HIV/AIDS and providing better care for the district’s high population of individuals with HIV/AIDS. Electronic lab reporting and electronic prescribing within the HIE can assist the DOH and providers in identifying specific diseases, such as tuberculosis and viral hepatitis, before they affect a significant part of the population. Discussion: Given the severe health disparities in the district, the ability of the D.C. HIE program to collect public health information on affected populations will be instrumental in better understanding and identifying methods of supporting these populations through improved surveillance and identification of the appropriate treatments. The D.C. HIE program is uniquely positioned to support these populations due to the partnership of DHCF with the D.C. DOH. Conclusion and Next Steps: The District of Columbia has made significant strides in expanding its public health infrastructure and activities. Three key areas of growth were identified that have the potential to transform the District of Columbia’s public health approach: establishing sufficient feedback loops, collection of environmental data, integration, and interoperability.
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Dixon BE, Grannis SJ, Revere D. Measuring the impact of a health information exchange intervention on provider-based notifiable disease reporting using mixed methods: a study protocol. BMC Med Inform Decis Mak 2013; 13:121. [PMID: 24171799 PMCID: PMC3819468 DOI: 10.1186/1472-6947-13-121] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 10/29/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Health information exchange (HIE) is the electronic sharing of data and information between clinical care and public health entities. Previous research has shown that using HIE to electronically report laboratory results to public health can improve surveillance practice, yet there has been little utilization of HIE for improving provider-based disease reporting. This article describes a study protocol that uses mixed methods to evaluate an intervention to electronically pre-populate provider-based notifiable disease case reporting forms with clinical, laboratory and patient data available through an operational HIE. The evaluation seeks to: (1) identify barriers and facilitators to implementation, adoption and utilization of the intervention; (2) measure impacts on workflow, provider awareness, and end-user satisfaction; and (3) describe the contextual factors that impact the effectiveness of the intervention within heterogeneous clinical settings and the HIE. METHODS/DESIGN The intervention will be implemented over a staggered schedule in one of the largest and oldest HIE infrastructures in the U.S., the Indiana Network for Patient Care. Evaluation will be conducted utilizing a concurrent design mixed methods framework in which qualitative methods are embedded within the quantitative methods. Quantitative data will include reporting rates, timeliness and burden and report completeness and accuracy, analyzed using interrupted time-series and other pre-post comparisons. Qualitative data regarding pre-post provider perceptions of report completeness, accuracy, and timeliness, reporting burden, data quality, benefits, utility, adoption, utilization and impact on reporting workflow will be collected using semi-structured interviews and open-ended survey items. Data will be triangulated to find convergence or agreement by cross-validating results to produce a contextualized portrayal of the facilitators and barriers to implementation and use of the intervention. DISCUSSION By applying mixed research methods and measuring context, facilitators and barriers, and individual, organizational and data quality factors that may impact adoption and utilization of the intervention, we will document whether and how the intervention streamlines provider-based manual reporting workflows, lowers barriers to reporting, increases data completeness, improves reporting timeliness and captures a greater portion of communicable disease burden in the community.
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Affiliation(s)
- Brian E Dixon
- Indiana University, School of Informatics and Computing, Indianapolis, IN, USA
- Regenstrief Institute, Center for Biomedical Informatics, Indianapolis, IN, USA
- Department of Veterans Affairs, Health Services Research & Development Service, Center for Implementing Evidence-Based Practice, Indianapolis, IN, USA
| | - Shaun J Grannis
- Indiana University, School of Informatics and Computing, Indianapolis, IN, USA
- Regenstrief Institute, Center for Biomedical Informatics, Indianapolis, IN, USA
- Indiana University, School of Medicine, Indianapolis, IN, USA
| | - Debra Revere
- University of Washington, School of Public Health, Seattle, WA, USA
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Vest JR, Campion TR, Kaushal R. Challenges, Alternatives, and Paths to Sustainability for Health Information Exchange Efforts. J Med Syst 2013; 37:9987. [DOI: 10.1007/s10916-013-9987-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 10/07/2013] [Indexed: 11/30/2022]
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Khurshid A, Diana ML, Luce SD. Health information exchange: metrics to address quality of care and return on investment. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2012; 9:1e. [PMID: 22783153 PMCID: PMC3392952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The purpose of this study was to find out how many health information exchanges (HIEs) are using metrics to gauge their impact and to gather examples of metrics being used by HIEs. We administered a web-based survey to a list of functioning HIEs. Valid responses were received from 18 HIEs. Most respondents were nonprofits, most had sustainable business models, and half used metrics to gauge their impact. Reduction of duplicative testing, quality improvement efforts, care coordination, and improved readmission rates were cited as having the greatest potential to show return on investment. Most respondents selected patient-centered care as having the greatest potential to show quality improvement. The major limitation of this study is the low response rate. This study suggests that there are no standard metrics used by HIEs to evaluate their impact. The HIE community needs to take the lead in developing metrics to evaluate the benefits of information exchange.
