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Born C, Schwarz R, Böttcher TP, Hein A, Krcmar H. The role of information systems in emergency department decision-making-a literature review. J Am Med Inform Assoc 2024; 31:1608-1621. [PMID: 38781289 PMCID: PMC11187435 DOI: 10.1093/jamia/ocae096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES Healthcare providers employ heuristic and analytical decision-making to navigate the high-stakes environment of the emergency department (ED). Despite the increasing integration of information systems (ISs), research on their efficacy is conflicting. Drawing on related fields, we investigate how timing and mode of delivery influence IS effectiveness. Our objective is to reconcile previous contradictory findings, shedding light on optimal IS design in the ED. MATERIALS AND METHODS We conducted a systematic review following PRISMA across PubMed, Scopus, and Web of Science. We coded the ISs' timing as heuristic or analytical, their mode of delivery as active for automatic alerts and passive when requiring user-initiated information retrieval, and their effect on process, economic, and clinical outcomes. RESULTS Our analysis included 83 studies. During early heuristic decision-making, most active interventions were ineffective, while passive interventions generally improved outcomes. In the analytical phase, the effects were reversed. Passive interventions that facilitate information extraction consistently improved outcomes. DISCUSSION Our findings suggest that the effectiveness of active interventions negatively correlates with the amount of information received during delivery. During early heuristic decision-making, when information overload is high, physicians are unresponsive to alerts and proactively consult passive resources. In the later analytical phases, physicians show increased receptivity to alerts due to decreased diagnostic uncertainty and information quantity. Interventions that limit information lead to positive outcomes, supporting our interpretation. CONCLUSION We synthesize our findings into an integrated model that reveals the underlying reasons for conflicting findings from previous reviews and can guide practitioners in designing ISs in the ED.
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Affiliation(s)
- Cornelius Born
- School of Computation, Information and Technology, Technical University of Munich, 85748 Garching bei München, Germany
| | - Romy Schwarz
- School of Computation, Information and Technology, Technical University of Munich, 85748 Garching bei München, Germany
| | - Timo Phillip Böttcher
- School of Computation, Information and Technology, Technical University of Munich, 85748 Garching bei München, Germany
| | - Andreas Hein
- Institute of Information Systems and Digital Business, University of St. Gallen, 9000 St. Gallen, Switzerland
| | - Helmut Krcmar
- School of Computation, Information and Technology, Technical University of Munich, 85748 Garching bei München, Germany
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Schwartz CI, Farag A, Lopez KD, Moorhead S, Monsen KA. Using Omaha System data to explore relationships between client outcomes, phenotypes, and targeted home intervention approaches: an exemplar examining practice effectiveness for older women with circulation problems. J Am Med Inform Assoc 2023; 30:1773-1783. [PMID: 37335871 PMCID: PMC10586038 DOI: 10.1093/jamia/ocad106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/05/2023] [Accepted: 06/07/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Improved health among older women remains elusive and may be linked to limited knowledge of and interventions targeted to population subgroups. Use of structured community nurse home visit data exploring relationships between client outcomes, phenotypes, and targeted intervention approaches may reveal new understandings of practice effectiveness. MATERIALS AND METHODS Omaha System data of 2363 women 65 years and older with circulation problems receiving at least 2 community nurse home visits were accessed. Previously identified phenotypes (Poor circulation; Irregular heart rate; and Limited symptoms), 7 intervention approaches (High-Surveillance; High-Teaching/Guidance/Counseling; Balanced-All; Balanced-Surveillance-Teaching/Guidance/Counseling; Low-Teaching/Guidance/Counseling-Balanced Other; Low-Surveillance-Mostly-Teaching/Guidance/Couseling-TreatmentProcedure-CaseManagement; and Mostly-TreatementProcedure+CaseManagement), and client knowledge, behavior, and status outcomes were used. Client-linked intervention approach counts, proportional use per phenotypes, and associations with client outcome scores were descriptively analyzed. Associations between intervention approach proportional use by phenotype and outcome scores were analyzed using parallel coordinate graph methodology for intervention approach effectiveness. RESULTS Percent use of intervention approach differed significantly by phenotype. The 2 most widely employed intervention approaches were characterized by either a high use of surveillance interventions or a balanced use of all intervention categories (surveillance, teaching/guidance/counseling, treatment-procedure, case-management). Mean outcome discharge and change scores significantly differed by intervention approach. Proportionally deployed intervention approach patterns by phenotype were associated with outcome small effects improvement. DISCUSSIONS AND CONCLUSIONS The Omaha System taxonomy supported the management and exploration of large multidimensional community nursing data of older women with circulation problems. This study offers a new way to examine intervention effectiveness using phenotype- and targeted intervention approach-informed structured data.
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Affiliation(s)
| | | | | | | | - Karen A Monsen
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
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Ben‐Assuli O, Arazy O, Kumar N, Shabtai I. Too much information? The use of extraneous information to support decision‐making in emergency settings. DECISION SCIENCES 2022. [DOI: 10.1111/deci.12585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ofir Ben‐Assuli
- Information System Department, Faculty of Business Administration, Ono Academic College Kiryat Ono Israel
| | - Ofer Arazy
- Department of Information Systems, University of Haifa Haifa Israel
| | - Nanda Kumar
- Computer Information Systems Department, Zicklin School of Business, Baruch College City University of New York New York City New York
| | - Itamar Shabtai
- School of Economics, College of Management Academic Studies Rishon Lezion Israel
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Holmgren AJ, Everson J, Adler-Milstein J. Association of Hospital Interoperable Data Sharing With Alternative Payment Model Participation. JAMA HEALTH FORUM 2022; 3:e215199. [PMID: 35977275 PMCID: PMC8903122 DOI: 10.1001/jamahealthforum.2021.5199] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/20/2021] [Indexed: 01/28/2023] Open
Abstract
Importance Interoperable patient data exchange across hospitals remains an important policy goal for reducing costs and improving the quality of care. Congress designated 2018 as the goal for nationwide interoperability, and policy makers hoped that aligning financial incentives via alternative payment models (APMs) would help achieve that goal. Objective To measure interoperability progress since 2014, assess the association between alternative payment model participation and hospital engagement in interoperable data sharing from 2014 to 2018, and evaluate hospital-reported barriers to interoperability in 2018. Design Setting and Participants This cohort study included nonfederal acute care hospitals in the US from January 2014 to December 2018 that responded to the American Hospital Association Annual Survey. Data were analyzed from October 2019 through March 2021. Exposures Participation in an APM, including accountable care organizations, bundled payments, or patient-centered medical homes. Main Outcomes and Measures Hospital engagement in all 4 domains of interoperability: finding/querying for data, sending data electronically, receiving data electronically, and integrating electronic patient data from external care delivery organizations. Results The sample included 3928 hospitals in the US from January 2014 to December 2018. Progress across interoperability domains was uneven, 2430 (88.3%) hospitals sending and 2115 (76.9%) receiving patient data electronically in 2018. However, only 1249 (45.4%) hospitals engaged in all 4 domains of interoperability in 2018, and growth between 2014 and 2018 was slow. There was no evidence that participation in APMs was associated with interoperability, with multivariate models suggesting that participation in an APM was associated with only a non-statistically significant 1-percentage point increase in interoperability engagement (β = 0.01; 95% CI, -0.01 to 0.03). The most commonly cited barrier to interoperability was challenges associated with sharing data across different electronic health record vendors. Conclusions and Relevance In this cohort study of hospital interoperability, fewer than half of US hospitals were engaged in interoperable data exchange in 2018. There was no observable evidence that hospital APM participation was associated with interoperability engagement. Many hospitals report technical and governance challenges to data sharing that are unlikely to be addressed by the alignment of financial incentives alone.
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Affiliation(s)
| | - Jordan Everson
- Vanderbilt University Medical Center, Nashville, Tennessee
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Mullins AK, Morris H, Enticott J, Ben-Meir M, Rankin D, Mantripragada K, Skouteris H. Use of My Health Record by Clinicians in the Emergency Department: An Analysis of Log Data. Front Digit Health 2021; 3:725300. [PMID: 34713198 PMCID: PMC8521888 DOI: 10.3389/fdgth.2021.725300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/26/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Leverage log data to explore access to My Health Record (MHR), the national electronic health record of Australia, by clinicians in the emergency department. Materials and Methods: A retrospective analysis was conducted using secondary routinely-collected data. Log data pertaining to all patients who presented to the emergency department between 2019 and 2021 of a not-for-profit hospital (that annually observes 23,000 emergency department presentations) were included in this research. Attendance data and human resources data were linked with MHR log data. The primary outcome was a dichotomous variable that indicated whether the MHR of a patient was accessed. Logistic regression facilitated the exploration of factors (user role, day of the week, and month) associated with access. Results: My Health Record was accessed by a pharmacist, doctor, or nurse in 19.60% (n = 9,262) of all emergency department presentations. Access was dominated by pharmacists (18.31%, n = 8,656). All users demonstrated a small, yet significant, increase in access every month (odds ratio = 1.07, 95% Confidence interval: 1.06-1.07, p ≤ 0.001). Discussion: Doctors, pharmacists, and nurses are increasingly accessing MHR. Based on this research, substantially more pharmacists appear to be accessing MHR, compared to other user groups. However, only one in every five patients who present to the emergency department have their MHR accessed, thereby indicating a need to accelerate and encourage the adoption and access of MHR by clinicians.
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Affiliation(s)
- Alexandra K Mullins
- Health and Social Care Unit, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Heather Morris
- Health and Social Care Unit, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Joanne Enticott
- Health and Social Care Unit, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | | | | | | | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia.,Warwick Business School, University of Warwick, Coventry, United Kingdom
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Vijayaraghavan M, Genes N, Darrow BJ, Rucker DW. The 21st Century Cures Act and Emergency Medicine - Part 2: Facilitating Interoperability. Ann Emerg Med 2021; 79:13-17. [PMID: 34607740 DOI: 10.1016/j.annemergmed.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Mahima Vijayaraghavan
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Information Technology, Mount Sinai Health System, New York, NY
| | - Nicholas Genes
- Information Technology, Mount Sinai Health System, New York, NY; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Bruce J Darrow
- Information Technology, Mount Sinai Health System, New York, NY; Cardiovascular Institute, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Donald W Rucker
- Department of Emergency Medicine, Ohio State University, Columbus, OH
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Johnson KB, Neuss MJ, Detmer DE. Electronic health records and clinician burnout: A story of three eras. J Am Med Inform Assoc 2021; 28:967-973. [PMID: 33367815 DOI: 10.1093/jamia/ocaa274] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/16/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The study sought to provide physicians, informaticians, and institutional policymakers with an introductory tutorial about the history of medical documentation, sources of clinician burnout, and opportunities to improve electronic health records (EHRs). We now have unprecedented opportunities in health care, with the promise of new cures, improved equity, greater sensitivity to social and behavioral determinants of health, and data-driven precision medicine all on the horizon. EHRs have succeeded in making many aspects of care safer and more reliable. Unfortunately, current limitations in EHR usability and problems with clinician burnout distract from these successes. A complex interplay of technology, policy, and healthcare delivery has contributed to our current frustrations with EHRs. Fortunately, there are opportunities to improve the EHR and health system. A stronger emphasis on improving the clinician's experience through close collaboration by informaticians, clinicians, and vendors can combine with specific policy changes to address the causes of burnout. TARGET AUDIENCE This tutorial is intended for clinicians, informaticians, policymakers, and regulators, who are essential participants in discussions focused on improving clinician burnout. Learners in biomedicine, regardless of clinical discipline, also may benefit from this primer and review. SCOPE We include (1) an overview of medical documentation from a historical perspective; (2) a summary of the forces converging over the past 20 years to develop and disseminate the modern EHR; and (3) future opportunities to improve EHR structure, function, user base, and time required to collect and extract information.
