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Alexandre PK, Monestime JP, Alexandre K. The impact of county-level factors on meaningful use of electronic health records (EHRs) among primary care providers. PLoS One 2024; 19:e0295435. [PMID: 38271332 PMCID: PMC10810449 DOI: 10.1371/journal.pone.0295435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 11/21/2023] [Indexed: 01/27/2024] Open
Abstract
This study examines the impact of county-level factors on "meaningful use" (MU) of electronic health records (EHRs) for 8415 primary care providers (PCPs) that enrolled in the Florida Medicaid EHR Incentive Program through adopting, improving, or upgrading (AIU) a certified EHR technology. PCPs received incentive payments at enrollment and if they used their EHRs in meaningful ways; ways that benefit patients and providers alike they received additional payments. We conducted a retrospective cohort study of these providers over the 2011-2018 period while linking their records to other state data. We used the core constructs of the resource dependence theory (RDT), a well-established organization theory in business management, to operationalize the county-level variables. These variables were rurality, poverty, educational attainment, managed care penetration, changes in population, and number of PCPs per capita. The unit of analysis was provider-years. For practical and computational purposes, all the county variables were dichotomized. We used analysis of variance (ANOVA) to test for differences in MU attestation rates across each county variable. Odds ratios and corresponding 95% confidence intervals were derived from pooled logistic regressions using generalized estimated equations (GEE) with the binomial family and logit link functions. Clustered standard errors were used. Approximately 42% of these providers attested to MU after receiving first-year incentives. Rurality and poverty were significantly associated with MU. To some degree, managed care penetration, change in population size, and number of PCPs per capita were also associated with MU. Policy makers and healthcare managers should not ignore the contribution of county-level factors in the diffusion of EHRs among physician practices. These county-level findings provide important insights about EHR diffusion in places where traditionally underserved populations live. This county-perspective is particularly important because of the potential for health IT to enable public health monitoring and population health management that might benefit individuals beyond the patients treated by the Medicaid providers.
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Affiliation(s)
- Pierre K. Alexandre
- Health Administration Program, Department of Management, College of Business, Florida Atlantic University, Boca Raton, Florida, United States of America
| | - Judith P. Monestime
- Health Administration Program, Department of Management, College of Business, Florida Atlantic University, Boca Raton, Florida, United States of America
| | - Kessie Alexandre
- Department of Geography, University of Washington, Seattle, Washington, United States of America
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Mussi CC, Luz R, Damázio DDR, dos Santos EM, Sun V, Porto BSDS, Parma GOC, Cordioli LA, Birch RS, de Andrade Guerra JBSO. The Large-Scale Implementation of a Health Information System in Brazilian University Hospitals: Process and Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6971. [PMID: 37947529 PMCID: PMC10650123 DOI: 10.3390/ijerph20216971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023]
Abstract
Governments around the globe are paving the way for healthcare services that can have a profound impact on the overall well-being and development of their nations. However, government programs to implement health information technologies on a large-scale are challenging, especially in developing countries. In this article, the process and outcomes of the large-scale implementation of a hospital information system for the management of Brazilian university hospitals are analyzed. Based on a qualitative approach, this research involved 21 hospitals and comprised a documentary search, interviews with 24 hospital managers and two system user focus groups, and a questionnaire of 736 respondents. Generally, we observed that aspects relating to the wider context of system implementation (macro level), the managerial structure, cultural nuances, and political dynamics within each hospital (meso level), as well as the technology, work activities, and individuals themselves (micro level) acted as facilitators and/or obstacles to the implementation process. The dynamics and complex interactions established between these aspects had repercussions on the process, including the extended time necessary to implement the national program and the somewhat mixed outcomes obtained by hospitals in the national network. Mostly positive, these outcomes were linked to the eight emerging dimensions of practices and work processes; planning, control, and decision making; transparency and accountability; optimization in the use of resources; productivity of professionals; patient information security; safety and quality of care; and improvement in teaching and research. We argued here that to maximize the potential of information technology in healthcare on a large-scale, an integrative and cooperative vision is required, along with a high capacity for change management, considering the different regional, local, and institutional contexts.
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Affiliation(s)
- Clarissa Carneiro Mussi
- Postgraduate Program in Administration, University of Southern Santa Catarina, Palhoça 88137-270, Brazil; (R.L.); (D.d.R.D.); (G.O.C.P.); (L.A.C.); (J.B.S.O.d.A.G.)
| | - Ricardo Luz
- Postgraduate Program in Administration, University of Southern Santa Catarina, Palhoça 88137-270, Brazil; (R.L.); (D.d.R.D.); (G.O.C.P.); (L.A.C.); (J.B.S.O.d.A.G.)
| | - Dioni da Rosa Damázio
- Postgraduate Program in Administration, University of Southern Santa Catarina, Palhoça 88137-270, Brazil; (R.L.); (D.d.R.D.); (G.O.C.P.); (L.A.C.); (J.B.S.O.d.A.G.)
| | | | - Violeta Sun
- School of Arts, Sciences, and Humanities, University of São Paulo, São Paulo 03828-000, Brazil;
| | | | - Gabriel Oscar Cremona Parma
- Postgraduate Program in Administration, University of Southern Santa Catarina, Palhoça 88137-270, Brazil; (R.L.); (D.d.R.D.); (G.O.C.P.); (L.A.C.); (J.B.S.O.d.A.G.)
| | - Luiz Alberto Cordioli
- Postgraduate Program in Administration, University of Southern Santa Catarina, Palhoça 88137-270, Brazil; (R.L.); (D.d.R.D.); (G.O.C.P.); (L.A.C.); (J.B.S.O.d.A.G.)
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Köse İ, Cece S, Yener S, Seyhan S, Özge Elmas B, Rayner J, Birinci Ş, Mahir Ülgü M, Zehir E, Gündoğdu B. Basic electronic health record (EHR) adoption in **Türkiye is nearly complete but challenges persist. BMC Health Serv Res 2023; 23:987. [PMID: 37710253 PMCID: PMC10500820 DOI: 10.1186/s12913-023-09859-w] [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: 10/14/2022] [Accepted: 07/28/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND The digitalization studies in public hospitals in Türkiye started with the Health Transformation Program in 2003. As digitalization was accomplished, the policymakers needed to measure hospitals' electronic health record (EHR) usage and adoptions. The ministry of health has been measuring the dissemination of meaningful usage and adoption of EHR since 2013 using Electronic Medical Record Adoption Model (EMRAM). The first published study about this analysis covered the surveys applied between 2013 and 2017. The results showed that 63.1% of all hospitals in Türkiye had at least basic EHR functions, and 36% had comprehensive EHR functions. Measuring the countrywide EHR adoption level is becoming popular in the world. This study aims to measure adoption levels of EHR in public hospitals in Türkiye, indicate the change to the previous study, and make a benchmark with other countries measuring national EHR adoption levels. The research question of this study is to reveal whether there has been a change in the adoption level of EHR in the three years since 2018 in Türkiye. Also, make a benchmark with other countries such as the US, Japan, and China in country-wide EHR adoption in 2021. METHODS In 2021, 717 public hospitals actively operating in Türkiye completed the EMRAM survey. The survey results, deals with five topics (General Stage Status, Information Technology Security, Electronic Health Record/Clinical Data Repository, Clinical Documentation, Closed-Loop Management), was reviewed by the authors. Survey data were compared according to hospital type (Specialty Hospitals, General Hospitals, Teaching and Research Hospitals) in terms of general stage status. The data obtained from the survey results were analyzed with QlikView Personal Edition. The availability and prevalence of medical information systems and EHR functions and their use were measured. RESULTS We found that 33.7% of public hospitals in Türkiye have only basic EHR functions, and 66.3% have extensive EHR functions, which yields that all hospitals (100%) have at least basic EHR functions. That means remarkable progress from the previous study covering 2013 and 2017. This level also indicates that Türkiye has slightly better adoption from the US (96%) and much better than China (85.3%) and Korea (58.1%). CONCLUSIONS Although there has been outstanding (50%) progress since 2017 in Turkish public hospitals, it seems there is still a long way to disseminate comprehensive EHR functions, such as closed-loop medication administration, clinical decision support systems, patient engagement, etc. Measuring the stage of EHR adoption at regular intervals and on analytical scales is an effective management tool for policymakers. The bottom-up adoption approach established for adopting and managing EHR functions in the US has also yielded successful results in Türkiye.
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Affiliation(s)
- İlker Köse
- Department of Computer Engineering, Alanya University, Saraybeleni St., No:7, Antalya, Turkey.
| | | | - Songül Yener
- Department of Healthcare Management, İstanbul Medipol University, İstanbul, Turkey
| | - Senanur Seyhan
- Department of Healthcare Management, İstanbul Medipol University, İstanbul, Turkey
| | - Beytiye Özge Elmas
- Department of Healthcare Management, İstanbul Medipol University, İstanbul, Turkey
| | - John Rayner
- HIMSS Analytics for Europe and Latin America, Leipzig, Germany
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Iott BE, Pantell MS, Adler-Milstein J, Gottlieb LM. Physician awareness of social determinants of health documentation capability in the electronic health record. J Am Med Inform Assoc 2022; 29:2110-2116. [PMID: 36069887 PMCID: PMC9667172 DOI: 10.1093/jamia/ocac154] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/26/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
Healthcare organizations are increasing social determinants of health (SDH) screening and documentation in the electronic health record (EHR). Physicians may use SDH data for medical decision-making and to provide referrals to social care resources. Physicians must be aware of these data to use them, however, and little is known about physicians' awareness of EHR-based SDH documentation or documentation capabilities. We therefore leveraged national physician survey data to measure level of awareness and variation by physician, practice, and EHR characteristics to inform practice- and policy-based efforts to drive medical-social care integration. We identify higher levels of social needs documentation awareness among physicians practicing in community health centers, those participating in payment models with social care initiatives, and those aware of other advanced EHR functionalities. Findings indicate that there are opportunities to improve physician education and training around new EHR-based SDH functionalities.
