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Rinner C, Sauter SK, Endel G, Heinze G, Thurner S, Klimek P, Duftschmid G. Improving the informational continuity of care in diabetes mellitus treatment with a nationwide Shared EHR system: Estimates from Austrian claims data. Int J Med Inform 2016; 92:44-53. [PMID: 27318070 DOI: 10.1016/j.ijmedinf.2016.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 05/04/2016] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Shared Electronic Health Record (EHR) systems, which provide a health information exchange (HIE) within a community of care, were found to be a key enabler of informational continuity of diabetes mellitus (DM) care. Quantitative analyses of the actual contribution of Shared EHR systems to informational continuity of care are rare. The goal of this study was to quantitatively analyze (i) the degree of fragmentation of DM care in Austria as an indicator for the need for HIE, and (ii) the quantity of information (i.e. number of documents) from Austrian DM patients that would be made available by a nationwide Shared EHR system for HIE. METHODS Our analyses are based on social security claims data of 7.9 million Austrians from 2006 and 2007. DM patients were identified through medication data and inpatient diagnoses. The degree of fragmentation was determined by the number of different healthcare providers per patient. The amount of information that would be made available by a nationwide Shared EHR system was estimated by the number of documents that would have been available to a healthcare provider if he had access to information on the patient's visits to any of the other healthcare providers. As a reference value we determined the number of locally available documents that would have originated from the patient's visits to the healthcare provider himself. We performed our analysis for two types of systems: (i) a "comprehensive" Shared EHR system (SEHRS), where each visit of a patient results in a single document (progress note), and (ii) the Austrian ELGA system, which allows four specific document types to be shared. RESULTS 391,630 DM patients were identified, corresponding to 4.7% of the Austrian population. More than 90% of the patients received health services from more than one healthcare provider in one year. Both, the SEHRS as well as ELGA would have multiplied the available information during a patient visit in comparison to an isolated local EHR system; the median ratio of external to local medical documents was between 1:1 for a typical visit at a primary care provider (SEHRS as well as ELGA) and 39:1 (SEHRS) respectively 28:1 (ELGA) for a typical visit at a hospital. CONCLUSIONS Due to the high degree of care fragmentation, there is an obvious need for HIE for Austrian DM patients. Both, the SEHRS as well as ELGA could provide a substantial contribution to informational continuity of care in Austrian DM treatment. Hospitals and specialists would have gained the most amount of external information, primary care providers and pharmacies would have at least doubled their available information. Despite being the most important potential feeders of a national Shared EHR system according to our analysis, primary care providers will not tap their full corresponding potential under the current implementation scenario of ELGA.
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Affiliation(s)
- Christoph Rinner
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria
| | - Simone Katja Sauter
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria
| | - Gottfried Endel
- Main Association of Austrian Social Security Institutions, Kundmanngasse 21, A-1031 Vienna, Austria
| | - Georg Heinze
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria
| | - Stefan Thurner
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria; Santa Fe Institute, Santa Fe, NM 87501, USA; International Institute for Applied Systems Analysis, A-2361 Laxenburg, Austria
| | - Peter Klimek
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria
| | - Georg Duftschmid
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria.
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Strauss AT, Martinez DA, Garcia-Arce A, Taylor S, Mateja C, Fabri PJ, Zayas-Castro JL. A user needs assessment to inform health information exchange design and implementation. BMC Med Inform Decis Mak 2015; 15:81. [PMID: 26459258 PMCID: PMC4603345 DOI: 10.1186/s12911-015-0207-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 10/05/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Important barriers for widespread use of health information exchange (HIE) are usability and interface issues. However, most HIEs are implemented without performing a needs assessment with the end users, healthcare providers. We performed a user needs assessment for the process of obtaining clinical information from other health care organizations about a hospitalized patient and identified the types of information most valued for medical decision-making. METHODS Quantitative and qualitative analysis were used to evaluate the process to obtain and use outside clinical information (OI) using semi-structured interviews (16 internists), direct observation (750 h), and operational data from the electronic medical records (30,461 hospitalizations) of an internal medicine department in a public, teaching hospital in Tampa, Florida. RESULTS 13.7 % of hospitalizations generate at least one request for OI. On average, the process comprised 13 steps, 6 decisions points, and 4 different participants. Physicians estimate that the average time to receive OI is 18 h. Physicians perceived that OI received is not useful 33-66 % of the time because information received is irrelevant or not timely. Technical barriers to OI use included poor accessibility and ineffective information visualization. Common problems with the process were receiving extraneous notes and the need to re-request the information. Drivers for OI use were to trend lab or imaging abnormalities, understand medical history of critically ill or hospital-to-hospital transferred patients, and assess previous echocardiograms and bacterial cultures. About 85 % of the physicians believe HIE would have a positive effect on improving healthcare delivery. CONCLUSIONS Although hospitalists are challenged by a complex process to obtain OI, they recognize the value of specific information for enhancing medical decision-making. HIE systems are likely to have increased utilization and effectiveness if specific patient-level clinical information is delivered at the right time to the right users.