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Affiliation(s)
- Kevin B Johnson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael J Neuss
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Don Eugene Detmer
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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Chartash D, Sharifi M, Emerson B, Frank R, Schoenfeld EM, Tanner J, Brandt C, Taylor RA. Documentation of Shared Decisionmaking in the Emergency Department. Ann Emerg Med 2021; 78:637-649. [PMID: 34340873 DOI: 10.1016/j.annemergmed.2021.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE While patient-centered communication and shared decisionmaking are increasingly recognized as vital aspects of clinical practice, little is known about their characteristics in real-world emergency department (ED) settings. We constructed a natural language processing tool to identify patient-centered communication as documented in ED notes and to describe visit-level, site-level, and temporal patterns within a large health system. METHODS This was a 2-part study involving (1) the development and validation of an natural language processing tool using regular expressions to identify shared decisionmaking and (2) a retrospective analysis using mixed effects logistic regression and trend analysis of shared decisionmaking and general patient discussion using the natural language processing tool to assess ED physician and advanced practice provider notes from 2013 to 2020. RESULTS Compared to chart review of 600 ED notes, the accuracy rates of the natural language processing tool for identification of shared decisionmaking and general patient discussion were 96.7% (95% CI 94.9% to 97.9%) and 88.9% (95% confidence interval [CI] 86.1% to 91.3%), respectively. The natural language processing tool identified shared decisionmaking in 58,246 (2.2%) and general patient discussion in 590,933 (22%) notes. From 2013 to 2020, natural language processing-detected shared decisionmaking increased 300% and general patient discussion increased 50%. We observed higher odds of shared decisionmaking documentation among physicians versus advanced practice providers (odds ratio [OR] 1.14, 95% CI 1.07 to 1.23) and among female versus male patients (OR 1.13, 95% CI 1.11 to 1.15). Black patients had lower odds of shared decisionmaking (OR 0.8, 95% CI 0.84 to 0.88) compared with White patients. Shared decisionmaking and general patient discussion were also associated with higher levels of triage and commercial insurance status. CONCLUSION In this study, we developed and validated an natural language processing tool using regular expressions to extract shared decisionmaking from ED notes and found multiple potential factors contributing to variation, including social, demographic, temporal, and presentation characteristics.
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Affiliation(s)
- David Chartash
- Center for Medical Informatics, Yale University School of Medicine, New Haven, CT
| | - Mona Sharifi
- Center for Medical Informatics, Yale University School of Medicine, New Haven, CT; Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Beth Emerson
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Robert Frank
- Department of Linguistics, Yale University, New Haven, CT
| | - Elizabeth M Schoenfeld
- Department of Emergency Medicine, University of Massachusetts Medical School - Baystate Institute for Healthcare Delivery and Population Science, Springfield, MS
| | - Jason Tanner
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Cynthia Brandt
- Center for Medical Informatics, Yale University School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Richard A Taylor
- Center for Medical Informatics, Yale University School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
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Adler-Milstein J, Wang MD. The impact of transitioning from availability of outside records within electronic health records to integration of local and outside records within electronic health records. J Am Med Inform Assoc 2021; 27:606-612. [PMID: 32134449 DOI: 10.1093/jamia/ocaa006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/12/2019] [Accepted: 01/13/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE While there has been a substantial increase in health information exchange, levels of outside records use by frontline providers are low. We assessed whether integration between outside data and local data results in increased viewing of outside records, overall and by encounter, provider, and patient type. MATERIALS AND METHODS Using data from UCSF Health, we measured change in outside record views after integrating the list of local (UCSF) and outside (other health systems on Epic [Epic Systems, Verona, WI]) encounters on the Chart Review tab. Previously, providers only viewed records from outside encounters on a separate tab. We used an interrupted time series design (with outside record viewing event counts aggregated to the week level) to measure changes in the level and trend over a 1-year period. RESULTS There was a large increase in the level of outside record views of 22 920 per week (P < .001). The change in trend went from a weekly increase of 116 (P < .05) to a decrease of 402 (P = .08), reflecting a small effect decay. There were increases in the level of views for all provider and encounter types: attendings (n = 3675), residents (n = 3277), and nurses (n = 914); and inpatient (n = 1676), emergency (n = 487), and outpatient (n = 7228) (P < .001 for all). Results persisted when adjusted for total encounter volume. DISCUSSION While outside records were readily available before the encounter integration, the simple step of clicking on a separate tab appears to have depressed use. CONCLUSIONS User interface designs that comingle local and outside data result in higher levels of viewing and should be more broadly pursued.
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Affiliation(s)
- Julia Adler-Milstein
- Center for Clinical Informatics and Improvement Research, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Michael D Wang
- Center for Clinical Informatics and Improvement Research, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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Park YT, Kim YS, Heo YJ, Lee JH, Chang H. Association of the Magnitude of Nurses With the Use of Health Information Exchanges: Analyzing the National Health Insurance Claim Data of Hospitals and Clinics in Korea. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211060788. [PMID: 34865552 PMCID: PMC8649911 DOI: 10.1177/00469580211060788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Many features of health care organizations (HCOs) have been identified to be associated with health information exchange (HIE), but subcategories of organizational factors focusing on nurse workforces still need to be identified. The objective of this study is to investigate the association of number of nurses with HIE use in Korea. METHODS This study had a retrospective study design and used health insurance claim data from June 1, 2016 to June 30, 2018. The unit of analysis was the HCO, and any health insurance claims having HIE were counted by HCO. There were a total of 1490 HCOs having any HIE and 24 026 HCOs not having HIE. For statistical analysis, two-part model was used: logistic regression for HIE participation and the generalized linear model for the volume of HIE use. RESULTS HIE was used by 44.6% of general hospitals, and 8.6% and 5.3% of small hospitals and clinics, respectively. Both HIE use and its volume were significantly positively associated with nurse variables. The use of HIE was significantly positively associated with nurse-to-bed ratio in general hospitals (OR 1.028; 1.016 to 1.041) and in small hospitals (OR 1.021; 1.016 to 1.027), and with the number of nurses (OR 1.041; 1.028 to 1.054) in clinics (P<.001). The volume of HIE use was also positively associated with nurse-to-bed ratio in general hospitals (OR 1.010; 1.004 to 1.017) and in small hospitals (OR 1.014; 1.006 to 1.022), and with the number of nurses (OR 1.055; 1.037 to 1.073) in clinics (P<.01). CONCLUSION This study found that there was a low rate of HIE use in small hospitals and clinics. The number of nurses was critically associated with the use of HIE and the volume of HIE claims. HIE policy makers need to be aware of this factor in seeking to accelerate HIE.
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Affiliation(s)
- Young-Taek Park
- HIRA Research Institute, Health Insurance Review and Assessment Service (HIRA), Wonju, Korea
- Department of Medical Humanities & Social Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Yeon Sook Kim
- Department of Nursing, California State University, San Bernardino, CA, USA
| | - Yun-Jung Heo
- Department of Medical Humanities & Social Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Jae-Ho Lee
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyejung Chang
- School of Management, Kyung Hee University, Seoul, Korea
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Politi L, Codish S, Sagy I, Fink L. Substitution and complementarity in the use of health information exchange and electronic medical records. EUR J INFORM SYST 2020. [DOI: 10.1080/0960085x.2020.1850185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Liran Politi
- Department of Industrial Engineering & Management, Ben-Gurion University of the Negev , Beer Sheva, Israel
| | - Shlomi Codish
- Clinical Research Center, Soroka University Medical Center , Beer Sheva, Israel
| | - Iftach Sagy
- Clinical Research Center, Soroka University Medical Center , Beer Sheva, Israel
| | - Lior Fink
- Department of Industrial Engineering & Management, Ben-Gurion University of the Negev , Beer Sheva, Israel
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Bowden T, Lyell D, Coiera E. Emergency care access to primary care records: an observational study. BMJ Health Care Inform 2020; 27:bmjhci-2020-100153. [PMID: 32830108 PMCID: PMC7445344 DOI: 10.1136/bmjhci-2020-100153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/18/2020] [Accepted: 07/08/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To measure lookup rates of externally held primary care records accessed in emergency care and identify patient characteristics, conditions and potential consequences associated with access. MEASURES Rates of primary care record access and re-presentation to the emergency department (ED) within 30 days and hospital admission. DESIGN A retrospective observational study of 77 181 ED presentations over 4 years and 9 months, analysing 8184 index presentations in which patients' primary care records were accessed from the ED. Data were compared with 17 449 randomly selected index control presentations. Analysis included propensity score matching for age and triage categories. RESULTS 6.3% of overall ED presentations triggered a lookup (rising to 8.3% in year 5); 83.1% of patients were only looked up once and 16.9% of patients looked up on multiple occasions. Lookup patients were on average 25 years older (z=-9.180, p<0.001, r=0.43). Patients with more urgent triage classifications had their records accessed more frequently (z=-36.47, p<0.001, r=0.23). Record access was associated with a significant but negligible increase in hospital admission (χ2 (1, n=13 120)=98.385, p<0.001, phi=0.087) and readmission within 30 days (χ2 (1, n=13 120)=86.288, p<0.001, phi=0.081). DISCUSSION Emergency care clinicians access primary care records more frequently for older patients or those in higher triage categories. Increased levels of inpatient admission and re-presentation within 30 days are likely linked to age and triage categories. CONCLUSION Further studies should focus on the impact of record access on clinical and process outcomes and which record elements have the most utility to shape clinical decisions.
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Affiliation(s)
- Thomas Bowden
- HREC, Macquarie University, Sydney, New South Wales, Australia
| | - David Lyell
- HREC, Macquarie University, Sydney, New South Wales, Australia
| | - Enrico Coiera
- HREC, Macquarie University, Sydney, New South Wales, Australia
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Information resource orchestration during the COVID-19 pandemic: A study of community lockdowns in China. INTERNATIONAL JOURNAL OF INFORMATION MANAGEMENT 2020; 54:102143. [PMID: 32394997 PMCID: PMC7211621 DOI: 10.1016/j.ijinfomgt.2020.102143] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 11/29/2022]
Abstract
The outbreak of the COVID-19 pandemic has created significant challenges for people worldwide. To combat the virus, one of the most dramatic measures was the lockdown of 4 billion people in what is believed to be the largest quasi-quarantine in human history. As a response to the call to study information behavior during a global health crisis, we adopted a resource orchestration perspective to investigate six Chinese families who survived the lockdown. We explored how elderly, young and middle-aged individuals and children resourced information and how they adapted their information behavior to emerging online technologies. Two information resource orchestration practices (information resourcing activities and information behavior adaptation activities) and three mechanisms (online emergence and convergence in community resilience, the overcoming of information flow impediments, and the application of absorptive capacity) were identified in the study.