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Affiliation(s)
- Bradley E Iott
- Center for Clinical Informatics and Improvement Research, University of California, San Francisco (UCSF), San Francisco, California, USA
- Social Interventions Research and Evaluation Network, UCSF, San Francisco, California, USA
| | - Matthew S Pantell
- Department of Pediatrics, UCSF, San Francisco, California, USA
- Center for Health and Community, UCSF, San Francisco, California, USA
| | - Julia Adler-Milstein
- Center for Clinical Informatics and Improvement Research, University of California, San Francisco (UCSF), San Francisco, California, USA
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Laura M Gottlieb
- Social Interventions Research and Evaluation Network, UCSF, San Francisco, California, USA
- Center for Health and Community, UCSF, San Francisco, California, USA
- Department of Family and Community Medicine, UCSF, San Francisco, California, USA
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Wowak KD, Handley S, Kelley K, Angst CM. Strategic sourcing of multicomponent software systems: The case of electronic medical records. DECISION SCIENCES 2022. [DOI: 10.1111/deci.12576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kaitlin D. Wowak
- Department of IT, Analytics, and Operations, Mendoza College of Business University of Notre Dame Notre Dame Indiana
| | - Sean Handley
- Department of Management Science, Darla Moore School of Business University of South Carolina Columbia South Carolina
| | - Ken Kelley
- Department of IT, Analytics, and Operations, Mendoza College of Business University of Notre Dame Notre Dame Indiana
| | - Corey M. Angst
- Department of IT, Analytics, and Operations, Mendoza College of Business University of Notre Dame Notre Dame Indiana
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Jimma BL, Enyew DB. Barriers to the acceptance of electronic medical records from the perspective of physicians and nurses:A scoping review. INFORMATICS IN MEDICINE UNLOCKED 2022. [DOI: 10.1016/j.imu.2022.100991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Rhoades CA, Whitacre BE, Davis AF. Higher Electronic Health Record Functionality Is Associated with Lower Operating Costs in Urban—but Not Rural—Hospitals. Appl Clin Inform 2022; 13:665-676. [PMID: 35926839 PMCID: PMC9329141 DOI: 10.1055/s-0042-1750415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives
The aim of the study is to examine the relationship between electronic health record (EHR) use/functionality and hospital operating costs (divided into five subcategories), and to compare the results across rural and urban facilities.
Methods
We match hospital-level data on EHR use/functionality with operating costs and facility characteristics to perform linear regressions with hospital- and time-fixed effects on a panel of 1,596 U.S. hospitals observed annually from 2016 to 2019. Our dependent variables are the logs of the various hospital operating cost categories, and alternative metrics for EHR use/functionality serve as the primary independent variables of interest. Data on EHR use/functionality are retrieved from the American Hospital Association's (AHA) Annual Survey of Hospitals Information Technology (IT) Supplement, and hospital operating cost and characteristic data are retrieved from the American Hospital Directory. We include only hospitals classified as “general medical and surgical,” removing specialty hospitals.
Results
Our results suggest, first, that increasing levels of EHR functionality are associated with hospital operating cost reductions. Second, that these significant cost reductions are exclusively seen in urban hospitals, with the associated coefficient suggesting cost savings of 0.14% for each additional EHR function. Third, that urban EHR-related cost reductions are driven by general/ancillary and outpatient costs. Finally, that a wide variety of EHR functions are associated with cost reductions for urban facilities, while no EHR function is associated with significant cost reductions in rural locations.
Conclusion
Increasing EHR functionality is associated with significant hospital operating cost reductions in urban locations. These results do not hold across geographies, and policies to promote greater EHR functionality in rural hospitals will likely not lead to short-term cost reductions.
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Affiliation(s)
- Claudia A. Rhoades
- Department of Agricultural Economics, Oklahoma State University, Stillwater, Oklahoma, United States
| | - Brian E. Whitacre
- Department of Agricultural Economics, Oklahoma State University, Stillwater, Oklahoma, United States
| | - Alison F. Davis
- Department of Agricultural Economics, University of Kentucky, Lexington, Kentucky, United States
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Apathy NC, Holmgren AJ, Adler-Milstein J. A decade post-HITECH: Critical access hospitals have electronic health records but struggle to keep up with other advanced functions. J Am Med Inform Assoc 2021; 28:1947-1954. [PMID: 34198342 PMCID: PMC8363800 DOI: 10.1093/jamia/ocab102] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/03/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Despite broad electronic health record (EHR) adoption in U.S. hospitals, there is concern that an "advanced use" digital divide exists between critical access hospitals (CAHs) and non-CAHs. We measured EHR adoption and advanced use over time to analyzed changes in the divide. MATERIALS AND METHODS We used 2008 to 2018 American Hospital Association Information Technology survey data to update national EHR adoption statistics. We stratified EHR adoption by CAH status and measured advanced use for both patient engagement (PE) and clinical data analytics (CDA) domains. We used a linear probability regression for each domain with year-CAH interactions to measure temporal changes in the relationship between CAH status and advanced use. RESULTS In 2018, 98.3% of hospitals had adopted EHRs; there were no differences by CAH status. A total of 58.7% and 55.6% of hospitals adopted advanced PE and CDA functions, respectively. In both domains, CAHs were less likely to be advanced users: 46.6% demonstrated advanced use for PE and 32.0% for CDA. Since 2015, the advanced use divide has persisted for PE and widened for CDA. DISCUSSION EHR adoption among hospitals is essentially ubiquitous; however, CAHs still lag behind in advanced use functions critical to improving care quality. This may be rooted in different advanced use needs among CAH patients and lack of access to technical expertise. CONCLUSIONS The advanced use divide prevents CAH patients from benefitting from a fully digitized healthcare system. To close the widening gap in CDA, policymakers should consider partnering with vendors to develop implementation guides and standards for functions like dashboards and high-risk patient identification algorithms to better support CAH adoption.
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Affiliation(s)
- Nate C Apathy
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Regenstrief Institute, Indianapolis, Indiana, USA
| | - A Jay Holmgren
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Center for Clinical Informatics and Improvement Research, University of California, San Francisco, San Francisco, California, USA
| | - Julia Adler-Milstein
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
- Center for Clinical Informatics and Improvement Research, University of California, San Francisco, San Francisco, California, USA
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Upadhyay S, Opoku-Agyeman W. Factors that Determine Comprehensive Categorical Classification of EHR Implementation Levels. Health Serv Insights 2021; 14:11786329211024788. [PMID: 34188485 PMCID: PMC8212366 DOI: 10.1177/11786329211024788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/21/2021] [Indexed: 11/24/2022] Open
Abstract
Electronic Health Records (EHRs) have the potential to alleviate patient safety
mistakes. Of the various levels of EHR, advanced or higher-level functionalities
of EHR are designed to improve patient safety. Certain organizational and
environmental factors may pose as barriers toward implementing all of the
functionalities, leaving certain hospitals intermediate between basic and
comprehensive levels of implementation. This study identifies a comprehensive
categorical classification that includes hospitals that have functionalities
between basic and comprehensive levels of EHR and determines the organizational
and environmental factors that may influence hospitals to implement one or more
combinations of these categories. A longitudinal panel design was used. Ordinal
logistic regression with random effects model was fitted with robust cluster
standard errors. Our sample consisted of non-federal general acute care
hospitals utilizing a panel design from 2010 to 2016 with 17 586 hospital-year
observations (or an average of 2600 hospitals per year). Larger size hospitals,
ones with higher total margin, metropolitan and urban hospitals, system
affiliated hospitals, and those in higher managed care penetration areas have
higher odds of belonging in one of the higher categories of EHR implementation.
Hospitals that can access a greater amount of human resources and financial
assets from their environments, may implement higher levels of EHR. Initial and
maintenance costs of EHR, interoperability issues, and inability to distribute
high costs of training across facilities may stymie implementation of higher EHR
functionalities. Policymaking to encourage competition among vendors may
possibly lower the implementation price for hospitals with limited
resources.