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Affiliation(s)
- Anjum Khurshid
- Health Systems Division, Louisiana Public Health Institute in New Orleans, USA
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Hincapie A, Warholak T. The impact of health information exchange on health outcomes. Appl Clin Inform 2011; 2:499-507. [PMID: 23616891 DOI: 10.4338/aci-2011-05-r-0027] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 10/15/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Healthcare professionals, industry and policy makers have identified Health Information Exchange (HIE) as a solution to improve patient safety and overall quality of care. The potential benefits of HIE on healthcare have fostered its implementation and adoption in the United States. However,there is a dearth of publications that demonstrate HIE effectiveness. The purpose of this review was to identify and describe evidence of HIE impact on healthcare outcomes. METHODS A database search was conducted. The inclusion criteria included original investigations in English that focused on a HIE outcome evaluation. Two independent investigators reviewed the articles. A qualitative coding approach was used to analyze the data. RESULTS Out of 207 abstracts retrieved, five articles met the inclusion criteria. Of these, 3 were randomized controlled trials, 1 involved retrospective review of data, and 1 was a prospective study. We found that HIE benefits on healthcare outcomes are still sparsely evaluated, and that among the measurements used to evaluate HIE healthcare utilization is the most widely used. CONCLUSIONS Outcomes evaluation is required to give healthcare providers and policy-makers evidence to incorporate in decision-making processes. This review showed a dearth of HIE outcomes data in the published peer reviewed literature so more research in this area is needed. Future HIE evaluations with different levels of interoperability should incorporate a framework that allows a detailed examination of HIE outcomes that are likely to positively affect care.
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Affiliation(s)
- A Hincapie
- The University of Arizona College of Pharmacy , Tucson, AZ
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Li JS, Zhou TS, Chu J, Araki K, Yoshihara H. Design and development of an international clinical data exchange system: the international layer function of the Dolphin Project. J Am Med Inform Assoc 2011; 18:683-9. [PMID: 21571747 DOI: 10.1136/amiajnl-2011-000111] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE At present, most clinical data are exchanged between organizations within a regional system. However, people traveling abroad may need to visit a hospital, which would make international exchange of clinical data very useful. BACKGROUND Since 2007, a collaborative effort to achieve clinical data sharing has been carried out at Zhejiang University in China and Kyoto University and Miyazaki University in Japan; each is running a regional clinical information center. Methods An international layer system named Global Dolphin was constructed with several key services, sharing patients' health information between countries using a medical markup language (MML). The system was piloted with 39 test patients. RESULTS The three regions above have records for 966,000 unique patients, which are available through Global Dolphin. Data exchanged successfully from Japan to China for the 39 study patients include 1001 MML files and 152 images. The MML files contained 197 free text-type paragraphs that needed human translation. Discussion The pilot test in Global Dolphin demonstrates that patient information can be shared across countries through international health data exchange. To achieve cross-border sharing of clinical data, some key issues had to be addressed: establishment of a super directory service across countries; data transformation; and unique one-language translation. Privacy protection was also taken into account. The system is now ready for live use. CONCLUSION The project demonstrates a means of achieving worldwide accessibility of medical data, by which the integrity and continuity of patients' health information can be maintained.
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Affiliation(s)
- Jing-song Li
- Healthcare Informatics Engineering Research Center, Zhejiang University, Hangzhou, China.
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Mäenpää T, Asikainen P, Gissler M, Siponen K, Maass M, Saranto K, Suominen T. Outcomes assessment of the regional health information exchange: a five-year follow-up study. Methods Inf Med 2011; 50:308-18. [PMID: 21336419 DOI: 10.3414/me10-01-0048] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2010] [Accepted: 12/21/2010] [Indexed: 11/09/2022]
Abstract
BACKGROUND The implementation of a technology such as health information exchange (HIE) through a Regional Health Information System (RHIS) may improve the mobilization of health care information electronically across organizations. There is a need to coordinate care and bring together regional and local stakeholders. OBJECTIVES To describe how HIE had influenced health care delivery in one hospital district area in Finland. METHOD Trend analysis was used to evaluate the influence of a regional HIE. We conducted a retrospective, longitudinal study for the period 2004-2008 for the eleven federations of municipalities in the study area. We reviewed statistical health data from the time of implementation of an RHIS. The t-test was used to determine statistical significance. The selected outcomes were the data obtained from the regional database on total appointments, emergency department visits, laboratory tests and radiology examinations, and selected laboratory tests and radiology examinations carried out in both primary care and special health care. RESULTS Access to HIE may have influenced health care delivery in the study area. There are indications that there is a connection between access to regional HIE and the number of laboratory tests and radiology examinations performed in both primary care and specialized health care, as observed in the decreased frequency in outcomes such as radiology examinations, number of appointments, and emergency department visits in the study environment. The decreased frequencies of the latter suggest an increased efficiency of outpatient care, but we were not able to estimate to what extent the readily available comprehensive clinical information contributed to these trends. CONCLUSION Outcome assessment of HIE through an RHIS is essential for the success of health information technology (HIT) and as evidence to use in the decision-making process. As health care information becomes more digital, it increases the potential for a strong HIE effect on health care delivery.