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Affiliation(s)
- Alexandra T Strauss
- Department of Internal Medicine, College of Medicine, University of South Florida, Tampa, FL, USA.
| | - Diego A Martinez
- Johns Hopkins Department of Emergency Medicine, Baltimore, MD, USA
| | - Andres Garcia-Arce
- Department of Industrial and Management Systems Engineering, College of Engineering, University of South Florida, Tampa, FL, USA
| | - Stephanie Taylor
- Department of Internal Medicine, Carolinas Medical Center, Charlotte, NC, USA
| | - Candice Mateja
- Department of Internal Medicine, College of Medicine, University of South Florida, Tampa, FL, USA
| | - Peter J Fabri
- Department of Surgery, College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jose L Zayas-Castro
- Department of Industrial and Management Systems Engineering, College of Engineering, University of South Florida, Tampa, FL, USA
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Kalankesh LR, Farahbakhsh M, Rahimi N. Data Content and Exchange in General Practice: a Review. Med Arch 2014; 68:414-418. [PMID: 25648317 PMCID: PMC4314165 DOI: 10.5455/medarh.2014.68.414-418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 12/01/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND efficient communication of data is inevitable requirement for general practice. Any issue in data content and its exchange among GP and other related entities hinders continuity of patient care. METHODS literature search for this review was conducted on three electronic databases including Medline, Scopus and Science Direct. RESULTS through reviewing papers, we extracted information on the GP data content, use cases of GP information exchange, its participants, tools and methods, incentives and barriers. CONCLUSION considering importance of data content and exchange for GP systems, it seems that more research is needed to be conducted toward providing a comprehensive framework for data content and exchange in GP systems.
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Affiliation(s)
- Leila R Kalankesh
- School of Management and Medical Informatics, Tabriz University of Medical Sciences
- School of Management and Medical Informatics, Tabriz Health Services Management Research Center
| | | | - Niloofar Rahimi
- School of Management and Medical Informatics, Tabriz University of Medical Sciences
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Campion TR, Vest JR, Ancker JS, Kaushal R. Patient encounters and care transitions in one community supported by automated query-based health information exchange. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2013; 2013:175-184. [PMID: 24551330 PMCID: PMC3900171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Care transitions from one facility to another threaten patient safety due to the potential loss of critical clinical information. Electronic clinical data exchange may address the problem. Approaches to exchange range from manual directed exchange, or sending point-to-point messages, to automated query-based health information exchange (HIE), or aggregating data from multiple sources. In this study, we measured the extent to which automated query-based HIE supported patient encounters and care transitions in one community. During the 23-month study period, 41% (n=33,219) of affirmatively consented patients had at least one encounter supported by automated query-based HIE. Of these patients, 41% (n=13,685) visited two or more facilities and accounted for 68% of total encounters. Of total encounters, 28% (n=40,828) were care transitions from one facility to another. Findings suggest that automated query-based HIE may support care transitions with efficient information sharing and assist United States providers in achieving stage two of meaningful use.
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Affiliation(s)
- Thomas R Campion
- Center for Healthcare Informatics and Policy, Weill Cornell Medical College, New York NY; ; Department of Public Health, Weill Cornell Medical College, New York NY; ; Department of Pediatrics, Weill Cornell Medical College, New York NY; ; Health Information Technology Evaluation Collaborative (HITEC), New York NY
| | - Joshua R Vest
- Center for Healthcare Informatics and Policy, Weill Cornell Medical College, New York NY; ; Department of Public Health, Weill Cornell Medical College, New York NY; ; Health Information Technology Evaluation Collaborative (HITEC), New York NY
| | - Jessica S Ancker
- Center for Healthcare Informatics and Policy, Weill Cornell Medical College, New York NY; ; Department of Public Health, Weill Cornell Medical College, New York NY; ; Department of Pediatrics, Weill Cornell Medical College, New York NY; ; Health Information Technology Evaluation Collaborative (HITEC), New York NY
| | - Rainu Kaushal
- Center for Healthcare Informatics and Policy, Weill Cornell Medical College, New York NY; ; Department of Public Health, Weill Cornell Medical College, New York NY; ; Department of Pediatrics, Weill Cornell Medical College, New York NY; ; Health Information Technology Evaluation Collaborative (HITEC), New York NY; ; Department of Medicine, Weill Cornell Medical College, New York NY; ; Komansky Center for Children's Health, NewYork-Presbyterian Hospital, New York NY