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Affiliation(s)
- Soumya Upadhyay
- School of Public Health, Department of Healthcare Administration and Policy, University of Nevada at Las Vegas, Las Vegas, NV, USA
| | - William Opoku-Agyeman
- School of Health and Applied Human Sciences, University of North Carolina at Wilmington, Wilmington, NC, USA
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10
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Holmgren AJ, Phelan J, Jha AK, Adler-Milstein J. Hospital organizational strategies associated with advanced EHR adoption. Health Serv Res 2021; 57:259-269. [PMID: 33779993 DOI: 10.1111/1475-6773.13655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 03/05/2021] [Accepted: 03/14/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To identify organizational complementarities of adoption and use of electronic health records (EHRs) and assess what organizational strategies were associated with more advanced EHR use. DATA SOURCES Primary survey data of US hospitals combined with secondary data from the American Hospital Association Annual Survey and IT Supplement. STUDY DESIGN In this cross-sectional study, we describe hospital organizational practices around EHR adoption and use and identify how these practices coalesce into distinct strategies. We then assess the association between those organizational strategies and adoption of advanced EHR functions. DATA COLLECTION Primary data collection consisted of surveys sent to 797 US acute care hospitals in 2018-2019, with 451 complete respondents. PRINCIPAL FINDINGS There was significant variation in hospital organizational practices for EHR adoption and use. Factor analysis identified practices in three domains: leadership engagement, human capital, and systems integration. Hospitals in the top quartile of the leadership engagement factor were 14 percentage points more likely to have adopted patient engagement EHR functions (P = 0.01) while hospitals in the top quartile of human capital were 14 percentage points less likely to have adopted these functions (P = 0.02). Hospitals in the top quartile of systems integration were 12 percentage points more likely to have adopted patient engagement functions (P = 0.02) and 14 percentage points more likely to have adopted EHR data analytics functions (P = 0.02). CONCLUSIONS Our findings suggest that specific organizational strategies are associated with more advanced EHR adoption. Hospital leaders interested in realizing more value from their EHR investment may find it useful to know that there is an association between adoption of more advanced EHR functions, and engaging senior leadership as well as building connectivity between clinical and administrative systems.
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Affiliation(s)
| | - Jessica Phelan
- Harvard T.H. Chan School of Public Health, Harvard Global Health Institute, Cambridge, Massachusetts, USA
| | - Ashish K Jha
- Brown School of Public Health, Providence, Rhode Island, USA
| | - Julia Adler-Milstein
- Center for Clinical Informatics and Improvement Research, University of California, San Francisco, San Francisco, California, USA
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11
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Everson J, Rubin JC, Friedman CP. Reconsidering hospital EHR adoption at the dawn of HITECH: implications of the reported 9% adoption of a "basic" EHR. J Am Med Inform Assoc 2021; 27:1198-1205. [PMID: 32585689 PMCID: PMC7481034 DOI: 10.1093/jamia/ocaa090] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/24/2020] [Accepted: 05/21/2020] [Indexed: 11/12/2022] Open
Abstract
Objective In 2009, a prominent national report stated that 9% of US hospitals had adopted a “basic” electronic health record (EHR) system. This statistic was widely cited and became a memetic anchor point for EHR adoption at the dawn of HITECH. However, its calculation relies on specific treatment of the data; alternative approaches may have led to a different sense of US hospitals’ EHR adoption and different subsequent public policy. Materials and Methods We reanalyzed the 2008 American Heart Association Information Technology supplement and complementary sources to produce a range of estimates of EHR adoption. Estimates included the mean and median number of EHR functionalities adopted, figures derived from an item response theory-based approach, and alternative estimates from the published literature. We then plotted an alternative definition of national progress toward hospital EHR adoption from 2008 to 2018. Results By 2008, 73% of hospitals had begun the transition to an EHR, and the majority of hospitals had adopted at least 6 of the 10 functionalities of a basic system. In the aggregate, national progress toward basic EHR adoption was 58% complete, and, when accounting for measurement error, we estimate that 30% of hospitals may have adopted a basic EHR. Discussion The approach used to develop the 9% figure resulted in an estimate at the extreme lower bound of what could be derived from the available data and likely did not reflect hospitals’ overall progress in EHR adoption. Conclusion The memetic 9% figure shaped nationwide thinking and policy making about EHR adoption; alternative representations of the data may have led to different policy.
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Affiliation(s)
- Jordan Everson
- Department of Health Policy and Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Joshua C Rubin
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Charles P Friedman
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Liang J, Li Y, Zhang Z, Shen D, Xu J, Zheng X, Wang T, Tang B, Lei J, Zhang J. Adoption of Electronic Health Records (EHRs) in China During the Past 10 Years: Consecutive Survey Data Analysis and Comparison of Sino-American Challenges and Experiences. J Med Internet Res 2021; 23:e24813. [PMID: 33599615 PMCID: PMC7932845 DOI: 10.2196/24813] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/29/2020] [Accepted: 01/21/2021] [Indexed: 11/17/2022] Open
Abstract
Background The adoption rate of electronic health records (EHRs) in hospitals has become a main index to measure digitalization in medicine in each country. Objective This study summarizes and shares the experiences with EHR adoption in China and in the United States. Methods Using the 2007-2018 annual hospital survey data from the Chinese Health Information Management Association (CHIMA) and the 2008-2017 United States American Hospital Association Information Technology Supplement survey data, we compared the trends in EHR adoption rates in China and the United States. We then used the Bass model to fit these data and to analyze the modes of diffusion of EHRs in these 2 countries. Finally, using the 2007, 2010, and 2014 CHIMA and Healthcare Information and Management Systems Services survey data, we analyzed the major challenges faced by hospitals in China and the United States in developing health information technology. Results From 2007 to 2018, the average adoption rates of the sampled hospitals in China increased from 18.6% to 85.3%, compared to the increase from 9.4% to 96% in US hospitals from 2008 to 2017. The annual average adoption rates in Chinese and US hospitals were 6.1% and 9.6%, respectively. However, the annual average number of hospitals adopting EHRs was 1500 in China and 534 in the US, indicating that the former might require more effort. Both countries faced similar major challenges for hospital digitalization. Conclusions The adoption rates of hospital EHRs in China and the United States have both increased significantly in the past 10 years. The number of hospitals that adopted EHRs in China exceeded 16,000, which was 3.3 times that of the 4814 nonfederal US hospitals. This faster adoption outcome may have been a benefit of top-level design and government-led policies, particularly the inclusion of EHR adoption as an important indicator for performance evaluation and the appointment of public hospitals.
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Affiliation(s)
- Jun Liang
- IT Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ying Li
- Department of Burns and Plastic Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zhongan Zhang
- Performance Management Department, Qingdao Central Hospital, Qingdao, China
| | - Dongxia Shen
- Editorial Department, Journal of Practical Oncology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jie Xu
- IT Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xu Zheng
- Center for Medical Informatics, Peking University Third Hospital, Beijing, China
| | - Tong Wang
- School of Public Health, Jilin University, Changchun, China
| | - Buzhou Tang
- Shenzhen Graduate School, Harbin Institute of Technology, Shenzhen, China
| | - Jianbo Lei
- Center for Medical Informatics, Peking University Third Hospital, Beijing, China.,Institute of Medical Technology, Health Science Center, Peking University, Beijing, China.,School of Medical Informatics and Engineering, Southwest Medical University, Luzhou, China
| | - Jiajie Zhang
- School of Biomedical Informatics, University of Texas Health Sciences Center, Houston, TX, United States
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Grossman LV, Masterson Creber RM, Benda NC, Wright D, Vawdrey DK, Ancker JS. Interventions to increase patient portal use in vulnerable populations: a systematic review. J Am Med Inform Assoc 2021; 26:855-870. [PMID: 30958532 DOI: 10.1093/jamia/ocz023] [Citation(s) in RCA: 121] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/05/2019] [Accepted: 02/12/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND More than 100 studies document disparities in patient portal use among vulnerable populations. Developing and testing strategies to reduce disparities in use is essential to ensure portals benefit all populations. OBJECTIVE To systematically review the impact of interventions designed to: (1) increase portal use or predictors of use in vulnerable patient populations, or (2) reduce disparities in use. MATERIALS AND METHODS A librarian searched Ovid MEDLINE, EMBASE, CINAHL, and Cochrane Reviews for studies published before September 1, 2018. Two reviewers independently selected English-language research articles that evaluated any interventions designed to impact an eligible outcome. One reviewer extracted data and categorized interventions, then another assessed accuracy. Two reviewers independently assessed risk of bias. RESULTS Out of 18 included studies, 15 (83%) assessed an intervention's impact on portal use, 7 (39%) on predictors of use, and 1 (6%) on disparities in use. Most interventions studied focused on the individual (13 out of 26, 50%), as opposed to facilitating conditions, such as the tool, task, environment, or organization (SEIPS model). Twelve studies (67%) reported a statistically significant increase in portal use or predictors of use, or reduced disparities. Five studies (28%) had high or unclear risk of bias. CONCLUSION Individually focused interventions have the most evidence for increasing portal use in vulnerable populations. Interventions affecting other system elements (tool, task, environment, organization) have not been sufficiently studied to draw conclusions. Given the well-established evidence for disparities in use and the limited research on effective interventions, research should move beyond identifying disparities to systematically addressing them at multiple levels.