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Affiliation(s)
- T Mäenpää
- University of Tampere, School of Health Sciences, Nursing Science, Lääkärikatu 1, 33014 Tampere, Finland.
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Hincapie AL, Warholak TL, Murcko AC, Slack M, Malone DC. Physicians' opinions of a health information exchange. J Am Med Inform Assoc 2010; 18:60-5. [PMID: 21106994 DOI: 10.1136/jamia.2010.006502] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Arizona Medicaid developed a Health Information Exchange (HIE) system called the Arizona Medical Information Exchange (AMIE). OBJECTIVE To evaluate physicians' perceptions regarding AMIE's impact on health outcomes and healthcare costs. MEASUREMENTS A focus-group guide was developed and included five domains: perceived impact of AMIE on (1) quality of care; (2) workflow and efficiency; (3) healthcare costs; (4) system usability; and (5) AMIE data content. Qualitative data were analyzed using analytical coding. RESULTS A total of 29 clinicians participated in the study. The attendance rate was 66% (N=19) for the first and last month of focus-group meetings and 52% (N=15) for the focus group meetings conducted during the second month. The benefits most frequently mentioned during the focus groups included: (1) identification of "doctor shopping"; (2) averting duplicative testing; and (3) increased efficiency of clinical information gathering. The most frequent disadvantage mentioned was the limited availability of data in the AMIE system. CONCLUSION Respondents reported that AMIE had the potential to improve care, but they felt that AMIE impact was limited due to the data available.
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Affiliation(s)
- Ana Lucia Hincapie
- Department of Pharmacy Practice and Science, The Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona, Tucson, Arizona, USA.
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Provider stakeholders' perceived benefit from a nascent health information exchange: a qualitative analysis. J Med Syst 2010; 36:601-13. [PMID: 20703673 PMCID: PMC3313032 DOI: 10.1007/s10916-010-9524-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 05/03/2010] [Indexed: 10/25/2022]
Abstract
We sought to better understand the perceived costs and benefits of joining a nascent health information exchange (HIE) from the perspective of potential provider organization participants. We therefore conducted semi-structured interviews with organizational representatives. Interview transcriptions were thematically coded, and coded text was subsequently aggregated to summarize the breadth and depth of responses. Although no respondents expected HIE to result in net financial benefit to their organization, all respondents recognized some potential benefits, and some respondents expected HIE to result in overall organizational benefit. Disproportionate benefit was expected for the poorest, sickest patients. Many respondents had concerns about HIE increasing the risk of data security breaches, and these concerns were most pronounced at larger organizations. We found little evidence of organizational concern regarding loss of patients to other organizations or publication of unfavorable quality data. If HIE's greatest benefactors are indeed the poorest, sickest patients, our current health care financing environment will make it difficult to align HIE costs with benefits. To sustain HIE, state and federal governments may need to consider ongoing subsidies. Furthermore, these governments will need to ensure that policies regulating data exchange have sufficient nationwide coordination and liability limitations that the perceived organizational risks of joining HIEs do not outweigh perceived benefits. HIE founders can address organizational concerns by attempting to coordinate HIE policies with those of their largest founding organizations, particularly for data security policies. Early HIE development and promotional efforts should not only focus on potential benefits, but should also address organizational concerns.
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Affiliation(s)
- Peter J Embi
- Center for Health Informatics, University of Cincinnati Academic Health Center, 231 Albert Sabin Way, Cincinnati, OH 45267-0840, USA.
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Hripcsak G. Developing common methods for evaluating health information exchange. J Biomed Inform 2007; 40:S1-2. [PMID: 17911045 DOI: 10.1016/j.jbi.2007.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Accepted: 08/13/2007] [Indexed: 11/26/2022]
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