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Azar KMJ, Petersen JP, Shen Z, Nasrallah C, Pesa J, LaMori J, Pressman A. Serious Mental Illness and Health-Related Factors Associated with Regional Emergency Department Utilization. Popul Health Manag 2019; 23:430-437. [PMID: 31816257 DOI: 10.1089/pop.2019.0161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Frequent emergency department (ED) utilization is an indicator of unmet health and social needs, especially among patients with mental and physical health problems. The authors aimed to characterize frequent ED utilizers and drivers of multiple ED use, including presence of serious mental illness (SMI), across 2 large health care systems in Northern California. Using electronic health records and a data-sharing platform, a cross-sectional analysis was conducted of patients aged 18+ years with ≥10 ED visits in 2016. Logistic regression was used to determine factors associated with multiple ED use versus single ED use. Among the 8036 patients who met inclusion criteria, the mean age was 55.9 years (95% CI = 55.5-56.4), 53% were female, 54% were non-Hispanic white, and 38% had any SMI. Overall, 51% of patients were single ED utilizers. Patients ages ≥65 years were less likely to use multiple EDs compared to younger patients (ages 18-23) (OR = 0.3, 95% CI = 0.2-0.4). African Americans exhibited more than 3 times the likelihood of multi-ED use compared to non-Hispanic whites (OR = 3.8, 95% CI = 3.3-4.3). A diagnosis of any SMI (OR = 2.3 [95% CI: 2.1-2.6]), major depressive disorder (OR = 1.3, 95% CI = 1.1-1.4), schizophrenia (OR = 2.1, 95% CI = 1.6-2.6), or suicidal attempts/ideation (OR = 2.7, 95% CI = 2.1-3.6) was significantly associated with increased likelihood of multi-ED use. Findings indicate heterogeneity in regional utilization patterns among frequent ED utilizers, with mental illness increasing the likelihood of multi-ED use.
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Affiliation(s)
- Kristen M J Azar
- Sutter Health, Research Development, and Dissemination, Walnut Creek, California, USA
| | - John P Petersen
- Sutter Health, Palo Alto Medical Foundation, Palo Alto, California, USA
| | - Zijun Shen
- Sutter Health, Research Development, and Dissemination, Walnut Creek, California, USA
| | | | - Jacqueline Pesa
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | - Joyce LaMori
- Janssen Scientific Affairs, LLC, Titusville, New Jersey, USA
| | - Alice Pressman
- Sutter Health, Research Development, and Dissemination, Walnut Creek, California, USA
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15
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Graham TA, Ballermann M, Lang E, Bullard MJ, Parsons D, Mercuur G, San Agustin P, Ali S. Emergency Physician Use of the Alberta Netcare Portal, a Province-Wide Interoperable Electronic Health Record: Multi-Method Observational Study. JMIR Med Inform 2018; 6:e10184. [PMID: 30274967 PMCID: PMC6231720 DOI: 10.2196/10184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 11/21/2022] Open
Abstract
Background The adoption and use of an electronic health record (EHR) can facilitate real-time access to key health information and support improved outcomes. Many Canadian provinces use interoperable EHRs (iEHRs) to facilitate health information exchange, but the clinical use and utility of iEHRs has not been well described. Objective The aim of this study was to describe the use of a provincial iEHR known as the Alberta Netcare Portal (ANP) in 4 urban Alberta emergency departments. The secondary objectives were to characterize the time spent using the respective electronic tools and identify the aspects that were perceived as most useful by emergency department physicians. Methods In this study, we have included 4 emergency departments, 2 using paper-based ordering (University of Alberta Hospital [UAH] and Grey Nuns Community Hospital [GNCH]) and 2 using a commercial vendor clinical information system (Peter Lougheed Centre [PLC] and Foothills Medical Centre [FMC]). Structured clinical observations of ANP use and system audit logs analysis were compared at the 4 sites from October 2014 to March 2016. Results Observers followed 142 physicians for a total of 566 hours over 376 occasions. The median percentage of observed time spent using ANP was 8.5% at UAH (interquartile range, IQR, 3.7%-13.3%), 4.4% at GNCH (IQR 2.4%-4.4%), 4.6% at FMC (IQR 2.4%-7.6%), and 5.1% at PLC (IQR 3.0%-7.7%). By combining administrative and access audit data, the median number of ANP screens (ie, results and reports displayed on a screen) accessed per patient visit were 20 at UAH (IQR 6-67), 9 at GNCH (IQR 4-29), 7 at FMC (IQR 2-18), and 5 at PLC (IQR 2-14). When compared with the structured clinical observations, the statistical analysis of screen access data showed that ANP was used more at UAH than the other sites. Conclusions This study shows that the iEHR is well utilized at the 4 sites studied, and the usage patterns implied clinical value. Use of the ANP was highest in a paper-based academic center and lower in the centers using a commercial emergency department clinical information system. More study about the clinical impacts of using iEHRs in the Canadian context including longer term impacts on quality of practice and safety are required.
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Affiliation(s)
- Timothy Ad Graham
- Alberta Health Services, Edmonton, AB, Canada.,Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Mark Ballermann
- Alberta Health Services, Edmonton, AB, Canada.,Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael J Bullard
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Denise Parsons
- Department of Paediatrics, University of Alberta, Edmonton, AB, Canada
| | - Gabriella Mercuur
- Department of Paediatrics, University of Alberta, Edmonton, AB, Canada
| | - Pat San Agustin
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Samina Ali
- Department of Paediatrics, University of Alberta, Edmonton, AB, Canada
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16
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The Nationwide Health Information Network: The Case of the Expansion of Health Information Exchanges in the United States. Health Care Manag (Frederick) 2018; 37:333-338. [PMID: 30234636 DOI: 10.1097/hcm.0000000000000231] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Nationwide Health Information Network (NHIN) implemented secure exchange of health records through utilization of the Internet. The NHIN has greatly assisted in achieving the goals of the Health Information Technology for Economic and Clinical Health Act by promoting the adoption of Meaningful Use. Epic introduced a Health Information Exchange platform, Care Everywhere, which has facilitated Health Information Exchange availability. The purpose of this research was to determine the impact of NHIN and Epic Care's Care Everywhere on health care to determine whether their use in the emergency department (ED) has increased. The methodology for this study utilized a literature review. Twenty-eight sources were referenced for this study. With the NHIN implementation, repeated visits were decreased, visit times became faster, and charges were lower. Emergency department reported significant benefits with sharing clinical information. The NHIN implementation throughout the ED has increased the quality of health care; duplicated tests and drug usage were determined, and a reduction of the ED length of stay was also achieved.
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17
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Walker DM. Does participation in health information exchange improve hospital efficiency? Health Care Manag Sci 2018; 21:426-438. [PMID: 28236178 PMCID: PMC5568978 DOI: 10.1007/s10729-017-9396-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 02/13/2017] [Indexed: 10/20/2022]
Abstract
The federal government allocated nearly $30 billion to spur the development of information technology infrastructure capable of supporting the exchange of interoperable clinical data, leading to growth in hospital participation in health information exchange (HIE) networks. HIEs have the potential to improve care coordination across healthcare providers, leading ultimately to increased productivity of health services for hospitals. However, the impact of HIE participation on hospital efficiency remains unclear. This dynamic prompts the question asked by this study: does HIE participation improve hospital efficiency. This study estimates the effect of HIE participation on efficiency using a national sample of 1017 hospitals from 2009 to 2012. Using a two-stage analytic design, efficiency indices were determined using the Malmquist algorithm and then regressed on a set of hospital characteristics. Results suggest that any participation in HIE can improve both technical efficiency change and total factor productivity (TFP). A second model examining total years of HIE participation shows a benefit of one and three years of participation on TFP. These results suggest that hospital investment in HIE participation may be a useful strategy to improve hospital operational performance, and that policy should continue to support increased participation and use of HIE. More research is needed to identify the exact mechanisms through which HIE participation can improve hospital efficiency.
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Affiliation(s)
- Daniel M Walker
- The Ohio State University, College of Medicine, 2231 North High St., Rm, Columbus, OH, 266, USA.
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18
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Holmgren AJ, Patel V, Adler-Milstein J. Progress In Interoperability: Measuring US Hospitals' Engagement In Sharing Patient Data. Health Aff (Millwood) 2018; 36:1820-1827. [PMID: 28971929 DOI: 10.1377/hlthaff.2017.0546] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Achieving an interoperable health care system remains a top US policy priority. Despite substantial efforts to encourage interoperability, the first set of national data in 2014 suggested that hospitals' engagement levels were low. With 2015 data now available, we examined the first national trends in engagement in four domains of interoperability: finding, sending, receiving, and integrating electronic patient information from outside providers. We found small gains, with 29.7 percent of hospitals engaging in all four domains in 2015 compared to 24.5 percent in 2014. The two domains with the most progress were sending (with an increase of 8.1 percentage points) and receiving (an increase of 8.4 percentage points) information, while there was no change in integrating systems. Hospitals' use for patient care of data from outside providers was low, with only 18.7 percent of hospitals reporting that they "often" used these data. Our results reveal that hospitals' progress toward interoperability is slow and that progress is focused on moving information between hospitals, not on ensuring usability of information in clinical decisions.
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Affiliation(s)
- A Jay Holmgren
- A Jay Holmgren is a doctoral student in Health Policy (Management) at Harvard Business School, in Boston, Massachusetts
| | - Vaishali Patel
- Vaishali Patel is a senior advisor in the Office of Planning, Evaluation, and Analysis, Office of the National Coordinator for Health Information Technology, Department of Health and Human Services, in Washington, D.C
| | - Julia Adler-Milstein
- Julia Adler-Milstein is an associate professor of medicine in the School of Medicine, University of California, San Francisco
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19
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Sadoughi F, Nasiri S, Ahmadi H. The impact of health information exchange on healthcare quality and cost-effectiveness: A systematic literature review. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 161:209-232. [PMID: 29852963 DOI: 10.1016/j.cmpb.2018.04.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/07/2018] [Accepted: 04/26/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Health Information Exchange (HIE) is known as a technology that electronically shares all clinical and administrative data throughout healthcare settings. Despite this technology has a great potential in the healthcare industry, there is a limited and sparse evidence of articles which illustrated the impact of HIE on quality of care and cost-effectiveness. This work presents a systematic review that evaluates the impact of HIE on quality and cost-effectiveness, and the rates of HIE adoption and participation in healthcare organizations. METHODS We systematically searched all English papers that were indexed in four major databases (Science Direct, PubMed, IEEE and Web of Science) between 2005 and 2016. Consequently, 32 identified papers appeared in 21 international journals and conferences. Eligible studies independently were critically appraised, collected within data extraction form and then thematically analyzed by two reviewers and if necessary, the third author. The selected papers have been classified based on 11 main categories including publication year, journal and conference names, country and study design, types of data exchanged, healthcare levels, disease or disorder, participants in organizations and individuals, settings characteristics and HIE types, the impact of HIE on quality and cost-effectiveness, and the rates of HIE adoption and participation. RESULTS Of the 32 articles, 25 studies investigated the financial and clinical impact of HIE. Overwhelmingly, HIE studies have reported positive findings for quality and cost-effectiveness of care. 15 of HIE studies (60%) demonstrated positive financial effects and 16 studies (64%) reported positive effects on quality improvement of patient care. However, the overall quality of the evidences was low. In this regard, cohort study (59.38%) was the most common used study design. Nine studies presented the rates of HIE adoption and participation. The lowest and highest participation rates were 15.7% and 79%, respectively. CONCLUSIONS HIE can be considered as a superior potential for healthcare information system, resulting to promote patient care quality and reduce costs related to resource utilization. However, further researches are needed in order to provide a better understanding of this domain and accordingly attain new opportunities to increase users' participation and motivation for successfully adopting this technology.