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Affiliation(s)
- Lisa V Grossman
- Department of Biomedical Informatics, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | | | - Natalie C Benda
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York, USA
| | - Drew Wright
- Samuel J Wood Library, Information Technologies and Services, Weill Cornell Medicine, New York, New York, USA
| | - David K Vawdrey
- Department of Biomedical Informatics, College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Value Institute, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Jessica S Ancker
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, New York, USA
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14
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Implementation status of health information systems in hospitals in the eastern province of Saudi Arabia. INFORMATICS IN MEDICINE UNLOCKED 2021. [DOI: 10.1016/j.imu.2020.100499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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15
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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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16
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Kose I, Rayner J, Birinci S, Ulgu MM, Yilmaz I, Guner S. Adoption rates of electronic health records in Turkish Hospitals and the relation with hospital sizes. BMC Health Serv Res 2020; 20:967. [PMID: 33087106 PMCID: PMC7580017 DOI: 10.1186/s12913-020-05767-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 09/27/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Nation-wide adoption of electronic health records (EHRs) in hospitals has become a Turkish policy priority in recognition of their benefits in maintaining the overall quality of clinical care. The electronic medical record maturity model (EMRAM) is a widely used survey tool developed by the Healthcare Information and Management Systems Society (HIMSS) to measure the rate of adoption of EHR functions in a hospital or a secondary care setting. Turkey completed many standardizations and infrastructural improvement initiatives in the health information technology (IT) domain during the first phase of the Health Transformation Program between 2003 and 2017. Like the United States of America (USA), the Turkish Ministry of Health (MoH) applied a bottom-up approach to adopting EHRs in state hospitals. This study aims to measure adoption rates and levels of EHR use in state hospitals in Turkey and investigate any relationship between adoption and use and hospital size. METHODS EMRAM surveys were completed by 600 (68.9%) state hospitals in Turkey between 2014 and 2017. The availability and prevalence of medical information systems and EHR functions and their use were measured. The association between hospital size and the availability/prevalence of EHR functions was also calculated. RESULTS We found that 63.1% of all hospitals in Turkey have at least basic EHR functions, and 36% have comprehensive EHR functions, which compares favourably to the results of Korean hospitals in 2017, but unfavorably to the results of US hospitals in 2015 and 2017. Our findings suggest that smaller hospitals are better at adopting certain EHR functions than larger hospitals. CONCLUSION Measuring the overall adoption rates of EHR functions is an emerging approach and a beneficial tool for the strategic management of countries. This study is the first one covering all state hospitals in a country using EMRAM. The bottom-up approach to adopting EHR in state hospitals that was successful in the USA has also been found to be successful in Turkey. The results are used by the Turkish MoH to disseminate the nation-wide benefits of EHR functions.
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Affiliation(s)
- Ilker Kose
- Department of Health System Engineering, Istanbul Medipol University, 34810 Istanbul, Turkey
| | - John Rayner
- HIMSS Analytics for Europe and Latin America, Huddersfield, UK
| | | | | | | | - Seyma Guner
- Istanbul Medipol University, 34810 Istanbul, Turkey
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17
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Recio-Boiles A, Karass M, Galeas JN, Sukrithan V, Gutwein AH, Babiker HM. Implementation of a Low-Cost Quality Improvement Intervention Increases Adherence to Cancer Screening Guidelines and Reduces Healthcare Costs at a University Medical Center. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:930-936. [PMID: 31093906 DOI: 10.1007/s13187-019-01544-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Adherence to US Preventative Services Task Force (USPSTF) cancer screening guidelines remains considerably lower than the recommendation of the Healthy People 2020 initiative. Patient populations recommended for screening are not screened at an appropriate rate, and populations not recommended for screening are inappropriately screened. Closer adherence to guidelines should improve outcomes and reduce costs, estimated to reach $158 billion/year by 2020. We evaluated whether a use of low-cost educational health maintenance (HM) card by medical residents at a university hospital could impact education and adherence to updated cancer screening guidelines. We also analyzed savings to the healthcare system. Adherence to cervical, breast, and colorectal cancer screening guidelines, defined as percentage that was screened (or not screened) in accordance with the USPSTF guidelines, in clinic visits from December 2012 (n = 336) was compared to those from December 2013 (n = 306) after a quality improvement intervention. Post-intervention, adherence to screening guidelines increased by 40.8% (p < 0.01) for cervical, 33.2% (p < 0.01) for breast, and 20.5% (p < 0.01) for colorectal cancer in average-risk patients. Inappropriate screening was reduced by 26.8% (p < 0.01) for cervical and 32.8% (p < 0.01) for breast cancer. A non-significant 1.1% decrease (p = 0.829) was observed for colorectal cancer. The annual potential savings from avoiding inappropriate screenings were $998,316 (95% CI; $644,484-$1,352,148). We showed a significant absolute increase in USPSTF knowledge of 28.3% irrespective of the house staff level that remained high at 2 years from the educational intervention. The low-cost HM card increased appropriate knowledgeable cancer screening adherence while reducing unnecessary testing and producing substantial savings to the healthcare system.
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Affiliation(s)
- Alejandro Recio-Boiles
- Fellow in Hematology and Medical Oncology, University of Arizona Cancer Center, 1515 N Campbell Av, Room 1969, Tucson, AZ, 85724, USA.
- Jacobi Medical Center, Department of Medicine, Albert Einstein College of Medicine, New York City, NY, USA.
| | - Michael Karass
- Westchester Medical Center-Department of Medicine, New York Medical College, Valhalla, NY, USA
| | - Jose N Galeas
- Jacobi Medical Center, Department of Medicine, Albert Einstein College of Medicine, New York City, NY, USA
| | - Vineeth Sukrithan
- Jacobi Medical Center, Department of Medicine, Albert Einstein College of Medicine, New York City, NY, USA
| | - Andrew H Gutwein
- Jacobi Medical Center, Department of Medicine, Albert Einstein College of Medicine, New York City, NY, USA
| | - Hani M Babiker
- University of Arizona Cancer Center, Department of Medicine, The University of Arizona, Tucson, AZ, USA
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18
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Bujnowska-Fedak MM, Wysoczański Ł. Access to an Electronic Health Record: A Polish National Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176165. [PMID: 32854345 PMCID: PMC7503705 DOI: 10.3390/ijerph17176165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/09/2020] [Accepted: 08/18/2020] [Indexed: 01/02/2023]
Abstract
In Poland, as in many countries around the world, e-health services are becoming more and more popular. Obligatory e-sick leave was implemented, followed by e-prescriptions and e-referrals. Therefore, it is worth considering the introduction of a complete electronic health record (EHR) that can be accessed by doctors and patients. The main aim of the study is to find out whether patients want to have access to their EHRs and if they would agree to pay for such a service. The research was based on three surveys conducted among 1000 Polish adults in 2007, 2012, and 2018. The sample collection was carried out by the national opinion poll agency, with the use of computer-assisted telephone interviews. Over 60% of respondents were interested in the possibility of accessing EHRs in general, and almost 50% of them were ready to pay for it. Nevertheless, when analyzing all the year-on-year trends, they were subject to a gradual decrease. The youngest age group was the one most interested in EHRs, while the group comprising respondents in middle age was the one most willing to pay for it. There is still great potential in implementing EHRs on a bigger scale.
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19
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Espinoza J, Shah P, Raymond J. Integrating Continuous Glucose Monitor Data Directly into the Electronic Health Record: Proof of Concept. Diabetes Technol Ther 2020; 22:570-576. [PMID: 31904260 DOI: 10.1089/dia.2019.0377] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background: Continuous glucose monitoring (CGM) systems are widely and increasingly used in diabetes self-management and in the context of clinic visits. However, access to CGM data during visits can be challenging. Clinic inefficiencies can restrict the time available for patient education, and the inability to integrate CGM data into electronic health record (EHR) systems can result in data being lost. In this study, we describe our institution's approach to integrating CGM data directly into the EHR through a partnership with a CGM device manufacturer and without a third-party data aggregation/data visualization platform. Methods: We interviewed key stakeholders with the hospital Information Technology Department, the Division of Pediatric Endocrinology, and a CGM device manufacturer. A collaborative, human-centered design approach was used to define the workflow. Health Level 7 (HL7) standards were used to build all data exchanges. Results: In collaboration with all parties, we created a simple network architecture design for both account linkage and data acquisition. The system uses the standard, computerized, physician order entry interface available in the EHR for both processes. Data acquisition occurs in real time, and customized reports are displayed within the results section of the EHR. The entire process is Health Insurance Portability and Accountability Act (HIPAA) compliant and meets all security requirements. Conclusions: Building scalable data integration using HL7 standards is possible and allows real-time access to CGM data within the diabetes provider's existing workflow and can occur with or without the patient present. This may lead to improved clinical outcomes, increased efficiency, and new revenue opportunities by documenting CGM data capture and review.
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Affiliation(s)
- Juan Espinoza
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Payal Shah
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Jennifer Raymond
- Keck School of Medicine, University of Southern California, Los Angeles, California
- Division of Endocrinology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
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20
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Adler-Milstein J, Raphael K, Bonner A, Pelton L, Fulmer T. Hospital adoption of electronic health record functions to support age-friendly care: results from a national survey. J Am Med Inform Assoc 2020; 27:1206-1213. [PMID: 32772089 DOI: 10.1093/jamia/ocaa129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/08/2020] [Accepted: 06/03/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To measure US hospitals' adoption of electronic health record (EHR) functions that support care for older adults, focusing on structured documentation of the 4Ms (What Matters, Medication, Mentation, and Mobility) and electronic health information exchange/communication with patients, caregivers, and long-term care providers. MATERIALS AND METHODS In an online survey of a national, random sample of 797 US acute-care hospitals in 2018-2019, 479 (60.1%) responded. We calculated nationally representative measures of the percentages of hospitals with EHRs that include structured documentation of the 4Ms and exchange/communications functions. RESULTS Structured EHR documentation of the 4Ms was fully implemented in at least 1 unit in 64.0% of hospitals and across all units in 41.5% of hospitals. Of the 4Ms, structured documentation was the highest for medications (91.3% in at least 1 unit) and the lowest for mentation (70.3% in at least 1 unit). All exchange/communication functions had been implemented in at least 1 unit in 16.2% of facilities and across all units in 7.6% of hospitals. Less than half of the hospitals had an EHR portal for long-term care facilities to access hospital information (45.4% in at least 1 unit), sent information electronically to long-term care facilities (44.6%), and had training for adults/caregivers on the patient portal (32.1%). DISCUSSION Despite significant national investment in EHRs, hospital EHRs do not yet include key documentation, exchange, and communication functions needed to support evidence-based care for the older adults who comprise the majority of the inpatient population. Additional policy efforts are likely needed to promote the expansion of EHR capabilities into these high-value domains. CONCLUSIONS US acute-care hospital EHRs are lacking key functions that support care for older adults.