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Ross SE, Radcliff TA, LeBlanc WG, Dickinson LM, Libby AM, Nease DE. Effects of health information exchange adoption on ambulatory testing rates. J Am Med Inform Assoc 2013; 20:1137-42. [PMID: 23698257 PMCID: PMC3822119 DOI: 10.1136/amiajnl-2012-001608] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 04/22/2013] [Accepted: 04/27/2013] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine the effects of the adoption of ambulatory electronic health information exchange (HIE) on rates of laboratory and radiology testing and allowable charges. DESIGN Claims data from the dominant health plan in Mesa County, Colorado, from 1 April 2005 to 31 December 2010 were matched to HIE adoption data on the provider level. Using mixed effects regression models with the quarter as the unit of analysis, the effect of HIE adoption on testing rates and associated charges was assessed. RESULTS Claims submitted by 306 providers in 69 practices for 34 818 patients were analyzed. The rate of testing per provider was expressed as tests per 1000 patients per quarter. For primary care providers, the rate of laboratory testing increased over the time span (baseline 1041 tests/1000 patients/quarter, increasing by 13.9 each quarter) and shifted downward with HIE adoption (downward shift of 83, p<0.01). A similar effect was found for specialist providers (baseline 718 tests/1000 patients/quarter, increasing by 19.1 each quarter, with HIE adoption associated with a downward shift of 119, p<0.01). Even so, imputed charges for laboratory tests did not shift downward significantly in either provider group, possibly due to the skewed nature of these data. For radiology testing, HIE adoption was not associated with significant changes in rates or imputed charges in either provider group. CONCLUSIONS Ambulatory HIE adoption is unlikely to produce significant direct savings through reductions in rates of testing. The economic benefits of HIE may reside instead in other downstream outcomes of better informed, higher quality care.
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Affiliation(s)
- Stephen E Ross
- University of Colorado Division of General Internal Medicine, Aurora, Colorado,USA
| | - Tiffany A Radcliff
- Department of Health Policy and Management, Texas A&M School of Rural Public Health, College Station, Texas, USA
- Department of Family Medicine, University of Colorado, Aurora, Colorado, USA
| | - William G LeBlanc
- Department of Family Medicine, University of Colorado, Aurora, Colorado, USA
| | - L Miriam Dickinson
- Department of Family Medicine, University of Colorado, Aurora, Colorado, USA
| | - Anne M Libby
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado, USA
| | - Donald E Nease
- Department of Family Medicine, University of Colorado, Aurora, Colorado, USA
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Williams C, Mostashari F, Mertz K, Hogin E, Atwal P. From the Office of the National Coordinator: the strategy for advancing the exchange of health information. Health Aff (Millwood) 2012; 31:527-36. [PMID: 22392663 DOI: 10.1377/hlthaff.2011.1314] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Electronic health information exchange addresses a critical need in the US health care system to have information follow patients to support patient care. Today little information is shared electronically, leaving doctors without the information they need to provide the best care. With payment reforms providing a strong business driver, the demand for health information exchange is poised to grow. The Office of the National Coordinator for Health Information Technology, Department of Health and Human Services, has led the process of establishing the essential building blocks that will support health information exchange. Over the coming year, this office will develop additional policies and standards that will make information exchange easier and cheaper and facilitate its use on a broader scale.
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Affiliation(s)
- Claudia Williams
- State Health Information Exchange Program at the Office of the National Coordinator for Health Information Technology (ONC), Department of Health and Human Services, Washington, DC, USA.
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Rudin RS, Schneider EC, Volk LA, Szolovits P, Salzberg CA, Simon SR, Bates DW. Simulation Suggests That Medical Group Mergers Won’t Undermine The Potential Utility Of Health Information Exchanges. Health Aff (Millwood) 2012; 31:548-59. [DOI: 10.1377/hlthaff.2011.0799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Robert S. Rudin
- Robert S. Rudin ( ) is an associate policy researcher at the RAND Corporation in Boston, Massachusetts
| | - Eric C. Schneider
- Eric C. Schneider is a senior scientist and director of the RAND Corporation’s Boston office
| | - Lynn A. Volk
- Lynn A. Volk is associate director of the Clinical and Quality Analysis Department in Partners HealthCare’s Information Services, in Boston
| | - Peter Szolovits
- Peter Szolovits is a professor of computer science and engineering at the Massachusetts Institute of Technology, in Cambridge, Massachusetts
| | - Claudia A. Salzberg
- Claudia A. Salzberg is a doctoral student in health policy and management at the Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
| | - Steven R. Simon
- Steven R. Simon is chief of general internal medicine at the Veterans Affairs Boston Healthcare System and an associate professor at both Harvard Medical School and Brigham and Women’s Hospital, in Boston
| | - David W. Bates
- David W. Bates is chief quality officer and chief of general internal medicine at Brigham and Women’s Hospital and a professor at Harvard Medical School
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