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Affiliation(s)
- Farahnaz Sadoughi
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Somayeh Nasiri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Hossein Ahmadi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
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20
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Motulsky A, Weir DL, Couture I, Sicotte C, Gagnon MP, Buckeridge DL, Tamblyn R. Usage and accuracy of medication data from nationwide health information exchange in Quebec, Canada. J Am Med Inform Assoc 2018; 25:722-729. [PMID: 29590350 DOI: 10.1093/jamia/ocy015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/02/2018] [Indexed: 11/14/2022] Open
Abstract
Objective (1) To describe the usage of medication data from the Health Information Exchange (HIE) at the health care system level in the province of Quebec; (2) To assess the accuracy of the medication list obtained from the HIE. Methods A descriptive study was conducted utilizing usage data obtained from the Ministry of Health at the individual provider level from January 1 to December 31, 2015. Usage patterns by role, type of site, and tool used to access the HIE were investigated. The list of medications of 111 high risk patients arriving at the emergency department of an academic healthcare center was obtained from the HIE and compared with the list obtained through the medication reconciliation process. Results There were 31 022 distinct users accessing the HIE 11 085 653 times in 2015. The vast majority of pharmacists and general practitioners accessed it, compared to a minority of specialists and nurses. The top 1% of users was responsible of 19% of access. Also, 63% of the access was made using the Viewer application, while using a certified electronic medical record application seemed to facilitate usage. Among 111 patients, 71 (64%) had at least one discrepancy between the medication list obtained from the HIE and the reference list. Conclusions Early adopters were mostly in primary care settings, and were accessing it more frequently when using a certified electronic medical record. Further work is needed to investigate how to resolve accuracy issues with the medication list and how certain tools provide different features.
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Affiliation(s)
- Aude Motulsky
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada.,Department of Management, Evaluation & Health Policy, School of Public Health, Université de Montréal, Montreal, Canada
| | - Daniala L Weir
- Department of Epidemiology, Biostatistics and Occupational Health & Department of Medicine, McGill University, Montreal, Canada
| | | | - Claude Sicotte
- Department of Management, Evaluation & Health Policy, School of Public Health, Université de Montréal, Montreal, Canada.,Healthcare organization management host team (EA7348 MOS - Management des organisations de santé - Healthcare Organization Management), EHESP - École des hautes études en santé publique, France
| | | | - David L Buckeridge
- Department of Epidemiology, Biostatistics and Occupational Health & Department of Medicine, McGill University, Montreal, Canada
| | - Robyn Tamblyn
- Department of Epidemiology, Biostatistics and Occupational Health & Department of Medicine, McGill University, Montreal, Canada
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21
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Raymond L, Paré G, Maillet É, Ortiz de Guinea A, Trudel MC, Marsan J. Improving performance in the ED through laboratory information exchange systems. Int J Emerg Med 2018. [PMID: 29532186 PMCID: PMC5847633 DOI: 10.1186/s12245-018-0179-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background The accessibility of laboratory test results is crucial to the performance of emergency departments and to the safety of patients. This study aims to develop a better understanding of which laboratory information exchange (LIE) systems emergency care physicians (ECPs) are using to consult their patients’ laboratory test results and which benefits they derive from such use. Methods A survey of 163 (36%) ECPs in Quebec was conducted in collaboration with the Quebec’s Department of Health and Social Services. Descriptive statistics, chi-square tests, cluster analyses, and ANOVAs were conducted. Results The great majority of respondents indicated that they use several LIE systems including interoperable electronic health record (iEHR) systems, laboratory results viewers (LRVs), and emergency department information systems (EDIS) to consult their patients’ laboratory results. Three distinct profiles of LIE users were observed. The extent of LIE usage was found to be primarily determined by the functional design differences between LIE systems available in the EDs. Our findings also indicate that the more widespread LIE usage, the higher the perceived benefits. More specifically, physicians who make extensive use of iEHR systems and LRVs obtain the widest range of benefits in terms of efficiency, quality, and safety of emergency care. Conclusions Extensive use of LIE systems allows ECPs to better determine and monitor the health status of their patients, verify their diagnostic assumptions, and apply evidence-based practices in laboratory medicine. But for such benefits to be possible, ECPs must be provided with LIE systems that produce accurate, up-to-date, complete, and easy-to-interpret information.
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Affiliation(s)
- Louis Raymond
- Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Guy Paré
- HEC Montréal, 3000, Cote-Sainte-Catherine Road, Montreal, Quebec, H3T 2A7, Canada.
| | | | - Ana Ortiz de Guinea
- HEC Montréal, 3000, Cote-Sainte-Catherine Road, Montreal, Quebec, H3T 2A7, Canada
| | - Marie-Claude Trudel
- HEC Montréal, 3000, Cote-Sainte-Catherine Road, Montreal, Quebec, H3T 2A7, Canada
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22
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Abstract
Background: In June 2014, the Office of the National Coordinator for Health Information Technology published a 10-year roadmap for the United States to achieve interoperability of electronic health records (EHR) by 2024. A key component of this strategy is the promotion of nationwide health information exchange (HIE). The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act provided significant investments to achieve HIE. Objective: We conducted a systematic literature review to describe the use of HIE through 2015. Methods: We searched MEDLINE, PsycINFO, CINAHL, and Cochrane databases (1990 – 2015); reference lists; and tables of contents of journals not indexed in the databases searched. We extracted data describing study design, setting, geographic location, characteristics of HIE implementation, analysis, follow-up, and results. Study quality was dual-rated using pre-specified criteria and discrepancies resolved through consensus. Results: We identified 58 studies describing either level of use or primary uses of HIE. These were a mix of surveys, retrospective database analyses, descriptions of audit logs, and focus groups. Settings ranged from community-wide to multinational. Results suggest that HIE use has risen substantially over time, with 82% of non-federal hospitals exchanging information (2015), 38% of physician practices (2013), and 17-23% of long-term care facilities (2013). Statewide efforts, originally funded by HITECH, varied widely, with a small number of states providing the bulk of the data. Characteristics of greater use include the presence of an EHR, larger practice size, and larger market share of the health-system. Conclusions: Use of HIE in the United States is growing but is still limited. Opportunities remain for expansion. Characteristics of successful implementations may provide a path forward.
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23
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Lyons TW, Olson KL, Palmer NP, Horwitz R, Mandl KD, Fine AM. Patients Visiting Multiple Emergency Departments: Patterns, Costs, and Risk Factors. Acad Emerg Med 2017; 24:1349-1357. [PMID: 28861915 DOI: 10.1111/acem.13304] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/23/2017] [Accepted: 08/27/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We sought to characterize the population of patients seeking care at multiple emergency departments (EDs) and to quantify the proportion of all ED visits and costs accounted for by these patients. METHODS We performed a retrospective, cohort study of deidentified insurance claims for privately insured patients with one of more ED visits between 2010 and 2016. We measured the number of EDs visited by each patient and determined the overall proportion of all ED visits and ED costs accounted for by patients who visit multiple EDs. We identified factors associated with visiting multiple EDs. RESULTS A total of 8,651,716 patients made 16,390,676 ED visits over the study period, accounting for $26,102,831,740 in ED costs. A significant minority (20.5%) of patients visited more than one ED over the study period. However, these patients accounted for a disproportionate amount of all ED visits (41.4%) and all ED costs (39.2%). A small proportion (0.4%) of patients visited five or more EDs but accounted for 2.8% of ED visits and costs. Among patients with two ED visits within 30 days, 32% were to different EDs. Having at least one ED visit for mental health or substance abuse-related diagnosis was associated with increased odds of visiting multiple EDs. CONCLUSIONS A substantial minority of patients visit multiple EDs, but account for a disproportionate burden of overall ED utilization and costs. Future work should evaluate the impact of visiting multiple EDs on care utilization and outcomes and explore systems for improving access to patient records across care centers.
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Affiliation(s)
- Todd W. Lyons
- Computational Health Informatics Program; Boston Children's Hospital; Boston MA
- Division of Emergency Medicine; Boston Children's Hospital; Boston MA
| | - Karen L. Olson
- Computational Health Informatics Program; Boston Children's Hospital; Boston MA
- Division of Emergency Medicine; Boston Children's Hospital; Boston MA
| | - Nathan P. Palmer
- Department of Biomedical Informatics; Harvard Medical School; Boston MA
| | - Reed Horwitz
- Computational Health Informatics Program; Boston Children's Hospital; Boston MA
| | - Kenneth D. Mandl
- Computational Health Informatics Program; Boston Children's Hospital; Boston MA
- Division of Emergency Medicine; Boston Children's Hospital; Boston MA
- Department of Biomedical Informatics; Harvard Medical School; Boston MA
| | - Andrew M. Fine
- Division of Emergency Medicine; Boston Children's Hospital; Boston MA
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24
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Ota S, Kudo KI, Taguchi K, Ihori M, Yoshie S, Yamamoto T, Sudoh O, Tsuji T, Iijima K. Development of a gateway for interoperability in community-based care: An empirical study. Technol Health Care 2017; 26:57-67. [PMID: 28946597 DOI: 10.3233/thc-170841] [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
BACKGROUND Information and communications technology has attracted attention as a useful way of sharing care records in community-based care. Such information sharing systems, however, imposed the burden of inputting the same records into different information systems due to a lack of interoperability of the systems. OBJECTIVES The purpose of this study was to develop a gateway that links information systems and to investigate the functionality and usability of the gateway through an empirical study. METHODS We developed a gateway with healthcare and welfare professionals in Kashiwa city, Japan. The gateway system consisted of two sub-systems: a data exchange sub-system and a common sub-system. Regarding the security, we used the transport layer security 1.2 and a public key infrastructure. For document formats, we utilized the health level seven international, extensible markup language, and portable document format. In addition, we performed an empirical study with 11 scenarios of four simulated patients and a questionnaire survey to the professionals. RESULTS Professionals of eight occupations participated the empirical study and verified the gateway to link information systems of six vendors. For a questionnaire survey, 32 professionals out of 40 reported that the gateway would eliminate the burden of inputting the same records into different information systems.