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Affiliation(s)
- Julia Adler-Milstein
- Department of Medicine & Center for Clinical Informatics and Improvement Research, University of California San Francisco, San Francisco, California, USA
| | - Katherine Raphael
- Department of Health Policy, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Alice Bonner
- Institute for Healthcare Improvement, Boston, Massachusetts, USA
| | - Leslie Pelton
- Institute for Healthcare Improvement, Boston, Massachusetts, USA
| | - Terry Fulmer
- John A. Hartford Foundation, New York City, New York, USA
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21
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Niazkhani Z, Toni E, Cheshmekaboodi M, Georgiou A, Pirnejad H. Barriers to patient, provider, and caregiver adoption and use of electronic personal health records in chronic care: a systematic review. BMC Med Inform Decis Mak 2020; 20:153. [PMID: 32641128 PMCID: PMC7341472 DOI: 10.1186/s12911-020-01159-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/22/2020] [Indexed: 11/21/2022] Open
Abstract
Background Electronic personal health records (ePHRs) are defined as electronic applications through which individuals can access, manage, and share health information in a private, secure, and confidential environment. Existing evidence shows their benefits in improving outcomes, especially for chronic disease patients. However, their use has not been as widespread as expected partly due to barriers faced in their adoption and use. We aimed to identify the types of barriers to a patient, provider, and caregiver adoption/use of ePHRs and to analyze their extent in chronic disease care. Methods A systematic search in Medline, PubMed, Science Direct, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Central Register of Controlled Trials, and the Institute of Electrical and Electronics Engineers (IEEE) database was performed to find original studies assessing barriers to ePHR adoption/use in chronic care until the end of 2018. Two researchers independently screened and extracted data. We used the PHR adoption model and the Unified Theory of Acceptance and Use of Technology to analyze the results. The Mixed Methods Appraisal Tool (MMAT) version 2018 was used to assess the quality of evidence in the included studies. Results Sixty publications met our inclusion criteria. Issues found hindering ePHR adoption/use in chronic disease care were associated with demographic factors (e.g., patient age and gender) along with key variables related to health status, computer literacy, preferences for direct communication, and patient’s strategy for coping with a chronic condition; as well as factors related to medical practice/environment (e.g., providers’ lack of interest or resistance to adopting ePHRs due to workload, lack of reimbursement, and lack of user training); technological (e.g., concerns over privacy and security, interoperability with electronic health record systems, and lack of customized features for chronic conditions); and chronic disease characteristics (e.g., multiplicities of co-morbid conditions, settings, and providers involved in chronic care). Conclusions ePHRs can be meaningfully used in chronic disease care if they are implemented as a component of comprehensive care models specifically developed for this care. Our results provide insight into hurdles and barriers mitigating ePHR adoption/use in chronic disease care. A deeper understating of the interplay between these barriers will provide opportunities that can lead to an enhanced ePHR adoption/use.
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Affiliation(s)
- Zahra Niazkhani
- Nephrology and Kidney Transplant Research Center, Urmia University of Medical Sciences, Urmia, Iran.,Department of Health Information Technology, Urmia University of Medical Sciences, Urmia, Iran
| | - Esmaeel Toni
- Department of Health Information Technology, Urmia University of Medical Sciences, Urmia, Iran.,Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
| | - Mojgan Cheshmekaboodi
- Office for Disease Registry and Health Outcomes, Urmia University of Medical Sciences, Urmia, Iran
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Habibollah Pirnejad
- Department of Health Information Technology, Urmia University of Medical Sciences, Urmia, Iran. .,Patient Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran. .,Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands.
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22
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Hu X, Qu H, Houser SH, Chen H, Zhou J, Yu M. Hospital Characteristics Associated with Certified EHR Adoption among US Psychiatric Hospitals. Risk Manag Healthc Policy 2020; 13:295-301. [PMID: 32308512 PMCID: PMC7135123 DOI: 10.2147/rmhp.s241553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/14/2020] [Indexed: 11/23/2022] Open
Abstract
Objective The aim of this study was to explore the relationship between hospital characteristics and certified electronic health record (EHR) adoption in psychiatric hospitals in the US. Methods Data were drawn from the American Hospital Association Annual Survey Database and the Centers for Medicare and Medicaid Services Hospital Compare data sets in 2016. Binary logistic regression analysis and χ2 tests were performed to examine the relationship between certified EHR adoption and hospital characteristics. Results Of 1,059 psychiatric hospitals in the US, 502 (47.4%) have adopted certified EHR technology. Large hospitals (OR 2.29, 95% CI 1.52–3.44; p<0.001), not-for-profit hospitals (OR 1.74, 95% CI 1.22–2.49; p=0.008), and hospitals participating in a network (OR 1.78, 95% CI 1.34–2.37; p<0.001) were more likely to adopt certified EHRs. Hospitals in the northeast were less likely to implement certified EHRs compared to other regions. However, there was no significant association found between EHR utilization and system affiliation, urban location, teaching status, or participation of health-maintenance organizations and preferred provider organizations. Conclusion The study results suggested variations in EHR adoption according to hospital location, size, ownership, and network participation. This study fills a gap in previous work on certified EHR adoption that focused exclusively on general hospitals, but overlooked psychiatric hospitals. Future policies designed to influence the implementation of certified EHRs should take into consideration how hospital size, ownership, and network-affiliation status affect certified EHR adoption among psychiatric hospitals.
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Affiliation(s)
- Xuejun Hu
- Department of Health Services Administration, Air Force Medical University, Xi'an, People's Republic of China.,Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Haiyan Qu
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shannon H Houser
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Huoliang Chen
- Department of Health Services Administration, Air Force Medical University, Xi'an, People's Republic of China
| | - Jinming Zhou
- Department of Health Services Administration, Air Force Medical University, Xi'an, People's Republic of China
| | - Min Yu
- Department of Health Services Administration, Academy of Military Medical Sciences, Beijing, People's Republic of China
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Huilgol YS, Miron-Shatz T, Joshi AU, Hollander JE. Hospital Telehealth Adoption Increased in 2014 and 2015 and Was Influenced by Population, Hospital, and Policy Characteristics. Telemed J E Health 2020; 26:455-461. [DOI: 10.1089/tmj.2019.0029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Yash S. Huilgol
- Department of Surgery, University of California San Francisco, San Francisco, California
- Center for Health and Well-Being, Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, New Jersey
| | - Talya Miron-Shatz
- Center for Medical Decision Making, Ono Academic College, Ono, Israel
- Winton Centre for Risk and Evidence Communication, University of Cambridge, Cambridge, United Kingdom
| | - Aditi U. Joshi
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
- Telehealth and JeffConnect, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - Judd E. Hollander
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
- Telehealth and JeffConnect, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
- National Academic Center for Telehealth, Thomas Jefferson University, Philadelphia, Pennsylvania
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Liang J, Li Y, Zhang Z, Shen D, Xu J, Yu G, Dai S, Ge F, Lei J. Evaluating the Applications of Health Information Technologies in China During the Past 11 Years: Consecutive Survey Data Analysis. JMIR Med Inform 2020; 8:e17006. [PMID: 32039815 PMCID: PMC7055786 DOI: 10.2196/17006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/10/2019] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Abstract
Background To achieve universal access to medical resources, China introduced its second health care reform in 2010, with health information technologies (HIT) as an important technical support point. Objective This study is the first attempt to explore the unique contributions and characteristics of HIT development in Chinese hospitals from the three major aspects of hospital HIT—human resources, funding, and materials—in an all-around, multi-angled, and time-longitudinal manner, so as to serve as a reference for decision makers in China and the rest of the world when formulating HIT development strategies. Methods A longitudinal research method is used to analyze the results of the CHIMA Annual Survey of Hospital Information System in China carried out by a Chinese national industrial association, CHIMA, from 2007 to 2018. The development characteristics of human resources, funding, and materials of HIT in China for the past 12 years are summarized. The Bass model is used to fit and predict the popularization trend of EMR in Chinese hospitals from 2007 to 2020. Results From 2007 to 2018, the CHIMA Annual Survey interviewed 10,954 hospital CIOs across 32 administrative regions in Mainland China. Compared with 2007, as of 2018, in terms of human resources, the average full time equivalent (FTE) count in each hospital’s IT center is still lower than the average level of US counterparts in 2014 (9.66 FTEs vs. 34 FTEs). The proportion of CIOs with a master’s degree or above was 25.61%, showing an increase of 18.51%, among which those with computer-related backgrounds accounted for 64.75%, however, those with a medical informatics background only accounted for 3.67%. In terms of funding, the sampled hospitals’ annual HIT investment increased from ¥957,700 (US $136,874) to ¥6.376 million (US $911,261), and the average investment per bed increased from ¥4,600 (US $658) to ¥8,100 (US $1158). In terms of information system construction, as of 2018, the average EMR implementation rate of the sampled hospitals exceeded the average level of their US counterparts in 2015 and their German counterparts in 2017 (85.26% vs. 83.8% vs. 68.4%, respectively). The results of the Bass prediction model show that Chinese hospitals will likely reach an adoption rate of 91.4% by 2020 (R2=0.95). Conclusions In more than 10 years, based on this top-down approach, China’s medical care industry has accepted government instructions and implemented the unified model planned by administrative intervention. With only about one-fifth of the required funding, and about one-fourth of the required human resources per hospital as compared to the US HITECH project, China’s EMR coverage in 2018 exceeded the average level of its US counterparts in 2015 and German counterparts in 2017. This experience deserves further study and analysis by other countries.