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Affiliation(s)
- Sakiko Ota
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
| | | | | | - Mikio Ihori
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
| | - Satoru Yoshie
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan.,Center for Home Care Medicine, The University of Tokyo, Tokyo, Japan
| | - Takuma Yamamoto
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
| | - Osamu Sudoh
- Graduate School of Interdisciplinary Information Studies, The University of Tokyo, Tokyo, Japan
| | - Tetsuo Tsuji
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
| | - Katsuya Iijima
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
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25
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Bowden T, Coiera E. The role and benefits of accessing primary care patient records during unscheduled care: a systematic review. BMC Med Inform Decis Mak 2017; 17:138. [PMID: 28938900 PMCID: PMC5610474 DOI: 10.1186/s12911-017-0523-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 08/08/2017] [Indexed: 11/12/2022] Open
Abstract
Background The purpose of this study was to assess the impact of accessing primary care records on unscheduled care. Unscheduled care is typically delivered in hospital Emergency Departments. Studies published to December 2014 reporting on primary care record access during unscheduled care were retrieved. Results Twenty-two articles met inclusion criteria from a pool of 192. Many shared electronic health records (SEHRs) were large in scale, servicing many millions of patients. Reported utilization rates by clinicians was variable, with rates >20% amongst health management organizations but much lower in nation-scale systems. No study reported on clinical outcomes or patient safety, and no economic studies of SEHR access during unscheduled care were available. Design factors that may affect utilization included consent and access models, SEHR content, and system usability and reliability. Conclusions Despite their size and expense, SEHRs designed to support unscheduled care have been poorly evaluated, and it is not possible to draw conclusions about any likely benefits associated with their use. Heterogeneity across the systems and the populations they serve make generalization about system design or performance difficult. None of the reviewed studies used a theoretical model to guide evaluation. Value of Information models may be a useful theoretical approach to design evaluation metrics, facilitating comparison across systems in future studies. Well-designed SEHRs should in principle be capable of improving the efficiency, quality and safety of unscheduled care, but at present the evidence for such benefits is weak, largely because it has not been sought.
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Affiliation(s)
- Tom Bowden
- Centre for Health Informatics Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
| | - Enrico Coiera
- Centre for Health Informatics Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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26
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Melvin CL, Saef SH, Pierce HO, Obeid JS, Carr CM. Health Information Exchange in the ED: What Do ED Clinicians Think? South Med J 2017; 109:419-26. [PMID: 27364028 DOI: 10.14423/smj.0000000000000466] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Our regional health information exchange (HIE), known as Carolina eHealth Alliance (CeHA)-HIE, serves all major hospital systems in our region and is accessible to emergency department (ED) clinicians in those systems. We wanted to understand reasons for low CeHA-HIE utilization and explore options for improving it. METHODS We implemented a 24-item user survey among ED clinician users of CeHA-HIE to investigate their perceptions of system usability and functionality, the quality of the information available through CeHA-HIE, the value of clinician time spent using CeHA-HIE, the ease of use of CeHA-HIE, and approaches for improving CeHA-HIE. RESULTS Of the 231 ED clinicians surveyed, 51 responded, and among those, 48 reported having used CeHA-HIE and completed the survey. CONCLUSIONS Results show most ED clinicians believed that CeHA-HIE was easy to use and added value to their work, but they also desired better integration of information available from CeHA-HIE into their system's electronic medical record.
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Affiliation(s)
- Cathy L Melvin
- From the Medical University of South Carolina, Department of Public Health Sciences, Division of General Internal Medicine and Geriatrics, Psychiatry and Behavioral Sciences, South Carolina Clinical and Translational Research Institute, and the Department of Medicine, Charleston, South Carolina
| | - Steven H Saef
- From the Medical University of South Carolina, Department of Public Health Sciences, Division of General Internal Medicine and Geriatrics, Psychiatry and Behavioral Sciences, South Carolina Clinical and Translational Research Institute, and the Department of Medicine, Charleston, South Carolina
| | - Holly O Pierce
- From the Medical University of South Carolina, Department of Public Health Sciences, Division of General Internal Medicine and Geriatrics, Psychiatry and Behavioral Sciences, South Carolina Clinical and Translational Research Institute, and the Department of Medicine, Charleston, South Carolina
| | - Jihad S Obeid
- From the Medical University of South Carolina, Department of Public Health Sciences, Division of General Internal Medicine and Geriatrics, Psychiatry and Behavioral Sciences, South Carolina Clinical and Translational Research Institute, and the Department of Medicine, Charleston, South Carolina
| | - Christine M Carr
- From the Medical University of South Carolina, Department of Public Health Sciences, Division of General Internal Medicine and Geriatrics, Psychiatry and Behavioral Sciences, South Carolina Clinical and Translational Research Institute, and the Department of Medicine, Charleston, South Carolina
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Petrova M, Barclay M, Barclay SS, Barclay SIG. Between "the best way to deliver patient care" and "chaos and low clinical value": General Practitioners' and Practice Managers' views on data sharing. Int J Med Inform 2017; 104:74-83. [PMID: 28599819 DOI: 10.1016/j.ijmedinf.2017.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 05/08/2017] [Accepted: 05/13/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE In the UK, General Practitioners and Practice Managers are key to enabling health information exchange (typically referred to as 'data sharing'). This study aimed to survey GPs and PMs for familiarity, engagement with and perceptions of patient data sharing. METHODS Cross-sectional survey. All 107 general practices in England's second largest Clinical Commissioning Group, Cambridgeshire & Peterborough CCG. Descriptive statistics; hierarchical logistic regression; thematic analysis. RESULTS 405 (64%) responses were received - from 338 (62%) GPs and 67 (71%) PMs. Familiarity and engagement were highest for local frail elderly and end of life care projects (>76% had used). The greatest difference in use concerned the now suspended national care.data initiative: PMs had odds of reporting use 75 times higher than GP partners (95% CI 27-211). Patient confusion was the most pronounced challenge and improved coordination the most pronounced expected benefit. Frequency of discussions with patients varied with IT competence (OR 4.2 for most competent users relative to least, 95% CI 1.7-10.7) and clinical system (OR 0.3, 95% CI 0.1-0.5). Patient reservations were reported more frequently by respondents who rated their IT competence as highest (OR 3.3, 95% CI 1.5-7.6), perceived more data sharing challenges (OR for a 1-point increase in challenges perception score 3.4, 95% CI 2.1-5.6) and by PMs (relative to GP partners, OR 18.0, 95% CI 7.9-41.3). CONCLUSIONS Familiarity with and use of data sharing projects was high among GPs and PMs. Both their individual and organisational characteristics were associated with the reported frequency of discussions and patients' responses. Improved awareness of the impact of provider characteristics and attitudes on patients' decisions about data sharing may enhance the equity and autonomy of those decisions.
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Affiliation(s)
- Mila Petrova
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | - Matthew Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sam S Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen I G Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Balancing volume and duration of information consumption by physicians: The case of health information exchange in critical care. J Biomed Inform 2017; 71:1-15. [PMID: 28502910 DOI: 10.1016/j.jbi.2017.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Revised: 05/07/2017] [Accepted: 05/08/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND The realization of the potential benefits of health information exchange systems (HIEs) for emergency departments (EDs) depends on the way these systems are actually used. The attributes of volume of information and duration of information processing are important for the study of HIE use patterns in the ED, as cognitive load and time constraints may result in a trade-off between these attributes. Experts and non-experts often use different problem-solving strategies, which may be consequential for their system use patterns. Little previous research focuses on the trade-off between volume and duration of system use or on the factors that affect it, including user expertise. OBJECTIVES This study aims at exploring the trade-off of volume and duration of use, examining whether this relationship differs between experts and non-experts, and identifying factors that are associated with use patterns characterized by volume and duration. METHODS The research objectives are pursued in the context of critically-ill patients, treated at a busy ED in the period 2010-2012. The primary source of internal and external data is an HIE linked to 14 hospitals, over 1300 clinics, and other clinical facilities. We define four use profiles based on the attributes of duration and volume: quick and basic, quick and deep, slow and basic, and slow and deep. The volume and duration of use are computed using HIE log files as the number of screens and the time per screen, respectively. Each session is then classified into a specific profile based on distances from predefined profile centroids. Experts are physicians that are board-certified in emergency medicine. We test the distribution of use profiles and their associations with multiple variables that describe the patient, physician, situation, information available in the HIE system, and use dynamics within the encounter. RESULTS The quick and basic profile is the most prevalent. While available admission summaries are associated with quick and basic use, lab and imaging results are associated with slower or deeper use. Physicians who are the first to use the system or are sole users during an encounter are less inclined to quick and deep use. These effects are intensified for experts. DISCUSSION A trade-off between volume and duration is identified. While system use is overall similar for experts and non-experts, the circumstances in which a certain profile is more likely to be observed vary across these two groups. Information availability and multiple-physician dynamics within the encounter emerge as important for the prediction of use profiles. The findings of this study provide implications for the design, implementation, and research of HIE use.
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Everson J, Kocher KE, Adler-Milstein J. Health information exchange associated with improved emergency department care through faster accessing of patient information from outside organizations. J Am Med Inform Assoc 2017; 24:e103-e110. [PMID: 27521368 PMCID: PMC7651934 DOI: 10.1093/jamia/ocw116] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/25/2016] [Accepted: 07/09/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To assess whether electronic health information exchange (HIE) is associated with improved emergency department (ED) care processes and utilization through more timely clinician viewing of information from outside organizations. MATERIALS AND METHODS Our data included 2163 patients seen in the ED of a large academic medical center for whom clinicians requested and viewed outside information from February 14, 2014, to February 13, 2015. Outside information requests w.ere fulfilled via HIE (Epic's Care Everywhere) or fax/scan to the electronic health record (EHR). We used EHR audit data to capture the time between the information request and when a clinician accessed the data. We assessed whether the relationship between method of information return and ED outcomes (length of visit, odds of imaging [computed tomography (CT), magnetic resonance imaging (MRI), radiographs] and hospitalization, and total charges) was mediated by request-to-access time, controlling for patient demographics, case mix, and acuity. RESULTS In multivariate analysis, there was no direct association between return of information via HIE vs fax/scan and ED outcomes. HIE was associated with faster outside information access (58.5 minutes on average), and faster access was associated with changes in ED care. For each 1-hour reduction in access time, visit length was 52.9 minutes shorter, the likelihood of imaging was lower (by 2.5, 1.6, and 2.4 percentage points for CT, MRI, and radiographs, respectively), the likelihood of admission was 2.4 percentage points lower, and average charges were $1187 lower ( P ≤ .001 for all). CONCLUSION The relationship between HIE and improved care processes and reduced utilization in the ED is mediated by faster accessing of information from outside organizations.
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Affiliation(s)
- Jordan Everson
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
| | - Keith E Kocher
- Department of Emergency Medicine, School of Medicine, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Julia Adler-Milstein
- School of Information and Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
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Everson J. The implications and impact of 3 approaches to health information exchange: community, enterprise, and vendor-mediated health information exchange. Learn Health Syst 2017; 1:e10021. [PMID: 31245558 PMCID: PMC6508570 DOI: 10.1002/lrh2.10021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/24/2016] [Accepted: 12/01/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Electronic health information exchange (HIE) is considered essential to establishing a learning health system, reducing medical errors, and improving efficiency, but establishment of widespread, high functioning HIE has been challenging. Healthcare organizations now have considerable flexibility in selecting among several HIE strategies, most prominently community HIE, enterprise HIE (led by a healthcare organization), and electronic health record vendor-mediated HIE. Each of these strategies is characterized by different conveners, capabilities, and motivations and may have different abilities to facilitate improved patient care. METHODS I reviewed the available scholarly literature to draw conceptual distinctions between these types of HIE, to assess the current evidence on each type of HIE, and to indicate important areas of future research. RESULTS While community HIE seems to offer the most open approach to HIE allowing for high levels of connectivity, both enterprise HIE and vendor-mediated HIE face lower barriers to formation and sustainability. Most existing evidence is focused on community HIE and points towards low overall use, challenges to usability, and ambiguous impact. To better guide organizational leaders and policymakers in the expansion of beneficial HIE and anticipate future trends, future research should work to better capture the prevalence of other forms of HIE, and to adopt common methods to allow comparisons of rate of use, usability, and impact on patient care across studies and types of HIE. CONCLUSIONS Healthcare organizations' choice of HIE strategy influences the set of partners the organization is connected to and may influence the benefit that efforts supported by HIE can offer to patients. Current research is not fully capturing the diversity of approaches to HIE and their potentially varying impact on providers and patients.
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Affiliation(s)
- Jordan Everson
- Department of Health Management and Policy, School of Public HealthUniversity of MichiganAnn ArborMichigan
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Downing NL, Adler-Milstein J, Palma JP, Lane S, Eisenberg M, Sharp C, Longhurst CA. Health information exchange policies of 11 diverse health systems and the associated impact on volume of exchange. J Am Med Inform Assoc 2017; 24:113-122. [PMID: 27301748 PMCID: PMC7654085 DOI: 10.1093/jamia/ocw063] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 02/13/2016] [Accepted: 03/30/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Provider organizations increasingly have the ability to exchange patient health information electronically. Organizational health information exchange (HIE) policy decisions can impact the extent to which external information is readily available to providers, but this relationship has not been well studied. OBJECTIVE Our objective was to examine the relationship between electronic exchange of patient health information across organizations and organizational HIE policy decisions. We focused on 2 key decisions: whether to automatically search for information from other organizations and whether to require HIE-specific patient consent. METHODS We conducted a retrospective time series analysis of the effect of automatic querying and the patient consent requirement on the monthly volume of clinical summaries exchanged. We could not assess degree of use or usefulness of summaries, organizational decision-making processes, or generalizability to other vendors. RESULTS Between 2013 and 2015, clinical summary exchange volume increased by 1349% across 11 organizations. Nine of the 11 systems were set up to enable auto-querying, and auto-querying was associated with a significant increase in the monthly rate of exchange (P = .006 for change in trend). Seven of the 11 organizations did not require patient consent specifically for HIE, and these organizations experienced a greater increase in volume of exchange over time compared to organizations that required consent. CONCLUSIONS Automatic querying and limited consent requirements are organizational HIE policy decisions that impact the volume of exchange, and ultimately the information available to providers to support optimal care. Future efforts to ensure effective HIE may need to explicitly address these factors.
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Affiliation(s)
- N Lance Downing
- Department of Medicine, Stanford University School of Medicine
| | | | - Jonathan P Palma
- Department of Medicine, Stanford University School of Medicine
- Department of Pediatrics, Stanford University School of Medicine
| | - Steven Lane
- Palo Alto Medical Foundation/Sutter Health, Palo Alto, CA
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Slovis BH, Lowry T, Delman BN, Beitia AO, Kuperman G, DiMaggio C, Shapiro JS. Patient crossover and potentially avoidable repeat computed tomography exams across a health information exchange. J Am Med Inform Assoc 2017; 24:30-38. [PMID: 27178985 PMCID: PMC5201178 DOI: 10.1093/jamia/ocw035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 02/02/2016] [Accepted: 02/17/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The purpose of this study was to measure the number of repeat computed tomography (CT) scans performed across an established health information exchange (HIE) in New York City. The long-term objective is to build an HIE-based duplicate CT alerting system to reduce potentially avoidable duplicate CTs. METHODS This retrospective cohort analysis was based on HIE CT study records performed between March 2009 and July 2012. The number of CTs performed, the total number of patients receiving CTs, and the hospital locations where CTs were performed for each unique patient were calculated. Using a previously described process established by one of the authors, hospital-specific proprietary CT codes were mapped to the Logical Observation Identifiers Names and Codes (LOINC®) standard terminology for inter-site comparison. The number of locations where there was a repeated CT performed with the same LOINC code was then calculated for each unique patient. RESULTS There were 717 231 CTs performed on 349 321 patients. Of these patients, 339 821 had all of their imaging studies performed at a single location, accounting for 668 938 CTs. Of these, 9500 patients had 48 293 CTs performed at more than one location. Of these, 6284 patients had 24 978 CTs with the same LOINC code performed at multiple locations. The median time between studies with the same LOINC code was 232 days (range of 0 to 1227); however, 1327 were performed within 7 days and 5000 within 30 days. CONCLUSIONS A small proportion (3%) of our cohort had CTs performed at more than one location, however this represents a large number of scans (48 293). A noteworthy portion of these CTs (51.7%) shared the same LOINC code and may represent potentially avoidable studies, especially those done within a short time frame. This represents an addressable issue, and future HIE-based alerts could be utilized to reduce potentially avoidable CT scans.
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Affiliation(s)
- Benjamin H Slovis
- The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, NY 10029, USA
- The Department of Biomedical Informatics, Columbia University, NY 10032, USA
| | - Tina Lowry
- The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, NY 10029, USA
| | - Bradley N Delman
- The Department of Radiology, Icahn School of Medicine at Mount Sinai, NY 10029, USA
| | - Anton Oscar Beitia
- The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, NY 10029, USA
| | - Gilad Kuperman
- The Department of Biomedical Informatics, New York-Presbyterian Hospital, NY 10032, USA
| | - Charles DiMaggio
- The Department of Surgery, New York University Medical School, NY 10016, USA
| | - Jason S Shapiro
- The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, NY 10029, USA
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Dixon BE, Ofner S, Perkins SM, Myers LJ, Rosenman MB, Zillich AJ, French DD, Weiner M, Haggstrom DA. Which veterans enroll in a VA health information exchange program? J Am Med Inform Assoc 2016; 24:96-105. [PMID: 27274014 DOI: 10.1093/jamia/ocw058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 03/06/2016] [Accepted: 03/24/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To characterize patients who voluntarily enrolled in an electronic health information exchange (HIE) program designed to share data between Veterans Health Administration (VHA) and non-VHA institutions. MATERIALS AND METHODS Patients who agreed to participate in the HIE program were compared to those who did not. Patient characteristics associated with HIE enrollment were examined using a multivariable logistic regression model. Variables selected for inclusion were guided by a health care utilization model adapted to explain HIE enrollment. Data about patients' sociodemographics (age, gender), comorbidity (Charlson index score), utilization (primary and specialty care visits), and access (distance to VHA medical center, insurance, VHA benefits) were obtained from VHA and HIE electronic health records. RESULTS Among 57 072 patients, 6627 (12%) enrolled in the HIE program during its first year. The likelihood of HIE enrollment increased among patients ages 50-64, of female gender, with higher comorbidity, and with increasing utilization. Living in a rural area and being unmarried were associated with decreased likelihood of enrollment. DISCUSSION AND CONCLUSION Enrollment in HIE is complex, with several factors involved in a patient's decision to enroll. To broaden HIE participation, populations less likely to enroll should be targeted with tailored recruitment and educational strategies. Moreover, inclusion of special populations, such as patients with higher comorbidity or high utilizers, may help refine the definition of success with respect to HIE implementation.
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Affiliation(s)
- Brian E Dixon
- Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN .,Richard M. Fairbanks School of Public Health, Indiana University.,Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN
| | - Susan Ofner
- Department of Biostatistics, School of Medicine, Indiana University
| | - Susan M Perkins
- Richard M. Fairbanks School of Public Health, Indiana University.,Department of Biostatistics, School of Medicine, Indiana University
| | - Laura J Myers
- Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN.,Department of General Internal Medicine and Geriatrics, School of Medicine, Indiana University
| | - Marc B Rosenman
- Department of Pediatrics, Children's Health Services Research, Indiana University.,Center for Health Services Research, Regenstrief Institute, Indianapolis, IN
| | - Alan J Zillich
- Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN.,Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN
| | - Dustin D French
- Department of Ophthalmology and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL.,Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN
| | - Michael Weiner
- Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN.,Department of General Internal Medicine and Geriatrics, School of Medicine, Indiana University.,Center for Health Services Research, Regenstrief Institute, Indianapolis, IN
| | - David A Haggstrom
- Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN.,Department of General Internal Medicine and Geriatrics, School of Medicine, Indiana University.,Center for Health Services Research, Regenstrief Institute, Indianapolis, IN
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Flaks-Manov N, Shadmi E, Hoshen M, Balicer RD. Health information exchange systems and length of stay in readmissions to a different hospital. J Hosp Med 2016; 11:401-6. [PMID: 26714040 DOI: 10.1002/jhm.2535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 11/29/2015] [Accepted: 12/04/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Readmission to a different hospital than the original discharge hospital may result in breakdowns in continuity of care. In different-hospital readmissions (DHRs), continuity can be maintained when hospitals are connected through health information exchange (HIE) systems. OBJECTIVE To examine whether length of readmission stay (LORS) differs between same-hospital readmissions and DHRs, and whether in DHRs the LORS differs by the availability of HIE. DESIGN A retrospective cohort study of all internal medicine 30-day readmissions in 27 Israeli hospitals between January 1, 2010 and December 31, 2010. SETTING Clalit Health Services-Israel's largest integrated healthcare provider and payer. POPULATION Adult Clalit members (aged 18 and older) with at least 1 readmission during the study period. METHODS A multivariate marginal Cox model tested the likelihood for discharge during each readmission day in same-hospital readmissions (SHRs), DHRs with HIE, and DHRs without HIE. RESULTS Of the 27,057 readmissions, 3130 (11.6%) were DHRs and 792 where DHRs with HIE in both the index and readmitting hospital. Partial continuity (DHRs with HIE) was associated with decreased likelihood of discharge on any given day compared with full continuity (SHRs) (hazard ratio [HR] = 0.85, 95% confidence interval [CI]: 0.79-0.91). Similar results were obtained for no continuity (DHRs without HIE) versus full continuity (HR = 0.90, 95% CI: 0.86-0.94). The difference between DHRs with and without HIE was not significant. CONCLUSIONS The prolonged LORS in DHRs versus SHRs was not mitigated by the existence of HIE systems. Future research is needed to further elucidate the effects of actual use of HIE on length of DHRs. Journal of Hospital Medicine 2016;11:401-406. © 2015 Society of Hospital Medicine.
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Affiliation(s)
| | - Efrat Shadmi
- Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Moshe Hoshen
- Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel
| | - Ran D Balicer
- Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel
- Department of Public Health, Ben-Gurion University of the Negev, Beersheba, Israel
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Abstract
Policy makers and practitioners argue that electronic exchange of clinical data across the healthcare system is a key component of improving health service delivery in the United States. Provider administrators, however, question the strategic value of participation in health information exchanges (HIEs) and remain reluctant to participate. Existing research fails to adequately illuminate the potential value derived from HIEs by participating organizations. This paper addresses this gap by developing a conceptual model informed by the complementary theoretical perspectives of the relational view and systems theory to specify both a provider organizationʼs internal conditions and the HIE structure necessary for both financial accrual and quality improvement. This two-sided model can assist policymakers as they attempt to encourage HIE development, as well as provider and HIE leadership that seek to benefit from HIEs. The propositions developed from this model can also help guide researchers as they evaluate the impact of HIEs.