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Affiliation(s)
- Jun Liang
- IT Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ying Li
- Department of Burn and Plastic Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Zhongan Zhang
- Performance Management Department, Qingdao Central Hospital, Qingdao, China
| | - Dongxia Shen
- Editorial Department of Journal of Practical Oncology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jie Xu
- IT Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Gang Yu
- IT Center, Children's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Siqi Dai
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Fangmin Ge
- International Network Medical Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jianbo Lei
- Center for Medical Informatics, Peking University, Beijing, China.,Institute of Medical Technology, Health Science Center, Peking University, Beijing, China.,School of Medical Informatics and Engineering, Southwest Medical University, Luzhou, China
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25
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Health information exchange: What matters at the organizational level? J Biomed Inform 2020; 102:103375. [DOI: 10.1016/j.jbi.2020.103375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 12/12/2019] [Accepted: 01/05/2020] [Indexed: 11/24/2022]
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Abstract
BACKGROUND The electronic medical record (EMR) is considered to be a vital tool of information and communication technology (ICT) to improve the quality of medical care, but the limited adoption of EMR by physicians results in a considerable warning to its successful implementation. The purpose of the present review is to explore and identify the potential barriers perceived by physicians in the adoption of EMR. METHODS The systematic review was carried out based on literature published in 5 databases: PubMed, Web of Science, Scopus, The Cochrane Library, and ProQuest from 2014 to 2018, concerning barriers perceived by physicians to the adoption of EMR. RESULTS The present study incorporates 26 articles based on their appropriateness out of 1354 for the final analysis. Authors explore 25 barriers that appeared 112 times in the literature for the present review; the top 5 frequently mentioned barriers are privacy and security concerns, high start-up cost, workflow changes, system complexity, lack of reliability, and interoperability. CONCLUSION The systematic review explores that physicians deal with different barriers as they intend to adopt EMR. The barriers explored in the present review are the potential to play as references for the implementer of the EMR system. Thus an attentive analysis of the definitive condition is needed before relevant intervention is determined as the implementation of EMR must be considered as a behavioral change in medical practice.
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Chan L, Beers K, Yau AA, Chauhan K, Duffy Á, Chaudhary K, Debnath N, Saha A, Pattharanitima P, Cho J, Kotanko P, Federman A, Coca SG, Van Vleck T, Nadkarni GN. Natural language processing of electronic health records is superior to billing codes to identify symptom burden in hemodialysis patients. Kidney Int 2019; 97:383-392. [PMID: 31883805 DOI: 10.1016/j.kint.2019.10.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 09/27/2019] [Accepted: 10/18/2019] [Indexed: 02/07/2023]
Abstract
Symptoms are common in patients on maintenance hemodialysis but identification is challenging. New informatics approaches including natural language processing (NLP) can be utilized to identify symptoms from narrative clinical documentation. Here we utilized NLP to identify seven patient symptoms from notes of maintenance hemodialysis patients of the BioMe Biobank and validated our findings using a separate cohort and the MIMIC-III database. NLP performance was compared for symptom detection with International Classification of Diseases (ICD)-9/10 codes and the performance of both methods were validated against manual chart review. From 1034 and 519 hemodialysis patients within BioMe and MIMIC-III databases, respectively, the most frequently identified symptoms by NLP were fatigue, pain, and nausea/vomiting. In BioMe, sensitivity for NLP (0.85 - 0.99) was higher than for ICD codes (0.09 - 0.59) for all symptoms with similar results in the BioMe validation cohort and MIMIC-III. ICD codes were significantly more specific for nausea/vomiting in BioMe and more specific for fatigue, depression, and pain in the MIMIC-III database. A majority of patients in both cohorts had four or more symptoms. Patients with more symptoms identified by NLP, ICD, and chart review had more clinical encounters. NLP had higher specificity in inpatient notes but higher sensitivity in outpatient notes and performed similarly across pain severity subgroups. Thus, NLP had higher sensitivity compared to ICD codes for identification of seven common hemodialysis-related symptoms, with comparable specificity between the two methods. Hence, NLP may be useful for the high-throughput identification of patient-centered outcomes when using electronic health records.
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Affiliation(s)
- Lili Chan
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Charles Bronfman Institute for Personalized Medicine, Department of Genetics and Genomics Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Kelly Beers
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amy A Yau
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kinsuk Chauhan
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Áine Duffy
- The Charles Bronfman Institute for Personalized Medicine, Department of Genetics and Genomics Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kumardeep Chaudhary
- The Charles Bronfman Institute for Personalized Medicine, Department of Genetics and Genomics Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Neha Debnath
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Aparna Saha
- The Charles Bronfman Institute for Personalized Medicine, Department of Genetics and Genomics Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Pattharawin Pattharanitima
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Judy Cho
- The Charles Bronfman Institute for Personalized Medicine, Department of Genetics and Genomics Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter Kotanko
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Renal Research Institute, New York, New York, USA
| | - Alex Federman
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Steven G Coca
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tielman Van Vleck
- The Charles Bronfman Institute for Personalized Medicine, Department of Genetics and Genomics Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Girish N Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; The Charles Bronfman Institute for Personalized Medicine, Department of Genetics and Genomics Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Yeung T. Local health department adoption of electronic health records and health information exchanges and its impact on population health. Int J Med Inform 2019; 128:1-6. [DOI: 10.1016/j.ijmedinf.2019.04.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 02/21/2019] [Accepted: 04/15/2019] [Indexed: 10/26/2022]
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Greenwood BN, Ganju KK, Angst CM. How Does the Implementation of Enterprise Information Systems Affect a Professional’s Mobility? An Empirical Study. INFORMATION SYSTEMS RESEARCH 2019. [DOI: 10.1287/isre.2018.0817] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Brad N. Greenwood
- Information and Decision Sciences, Carlson School of Management, University of Minnesota, Minneapolis, Minnesota 55455
| | - Kartik K. Ganju
- Desautels Faculty of Management, McGill University, Montréal, Quebec H3A 1G5, Canada
| | - Corey M. Angst
- Information Technology, Analytics, and Operations, Mendoza College of Business, University of Notre Dame, Notre Dame, Indiana 46556
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VitalSign 6: A Primary Care First (PCP-First) Model for Universal Screening and Measurement-Based Care for Depression. Pharmaceuticals (Basel) 2019; 12:ph12020071. [PMID: 31091770 PMCID: PMC6630588 DOI: 10.3390/ph12020071] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/03/2019] [Accepted: 05/08/2019] [Indexed: 12/15/2022] Open
Abstract
Major depressive disorder affects one in five adults in the United States. While practice guidelines recommend universal screening for depression in primary care settings, clinical outcomes suffer in the absence of optimal models to manage those who screen positive for depression. The current practice of employing additional mental health professionals perpetuates the assumption that primary care providers (PCP) cannot effectively manage depression, which is not feasible, due to the added costs and shortage of mental health professionals. We have extended our previous work, which demonstrated similar treatment outcomes for depression in primary care and psychiatric settings, using measurement-based care (MBC) by developing a model, called Primary Care First (PCP-First), that empowers PCPs to effectively manage depression in their patients. This model incorporates health information technology tools, through an electronic health records (EHR) integrated web-application and facilitates the following five components: (1) Screening (2) diagnosis (3) treatment selection (4) treatment implementation and (5) treatment revision. We have implemented this model as part of a quality improvement project, called VitalSign6, and will measure its success using the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework. In this report, we provide the background and rationale of the PCP-First model and the operationalization of VitalSign6 project.
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Sieja A, Markley K, Pell J, Gonzalez C, Redig B, Kneeland P, Lin CT. Optimization Sprints: Improving Clinician Satisfaction and Teamwork by Rapidly Reducing Electronic Health Record Burden. Mayo Clin Proc 2019; 94:793-802. [PMID: 30824281 DOI: 10.1016/j.mayocp.2018.08.036] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/25/2018] [Accepted: 08/20/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate a novel clinic-focused Sprint process (an intensive team-based intervention) to optimize electronic health record (EHR) efficiency. METHODS An 11-member team including 1 project manager, 1 physician informaticist, 1 nurse informaticist, 4 EHR analysts, and 4 trainers worked in conjunction with clinic leaders to conduct on-site EHR and workflow optimization for 2 weeks. The Sprint intervention included clinician and staff EHR training, building specialty-specific EHR tools, and redesigning teamwork. We used Agile project management principles to prioritize and track optimization requests. We surveyed clinicians about EHR burden, satisfaction with EHR, teamwork, and burnout 60 days before and 2 weeks after Sprint. We describe the curriculum, pre-Sprint planning, survey instruments, daily schedule, and strategies for clinician engagement. RESULTS We report the results of Sprint in 6 clinics. With the use of the Net Promoter Score, clinician satisfaction with the EHR increased from -15 to +12 (-100 [worst] to +100 [best]). The Net Promoter Score for Sprint was +52. Perceptions of "We provide excellent care with the EHR," "Our clinic's use of the EHR has improved," and "Time spent charting" all improved. We report clinician satisfaction with specific Sprint activities. The percentage of clinicians endorsing burnout was 39% (47/119) before and 34% (37/107) after the intervention. Response rates to the survey questions were 47% (97/205) to 61% (89/145). CONCLUSION The EHR optimization Sprint is highly recommended by clinicians and improves teamwork and satisfaction with the EHR. Key members of the Sprint team as well as effective local clinic leaders are crucial to success.