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Eden KB, Totten AM, Kassakian SZ, Gorman PN, McDonagh MS, Devine B, Pappas M, Daeges M, Woods S, Hersh WR. Barriers and facilitators to exchanging health information: a systematic review. Int J Med Inform 2016; 88:44-51. [PMID: 26878761 DOI: 10.1016/j.ijmedinf.2016.01.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 01/12/2016] [Accepted: 01/12/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We conducted a systematic review of studies assessing facilitators and barriers to use of health information exchange (HIE). METHODS We searched MEDLINE, PsycINFO, CINAHL, and the Cochrane Library databases between January 1990 and February 2015 using terms related to HIE. English-language studies that identified barriers and facilitators of actual HIE were included. Data on study design, risk of bias, setting, geographic location, characteristics of the HIE, perceived barriers and facilitators to use were extracted and confirmed. RESULTS Ten cross-sectional, seven multiple-site case studies, and two before-after studies that included data from several sources (surveys, interviews, focus groups, and observations of users) evaluated perceived barriers and facilitators to HIE use. The most commonly cited barriers to HIE use were incomplete information, inefficient workflow, and reports that the exchanged information that did not meet the needs of users. The review identified several facilitators to use. DISCUSSION Incomplete patient information was consistently mentioned in the studies conducted in the US but not mentioned in the few studies conducted outside of the US that take a collective approach toward healthcare. Individual patients and practices in the US may exercise the right to participate (or not) in HIE which effects the completeness of patient information available to be exchanged. Workflow structure and user roles are key but understudied. CONCLUSIONS We identified several facilitators in the studies that showed promise in promoting electronic health data exchange: obtaining more complete patient information; thoughtful workflow that folds in HIE; and inclusion of users early in implementation.
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Affiliation(s)
- Karen B Eden
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
| | - Annette M Totten
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Steven Z Kassakian
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Paul N Gorman
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Marian S McDonagh
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Beth Devine
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; University of Washington, Pharmaceutical Outcomes Research and Policy Program, Box 357630, Seattle, WA 98195-7630, USA
| | - Miranda Pappas
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Monica Daeges
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Susan Woods
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Veterans Affairs Maine Healthcare System, 1 VA Center, Augusta, ME 04330, USA
| | - William R Hersh
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
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Bahous MC, Shadmi E. Health information exchange and information gaps in referrals to a pediatric emergency department. Int J Med Inform 2015; 87:68-74. [PMID: 26806713 DOI: 10.1016/j.ijmedinf.2015.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/06/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE to assess the extent of information gaps between three information sources available at admission to a pediatric Emergency Department (ED): Health Information Exchange (HIE) system, physicians' referral letters and information collected from patients/parents at admission to the ED (patient's medical history). MATERIALS AND METHODS A retrospective cohort study of 170 medical records of children aged 6 months to 18 years referred to a pediatric ED for a common childhood disease. Each record was reviewed for information on lab and imaging tests, vaccinations, allergies, previous diagnoses, recent and chronic medical treatment in the HIE system and referral letter, or from the patient's medical history taken on admission to the ED. The percent overlap between information sources and information gaps was assessed. RESULTS The most informative source, in terms of addressing all key areas, was the patient's medical history, with an average of 73.5% indication of each information key area. Next was the HIE system, with 54.1% indication of each key area; the least informative was the referral letter (43.9%). The overall overlap in data availability among all information sources occurred on average in 23% of the cases. HIE's ability to provide data missing from other routinely available sources was mainly in the area of chronic medication dosages (37% of cases). CONCLUSIONS Each of the three major information sources available at admission to a pediatric ED lack important data and each makes its own unique contribution. Improving documentation in electronic health records, on which HIE systems feed from can narrow significant information gaps at the most critical time-point-admission to a pediatric ED.
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Affiliation(s)
- Marta Chacour Bahous
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, Haifa University, Mount Carmel 31905, Israel; Pediatric Emergency Department, The Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa 31096, Israel.
| | - Efrat Shadmi
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, Haifa University, Mount Carmel 31905, Israel
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Gordon BD, Bernard K, Salzman J, Whitebird RR. Impact of Health Information Exchange on Emergency Medicine Clinical Decision Making. West J Emerg Med 2015; 16:1047-51. [PMID: 26759652 PMCID: PMC4703172 DOI: 10.5811/westjem.2015.9.28088] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/04/2015] [Accepted: 09/06/2015] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The objective of the study was to understand the immediate utility of health information exchange (HIE) on emergency department (ED) providers by interviewing them shortly after the information was retrieved. Prior studies of physician perceptions regarding HIE have only been performed outside of the care environment. METHODS Trained research assistants interviewed resident physicians, physician assistants and attending physicians using a semi-structured questionnaire within two hours of making a HIE request. The responses were recorded, then transcribed for qualitative analysis. The transcribed interviews were analyzed for emerging qualitative themes. RESULTS We analyzed 40 interviews obtained from 29 providers. Primary qualitative themes discovered included the following: drivers for requests for outside information; the importance of unexpected information; historical lab values as reference points; providing context when determining whether to admit or discharge a patient; the importance of information in refining disposition; improved confidence of provider; and changes in decisions for diagnostic imaging. CONCLUSION ED providers are driven to use HIE when they're missing a known piece of information. This study finds two additional impacts not previously reported. First, providers sometimes find additional unanticipated useful information, supporting a workflow that lowers the threshold to request external information. Second, providers sometimes report utility when no changes to their existing plan are made as their confidence is increased based on external records. Our findings are concordant with previous studies in finding exchanged information is useful to provide context for interpreting lab results, making admission decisions, and prevents repeat diagnostic imaging.
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Affiliation(s)
- Bradley D Gordon
- HealthPartners Institute for Education and Research, Bloomington, Minnesota; University of Minnesota Medical School, Academic Health Center, Minneapolis, Minnesota
| | - Kyle Bernard
- Advocate Christ Medical Center, Chicago, Illinois
| | - Josh Salzman
- Critical Care Research Center, Regions Hospital, Saint Paul, Minnesota
| | - Robin R Whitebird
- University of St. Thomas, School of Social Work, Saint Paul, Minnesota
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Kim KK, Rudin RS, Wilson MD. Health information technology adoption in California community health centers. THE AMERICAN JOURNAL OF MANAGED CARE 2015; 21:e677-e683. [PMID: 26760431 PMCID: PMC4948293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVES National and state initiatives to spur adoption of electronic health records (EHRs) and health information exchange (HIE) among providers in rural and underserved communities have been in place for 15 years. Our goal was to systematically assess the impact of these initiatives by quantifying the level of adoption and key factors associated with adoption among community health centers in California. STUDY DESIGN Cross-sectional statewide survey. METHODS We conducted a telephone survey of all California primary care community health centers (CHCs) from August to September 2013. Multiple logistic regressions were fit to test for associations between various practice characteristics and adoption of EHRs, meaningful use-certified EHRs, and HIE. For the multivariable model, we included those variables which were significant at the P = .10 level in the univariate tests. RESULTS We received responses from 194 CHCs (73.5% response rate). Adoption of any EHRs (80.3%) and meaningful use-certified EHRs (94.6% of those with an EHR) was very high. Adoption of HIE is substantial (48.7%) and took place within a few years (mean = 2.61 years; SD = 2.01). More than half (54.7%) of CHCs are able to receive data into the EHR indicating some level of interoperability. Patient engagement capacity is moderate, with 21.6% offering a PHR, and 55.2% electronic visit summaries. Rural location and belonging to a multi-site clinic organization both increase the odds of adoption of EHRs, HIE, and electronic visit summary, with the odds ratio ranging from 0.63 to 3.28 (all P values < .05). CONCLUSIONS Greater adoption of health information technology (IT) in rural areas may be the result of both federal and state investments. As CHCs lack access to capital for investments, continued support of technology infrastructure may be needed for them to further leverage health IT to improve healthcare.
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Affiliation(s)
- Katherine K Kim
- University of California Davis, Betty Irene Moore School of Nursing, 2450 48th St, Ste 2600, Sacramento, CA 95817. E-mail:
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Probst MA, Dayan PS, Raja AS, Slovis BH, Yadav K, Lam SH, Shapiro JS, Farris C, Babcock CI, Griffey RT, Robey TE, Fortin EM, Johnson JO, Chong ST, Davenport M, Grigat DW, Lang EL. Knowledge Translation and Barriers to Imaging Optimization in the Emergency Department: A Research Agenda. Acad Emerg Med 2015; 22:1455-64. [PMID: 26568148 PMCID: PMC10548873 DOI: 10.1111/acem.12830] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 07/02/2015] [Indexed: 01/21/2023]
Abstract
Researchers have attempted to optimize imaging utilization by describing which clinical variables are more predictive of acute disease and, conversely, what combination of variables can obviate the need for imaging. These results are then used to develop evidence-based clinical pathways, clinical decision instruments, and clinical practice guidelines. Despite the validation of these results in subsequent studies, with some demonstrating improved outcomes, their actual use is often limited. This article outlines a research agenda to promote the dissemination and implementation (also known as knowledge translation) of evidence-based interventions for emergency department (ED) imaging, i.e., clinical pathways, clinical decision instruments, and clinical practice guidelines. We convened a multidisciplinary group of stakeholders and held online and telephone discussions over a 6-month period culminating in an in-person meeting at the 2015 Academic Emergency Medicine consensus conference. We identified the following four overarching research questions: 1) what determinants (barriers and facilitators) influence emergency physicians' use of evidence-based interventions when ordering imaging in the ED; 2) what implementation strategies at the institutional level can improve the use of evidence-based interventions for ED imaging; 3) what interventions at the health care policy level can facilitate the adoption of evidence-based interventions for ED imaging; and 4) how can health information technology, including electronic health records, clinical decision support, and health information exchanges, be used to increase awareness, use, and adherence to evidence-based interventions for ED imaging? Advancing research that addresses these questions will provide valuable information as to how we can use evidence-based interventions to optimize imaging utilization and ultimately improve patient care.
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Affiliation(s)
- Marc A Probst
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Peter S Dayan
- Department of Pediatrics, Division of Emergency Medicine, Columbia University College of Physicians & Surgeons, New York, NY
| | - Ali S Raja
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA
| | - Benjamin H Slovis
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kabir Yadav
- Department of Emergency Medicine, University of California, Los Angeles School of Medicine, Los Angeles, CA
| | - Samuel H Lam
- Department of Emergency Medicine, Advocate Christ Medical Center, Oak Lawn, IL
| | - Jason S Shapiro
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Coreen Farris
- RAND Corporation, Santa Monica, CA
- Central Michigan University College of Medicine, Mount Pleasant, MI
| | - Charlene I Babcock
- Department of Emergency Medicine, St. John Hospital and Medical Center, Detroit, MI
| | - Richard T Griffey
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO
| | - Thomas E Robey
- Department of Emergency Medicine, Waterbury Hospital, Yale University, New Haven, CT
| | - Emily M Fortin
- Central Michigan University College of Medicine, Mount Pleasant, MI
| | | | - Suzanne T Chong
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI
| | - Moira Davenport
- Department of Emergency Medicine, Allegheny General Hospital, Pittsburgh, PA
| | - Daniel W Grigat
- Alberta Health Services, Emergency Strategic Clinical Network, Calgary, Alberta, Canada
| | - Eddy L Lang
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
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Politi L, Codish S, Sagy I, Fink L. Use patterns of health information exchange systems and admission decisions: Reductionistic and configurational approaches. Int J Med Inform 2015. [DOI: 10.1016/j.ijmedinf.2015.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Schatz BR. National Surveys of Population Health: Big Data Analytics for Mobile Health Monitors. BIG DATA 2015; 3:219-229. [PMID: 26858915 PMCID: PMC4722603 DOI: 10.1089/big.2015.0021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
At the core of the healthcare crisis is fundamental lack of actionable data. Such data could stratify individuals within populations to predict which persons have which outcomes. If baselines existed for all variations of all conditions, then managing health could be improved by matching the measuring of individuals to their cohort in the population. The scale required for complete baselines involves effective National Surveys of Population Health (NSPH). Traditionally, these have been focused upon acute medicine, measuring people to contain the spread of epidemics. In recent decades, the focus has moved to chronic conditions as well, which require smaller measures over longer times. NSPH have long utilized quality of life questionnaires. Mobile Health Monitors, where computing technologies eliminate manual administration, provide richer data sets for health measurement. Older technologies of telephone interviews will be replaced by newer technologies of smartphone sensors to provide deeper individual measures at more frequent timings across larger-sized populations. Such continuous data can provide personal health records, supporting treatment guidelines specialized for population cohorts. Evidence-based medicine will become feasible by leveraging hundreds of millions of persons carrying mobile devices interacting with Internet-scale services for Big Data Analytics.
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Affiliation(s)
- Bruce R. Schatz
- Address correspondence to: Bruce R. Schatz, Department of Medical Information Science, Institute for Genomic Biology, University of Illinois at Urbana-Champaign, 1206 W. Gregory, Urbana, IL 61801, E-mail:
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Martinez DA, Mora E, Gemmani M, Zayas-Castro J. Uncovering Hospitalists' Information Needs from Outside Healthcare Facilities in the Context of Health Information Exchange Using Association Rule Learning. Appl Clin Inform 2015; 6:684-97. [PMID: 26767064 DOI: 10.4338/aci-2015-06-ra-0068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 10/01/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Important barriers to health information exchange (HIE) adoption are clinical workflow disruptions and troubles with the system interface. Prior research suggests that HIE interfaces providing faster access to useful information may stimulate use and reduce barriers for adoption; however, little is known about informational needs of hospitalists. OBJECTIVE To study the association between patient health problems and the type of information requested from outside healthcare providers by hospitalists of a tertiary care hospital. METHODS We searched operational data associated with fax-based exchange of patient information (previous HIE implementation) between hospitalists of an internal medicine department in a large urban tertiary care hospital in Florida, and any other affiliated and unaffiliated healthcare provider. All hospitalizations from October 2011 to March 2014 were included in the search. Strong association rules between health problems and types of information requested during each hospitalization were discovered using Apriori algorithm, which were then validated by a team of hospitalists of the same department. RESULTS Only 13.7% (2 089 out of 15 230) of the hospitalizations generated at least one request of patient information to other providers. The transactional data showed 20 strong association rules between specific health problems and types of information exist. Among the 20 rules, for example, abdominal pain, chest pain, and anaemia patients are highly likely to have medical records and outside imaging results requested. Other health conditions, prone to have records requested, were lower urinary tract infection and back pain patients. CONCLUSIONS The presented list of strong co-occurrence of health problems and types of information requested by hospitalists from outside healthcare providers not only informs the implementation and design of HIE, but also helps to target future research on the impact of having access to outside information for specific patient cohorts. Our data-driven approach helps to reduce the typical biases of qualitative research.
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Affiliation(s)
- D A Martinez
- Johns Hopkins University, Emergency Medicine , Baltimore, MD, United States
| | - E Mora
- Politecnico di Milano, Dipartimento di Ingegneria Gestionale, Milan, Italy
| | - M Gemmani
- Politecnico di Milano, Dipartimento di Ingegneria Gestionale, Milan, Italy
| | - J Zayas-Castro
- University of South Florida, Industrial and Management Systems Engineering , Tampa, FL, United States
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Klann JG, Pfiffner PB, Natter MD, Conner E, Blazejewski P, Murphy SN, Mandl KD. Supporting Multi-sourced Medication Information in i2b2. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2015; 2015:747-755. [PMID: 26958210 PMCID: PMC4765563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Postmarketing drug surveillance is critical to assessing adverse events associated with medications, because prelaunch clinical trials frequently miss negative drug effects. The Informatics for Integrating Biology and the Bedside platform (i2b2) has been used effectively for this. However, previous work suffers from incomplete medical data present in electronic health record (EHR) systems. Here, we develop a system to integrate non-traditional data sources with EHR data: pharmacy dispensing information and patient-reported data. We implement and validate a toolset to gather medication data from a Pharmacy Benefit Manager network, import it into an i2b2 EHR repository using a standard data format, merge it with the EHR data, and present it to for annotation with results returned to i2b2. This toolkit is enabling studies on medication list data quality, adherence, and adverse event detection.
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Affiliation(s)
- Jeffrey G Klann
- Partners Healthcare, Boston, MA;; Harvard Medical School, Boston, MA;; Massachusetts General Hospital, Boston, MA
| | - Pascal B Pfiffner
- Harvard Medical School, Boston, MA;; Boston Children's Hospital, Boston MA
| | - Marc D Natter
- Harvard Medical School, Boston, MA;; Boston Children's Hospital, Boston MA
| | | | | | - Shawn N Murphy
- Partners Healthcare, Boston, MA;; Harvard Medical School, Boston, MA;; Massachusetts General Hospital, Boston, MA
| | - Kenneth D Mandl
- Harvard Medical School, Boston, MA;; Boston Children's Hospital, Boston MA
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Kang MJ, Jung CY, Kim S, Boo Y, Lee Y, Kim S. Stakeholder analysis for adopting a personal health record standard in Korea. Health Inf Manag 2015; 44:33-42. [PMID: 26157084 DOI: 10.1177/183335831504400204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Interest in health information exchanges (HIEs) is increasing. Several countries have adopted core health data standards with appropriate strategies. OBJECTIVE This study was conducted to determine the feasibility of a continuity of care record (CCR) as the standard for an electronic version of the official transfer note and the HIE in Korean healthcare. METHOD A technical review of the CCR standard and analysis of stakeholders' views were undertaken. Transfer notes were reviewed and matched with CCR standard categories. The standard for the Korean coding system was selected. Stakeholder analysis included an online survey of members of the Korean Society of Medical Informatics, a public hearing to derive opinions of consumers, doctors, vendors, academic societies and policy makers about the policy process, and a focus group meeting with EMR vendors to determine which HIE objects were technically applicable. RESULTS Data objects in the official transfer note form matched CCR standards. Korean Classification of Diseases, Korean Standard Terminology of Medicine, Electronic Data Interchange code (EDI code), Logical Observation Identifiers Names and Codes, and Korean drug codes (KD code) were recommended as the Korean coding standard.'Social history', 'payers', and 'encounters' were mostly marked as optional or unnecessary sections, and 'allergies', 'alerts', 'medication list', 'problems/diagnoses', 'results',and 'procedures' as mandatory. Unlike the US, 'social history' was considered optional and 'advance directives' mandatory.At the public hearing there was some objection from the Korean Medical Association to the HIE on legal grounds in termsof intellectual property and patients' personal information. Other groups showed positive or neutral responses. Focus group members divided CCR data objects into three phases based onpredicted adoption time in CCR: (i) immediate adoption; (ii) short-term adoption ('alerts', 'family history'); and (iii) long-term adoption ('results', 'advanced directives', 'functional status', 'medical equipment', 'vital signs', 'plan of care', 'social history'). CONCLUSION There were no technical problems in generating the CCR standard document from EMRs. Matters of concern that arose from study results should be resolved with time and consultation.
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Affiliation(s)
- Min-Jeoung Kang
- College of Nursing, The Catholic University of Korea Seoul, Republic of Korea
| | - Chai Young Jung
- College of Medicine, The Catholic University of Korea Seoul, Republic of Korea
| | - Soyoun Kim
- College of Medicine, Yonsei University Seoul, Republic of Korea
| | - Yookyung Boo
- College of Healthcare Industry, Eulji University Sungnam-si, Gyeonggi-do, Republic of Korea
| | - Yuri Lee
- Graduate School of Public Health, Yonsei University Seoul, Republic of Korea
| | - Sundo Kim
- Bureau of Health Industry, Ministry of Health and Welfare Seoul, Republic of Korea
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Juhr M, Haux R, Suzuki T, Takabayashi K. Overview of recent trans-institutional health network projects in Japan and Germany. J Med Syst 2015; 39:50. [PMID: 25732082 DOI: 10.1007/s10916-015-0234-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/11/2015] [Indexed: 11/28/2022]
Abstract
Worldwide populations are aging and countries have to prepare for the effects of demographic change in health care. Health information exchange (HIE), which is the process of moving patient information across health care providers electronically, can help overcome health data fragmentation and open opportunities to improve patient care in terms of quality, economy and efficiency. Since Japan and Germany are among the first countries strongly impacted by demographic changes of aging populations, we report on current developments about health information systems carrying out HIE based on case studies in both countries. Four projects that address the improvement of HIE within a defined region have been selected and investigated: the German project of the Lower Saxony Bank of Health and the Japanese projects Chiba ITnet, Nagasaki AjisaiNet and the National Disaster and Backup System of Japan. The project descriptions are based on relevant English publications, on-site visits and interviews with developers and users. The projects are introduced in terms of their basic architecture and implementation, their present status and future objectives. The projects' developments are still in progress and all have to cope with significant challenges before they will be able to provide a fully working trans-institutional health network solution.
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Affiliation(s)
- Maren Juhr
- Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig and Hannover Medical School, Muehlenpfordtstr. 23, 38106, Braunschweig, Germany,
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Yaraghi N, Du AY, Sharman R, Gopal RD, Ramesh R. Health Information Exchange as a Multisided Platform: Adoption, Usage, and Practice Involvement in Service Co-Production. INFORMATION SYSTEMS RESEARCH 2015. [DOI: 10.1287/isre.2014.0547] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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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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Does an integrated Emergency Department Information System change the sequence of clinical work? A mixed-method cross-site study. Int J Med Inform 2014; 83:958-66. [DOI: 10.1016/j.ijmedinf.2014.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 08/26/2014] [Accepted: 08/27/2014] [Indexed: 11/21/2022]
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Politi L, Codish S, Sagy I, Fink L. Use patterns of health information exchange through a multidimensional lens: Conceptual framework and empirical validation. J Biomed Inform 2014; 52:212-21. [DOI: 10.1016/j.jbi.2014.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/22/2014] [Accepted: 07/05/2014] [Indexed: 10/25/2022]
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