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Affiliation(s)
- Amber Sieja
- Division of General Medicine, University of Colorado School of Medicine, Aurora
| | | | - Jonathan Pell
- Division of General Medicine, University of Colorado School of Medicine, Aurora
| | | | | | - Patrick Kneeland
- Division of General Medicine, University of Colorado School of Medicine, Aurora
| | - Chen-Tan Lin
- Division of General Medicine, University of Colorado School of Medicine, Aurora.
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Masterson Creber RM, Grossman LV, Ryan B, Qian M, Polubriaginof FCG, Restaino S, Bakken S, Hripcsak G, Vawdrey DK. Engaging hospitalized patients with personalized health information: a randomized trial of an inpatient portal. J Am Med Inform Assoc 2019; 26:115-123. [PMID: 30534990 PMCID: PMC6339515 DOI: 10.1093/jamia/ocy146] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/02/2018] [Accepted: 10/16/2018] [Indexed: 11/13/2022] Open
Abstract
Objective To determine the effects of an inpatient portal intervention on patient activation, patient satisfaction, patient engagement with health information, and 30-day hospital readmissions. Methods and Materials From March 2014 to May 2017, we enrolled 426 English- or Spanish-speaking patients from 2 cardiac medical-surgical units at an urban academic medical center. Patients were randomized to 1 of 3 groups: 1) usual care, 2) tablet with general Internet access (tablet-only), and 3) tablet with an inpatient portal. The primary study outcome was patient activation (Patient Activation Measure-13). Secondary outcomes included all-cause readmission within 30 days, patient satisfaction, and patient engagement with health information. Results There was no evidence of a difference in patient activation among patients assigned to the inpatient portal intervention compared to usual care or the tablet-only group. Patients in the inpatient portal group had lower 30-day hospital readmissions (5.5% vs. 12.9% tablet-only and 13.5% usual care; P = 0.044). There was evidence of a difference in patient engagement with health information between the inpatient portal and tablet-only group, including looking up health information online (89.6% vs. 51.8%; P < 0.001). Healthcare providers reported that patients found the portal useful and that the portal did not negatively impact healthcare delivery. Conclusions Access to an inpatient portal did not significantly improve patient activation, but it was associated with looking up health information online and with a lower 30-day hospital readmission rate. These results illustrate benefit of providing hospitalized patients with real-time access to their electronic health record data while in the hospital. Trial Registration ClinicalTrials.gov Identifier: NCT01970852.
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Affiliation(s)
- Ruth M Masterson Creber
- Department of Healthcare Policy & Research, Division of Health Informatics, Weill Cornell Medicine, New York, New York, USA
| | - Lisa V Grossman
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Beatriz Ryan
- The Value Institute at NewYork-Presbyterian Hospital, New York, New York, USA
| | - Min Qian
- Department of Biostatistics, Columbia University, New York, New York, USA
| | - Fernanda C G Polubriaginof
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- The Value Institute at NewYork-Presbyterian Hospital, New York, New York, USA
| | - Susan Restaino
- Columbia University Medical Center, New York, New York, USA
| | - Suzanne Bakken
- Department of Biomedical Informatics, School of Nursing, Data Science Institute, Columbia University, New York, New York, USA
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - David K Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
- The Value Institute at NewYork-Presbyterian Hospital, New York, New York, USA
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Bruthans J. The past and current state of the Czech outpatient electronic prescription (eRecept). Int J Med Inform 2019; 123:49-53. [PMID: 30654903 DOI: 10.1016/j.ijmedinf.2019.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/08/2018] [Accepted: 01/01/2019] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Outpatient Electronic Prescription Systems (OEPSs) are widely used in some European states, such as Denmark, Sweden and the Netherlands. The Czech OEPS (known as eRecept) was introduced in 2011, but with limited functions and voluntary usage it was not much accepted until 2018, when its usage was made compulsory not only for pharmacies, but for physicians as well. METHODS Using data from the Czech State Institute for Drug Control (Státní ústav pro kontrolu léčiv or SÚKL in Czech) and from other sources, the system was described and data about its performance since 2013 have been obtained. RESULTS The usage of the system was very low between 2013 and 2016, whilst moderate growth was seen in 2017. By 2018, the system has been widely adopted, although some twenty per cent of Czech physicians still do not use the system at all. DISCUSSION A sudden rise in usage can be explained as the result of making the system compulsory starting in January 2018. Still, new features of the system are eagerly awaited and should be introduced to expand its benefits. CONCLUSION The Czech Republic has joined the EU countries widely using the OEPS.
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Affiliation(s)
- Jan Bruthans
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Czech Republic nám. Sítná 3105, CZ-272 01 Kladno, Czech Republic.
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Grossman LV, Masterson Creber RM, Ancker JS, Ryan B, Polubriaginof F, Qian M, Alarcon I, Restaino S, Bakken S, Hripcsak G, Vawdrey DK. Technology Access, Technical Assistance, and Disparities in Inpatient Portal Use. Appl Clin Inform 2019; 10:40-50. [PMID: 30650448 PMCID: PMC6335107 DOI: 10.1055/s-0038-1676971] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 11/22/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Disadvantaged populations, including minorities and the elderly, use patient portals less often than relatively more advantaged populations. Limited access to and experience with technology contribute to these disparities. Free access to devices, the Internet, and technical assistance may eliminate disparities in portal use. OBJECTIVE To examine predictors of frequent versus infrequent portal use among hospitalized patients who received free access to an iPad, the Internet, and technical assistance. MATERIALS AND METHODS This subgroup analysis includes 146 intervention-arm participants from a pragmatic randomized controlled trial of an inpatient portal. The participants received free access to an iPad and inpatient portal while hospitalized on medical and surgical cardiac units, together with hands-on help using them. We used logistic regression to identify characteristics predictive of frequent use. RESULTS More technology experience (adjusted odds ratio [OR] = 5.39, p = 0.049), less severe illness (adjusted OR = 2.07, p = 0.077), and private insurance (adjusted OR = 2.25, p = 0.043) predicted frequent use, with a predictive performance (area under the curve) of 65.6%. No significant differences in age, gender, race, ethnicity, level of education, employment status, or patient activation existed between the frequent and infrequent users in bivariate analyses. Significantly more frequent users noticed medical errors during their hospital stay. DISCUSSION AND CONCLUSION Portal use was not associated with several sociodemographic characteristics previously found to limit use in the inpatient setting. However, limited technology experience and high illness severity were still barriers to frequent use. Future work should explore additional strategies, such as enrolling health care proxies and improving usability, to reduce potential disparities in portal use.
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Affiliation(s)
- Lisa V. Grossman
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
| | - Ruth M. Masterson Creber
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, United States
| | - Jessica S. Ancker
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, United States
| | - Beatriz Ryan
- Value Institute, New York-Presbyterian Hospital, New York, New York, United States
| | | | - Min Qian
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States
| | - Irma Alarcon
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
| | - Susan Restaino
- Department of Medicine, New York-Presbyterian Hospital, New York, New York, United States
| | - Suzanne Bakken
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
| | - George Hripcsak
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
| | - David K. Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
- Value Institute, New York-Presbyterian Hospital, New York, New York, United States
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Thompson MP, Graetz I. Hospital adoption of interoperability functions. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2018; 7:100347. [PMID: 30595558 DOI: 10.1016/j.hjdsi.2018.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 12/06/2018] [Accepted: 12/10/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND The seamless transmission of patient health information across health care settings, commonly referred to as interoperability, is a focal point of federal electronic health record (EHR) incentive programs. The objective of this study was to examine the extent to which interoperability functions outlined in Promoting Interoperability Stage 3 (PI3) requirements have been adopted by US hospitals, and barriers to interoperability. METHODS We conducted a cross-sectional analysis of 2781 non-federal, acute-care hospitals responding to the 2015 American Hospital Association Information Technology (IT) Supplement survey. We described the percentage of hospitals that adopted PI3 functionalities, identified hospital characteristics associated with adoption, and compared barriers to interoperability between hospitals that have and have not adopted PI3 functionalities. RESULTS Only 16.7% of hospitals had adopted all six core functionalities required to meet PI3 objectives. Over 70% of hospitals had implemented at least four of six functionalities, while 1.8% implemented none. Major teaching (adjusted odds ratio [aOR]=1.66), system affiliated (aOR=1.63), and regional health information exchange participating hospitals (aOR=1.86) were more likely to adopt PI3 functionalities, while for-profit hospitals (OR=0.11) were less likely. Hospitals that adopted PI3 functionalities more frequently reported experiencing barriers to interoperability, including the receiving provider's ability and interest to send/receive data. CONCLUSIONS While only a small proportion of hospitals had implemented all six PI3 functionalities at the time the requirements were finalized, the vast majority had already implemented most of the required functionalities. Still, several barriers stand in the way of achieving seamless interoperability, many of which lie outside hospitals' control.
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Affiliation(s)
- Michael P Thompson
- Center for Healthcare Outcomes and Policy, University of Michigan, USA; Section of Health Services Research and Quality, Department of Cardiac Surgery, University of Michigan Medical School, 5331K Frankel Cardiovascular Center, 1500 E. Medical Center Dr., SPC 5864, Ann Arbor, MI 48109, USA.
| | - Ilana Graetz
- Department of Preventive Medicine, University of Tennessee Health Science Center, USA
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Joneidy S, Burke M. Towards a deeper understanding of meaningful use in electronic health records. Health Info Libr J 2018; 36:134-152. [DOI: 10.1111/hir.12233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 08/20/2018] [Indexed: 11/28/2022]
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Vest JR, Simon K. Hospitals' adoption of intra-system information exchange is negatively associated with inter-system information exchange. J Am Med Inform Assoc 2018; 25:1189-1196. [PMID: 29860502 DOI: 10.1093/jamia/ocy058] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 05/22/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction U.S. policy on interoperable HIT has focused on increasing inter-system (ie, between different organizations) health information exchange. However, interoperable HIT also supports the movement of information within the same organization (ie, intra-system exchange). Methods We examined the relationship between hospitals' intra- and inter-system information exchange capabilities among health system hospitals included in the 2010-2014 American Hospital Association's Annual Health Information Technology Survey. We described the factors associated with hospitals that adopted more intra-system than inter-system exchange capability, and explored the extent of new capability adoption among hospitals that reported neither intra- or inter-system information capabilities at baseline. Results The prevalence of exchange increased over time, but the adoption of inter-system information exchange was slower; when hospitals adopt information exchange, adoption of intra-system exchange was more common. On average during our study period, hospitals could share 4.6 types of information by intra-system exchange, but only 2.7 types of information by inter-system exchange. Controlling for other factors, hospitals exchanged more types of information in an intra-system manner than inter-system when the number of different inpatient EHR vendors in use in health system is larger. Conclusion Consistent with the U.S. goals for more widely accessible patient information, hospitals' ability to share information has increased over time. However, hospitals are prioritizing within-organizational information exchange over exchange between different organizations. If increasing inter-system exchanges is a desired goal, current market incentives and government policies may be insufficient to overcome hospitals' motivations for pursuing an intra-system-information-exchange-first strategy.
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Affiliation(s)
- Joshua R Vest
- Indiana University Richard M. Fairbanks School of Public Health, Department of Health Policy & Management, Indianapolis, Indiana, USA.,Regenstrief Institute, Indianapolis, Indiana, USA
| | - Kosali Simon
- Indiana University School of Public & Environmental Affairs
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Savoy A, Militello LG, Patel H, Flanagan ME, Russ AL, Daggy JK, Weiner M, Saleem JJ. A cognitive systems engineering design approach to improve the usability of electronic order forms for medical consultation. J Biomed Inform 2018; 85:138-148. [DOI: 10.1016/j.jbi.2018.07.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 06/19/2018] [Accepted: 07/29/2018] [Indexed: 12/30/2022]
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Abstract
Medicare reimbursement for hospitals is increasingly tied to performance. The use of individual provider performance reports offers the potential to improve clinical outcomes through social comparison, and isolated cases of clinical dashboard uses at specific institutions have been previously reported. However, little is known about overall trends in how hospitals use the electronic health record to track and provide feedback on provider performance. We used data from 2013 to 2015 from the American Hospital Association (AHA) Annual Survey Information Technology Supplement, which asked hospitals if they have used electronic data to create performance profiles. We linked these data to AHA Annual Survey responses for all general adult and pediatric hospitals. Multivariable logistic regression was used to model the odds of use as a function of hospital characteristics. In 2015, 65.8% of the 2334 respondents used performance profiles, whereas 59.3% of the 2077 respondents used them in 2013. Report use was associated with non-profit status (odds ratio [OR], 2.77; 95% confidence interval [CI], 1.94-3.95) compared to for-profit, large hospital size (OR, 2.37; 95% CI, 1.56-3.60) compared to small size, highest quartile of bed-adjusted expenditures compared to bottom quartile (OR, 2.09; 95% CI, 1.55-2.82; P < .01), and participation in a health maintenance organization (OR, 1.50; 95% CI, 1.17-1.90; P < .01) or bundled payment program (OR, 1.61; 95% CI, 1.18- 2.19; P < .01). While a majority of hospitals now use such profiles, more than a third do not. The hospitals that do not use performance profiles may be less well positioned to adapt to value-based payment reforms.
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Affiliation(s)
- Joshua A. Rolnick
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- National Clinician Scholars Program, University of Pennsyvania, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Address for correspondence: Joshua A. Rolnick, MD, JD, University of Pennsylvania, National Clinician Scholars Program, Blockley Hall, 13th Floor, 423 Guardian Drive, Philadelphia, PA 19104-6021; Telephone: 617-538-5191; Fax: 610-642-4380;
| | - Kira L. Ryskina
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
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Vendor of choice and the effectiveness of policies to promote health information exchange. BMC Health Serv Res 2018; 18:405. [PMID: 29866179 PMCID: PMC5987601 DOI: 10.1186/s12913-018-3230-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As more hospitals adopt Electronic Health Records (EHR), focus has shifted to how these records can be used to improve patient care. One barrier to this improvement is limited information exchange between providers. In this work we examine the role of EHR vendors, hypothesizing that vendors strategically control the exchange of clinical care summaries. Their strategy may involve the creation of networks that easily exchange information between providers with the same vendor but frustrate exchange between providers with different vendors, even as both Federal and State policies attempt to incentivize exchange through a common format. METHODS Using data from the 2013 American Hospital Association's Information Technology Supplement, we examine the relationship between a hospital's decision to share clinical care summaries outside of their network and EHR vendor market share, measured by the percentage of hospitals that have the same vendor in a Hospital Referral Region. RESULTS Our findings show that the likelihood of a hospital exchanging clinical summaries with hospitals outside its health system increases as the percentage of hospitals with the same EHR vendor in the region increases. The estimated odds of a hospital sharing clinical care summaries outside their system is 5.4 (95% CI, 3.29-8.80) times greater if all hospitals in the Hospital Referral Region use the same EHR Vendor than the corresponding odds for a hospital in an area with no hospitals using the same EHR Vendor. When reviewing the relationship of vendor market concentration at the state level we find a positive significant relationship with the percentage of hospitals that share clinical care summaries within a state. We find no significant impact from state policies designed to incentivize information exchange through the State Health Information Exchange Cooperative Program. CONCLUSION There are benefits to exchanging using proprietary methods that are strengthened when the vendors are more concentrated. In order to avoid closed networks that foreclose some hospitals, it is important that future regulation attempt to be more inclusive of hospitals that do not use large vendors and are therefore unable to use proprietary methods for exchange.
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Abstract
Background Electronic health record (EHR) based research in oncology can be limited by missing data and a lack of structured data elements. Clinical research data warehouses for specific cancer types can enable the creation of more robust research cohorts. Methods We linked data from the Stanford University EHR with the Stanford Cancer Institute Research Database (SCIRDB) and the California Cancer Registry (CCR) to create a research data warehouse for prostate cancer. The database was supplemented with information from clinical trials, natural language processing of clinical notes and surveys on patient-reported outcomes. Results 11,898 unique prostate cancer patients were identified in the Stanford EHR, of which 3,936 were matched to the Stanford cancer registry and 6153 in the CCR. 7158 patients with EHR data and at least one of SCIRDB and CCR data were initially included in the warehouse. Conclusions A disease-specific clinical research data warehouse combining multiple data sources can facilitate secondary data use and enhance observational research in oncology.
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Gowrisankaran G, Lucarelli C, Schmidt-Dengler P, Town R. Can amputation save the hospital? The impact of the Medicare Rural Flexibility Program on demand and welfare. JOURNAL OF HEALTH ECONOMICS 2018; 58:110-122. [PMID: 29477951 DOI: 10.1016/j.jhealeco.2018.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 05/09/2017] [Accepted: 01/15/2018] [Indexed: 06/08/2023]
Abstract
This paper seeks to understand the impact of the Medicare Rural Hospital Flexibility (Flex) Program on hospital choice and consumer welfare for rural residents. The Flex Program created a new class of hospital, the Critical Access Hospital (CAH), which receives more generous Medicare reimbursements in return for limits on capacity and length of stay. We find that conversion to CAH status resulted in a 4.7 percent drop in inpatient admissions to participating hospitals, almost all of which was driven by factors other than capacity constraints. The Flex Program increased consumer welfare if it prevented the exit of at least 6.5 percent of randomly selected converting hospitals.
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Affiliation(s)
| | - Claudio Lucarelli
- Wharton School, University of Pennsylvania, United States; Leonard Davis Institute of Health Economics, United States; Universidad de los Andes, Chile
| | | | - Robert Town
- Universidad de los Andes, Chile; NBER, United States.
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Furukawa MF, Spector WD, Rhona Limcangco M, Encinosa WE. Meaningful use of health information technology and declines in in-hospital adverse drug events. J Am Med Inform Assoc 2018; 24:729-736. [PMID: 28339642 DOI: 10.1093/jamia/ocw183] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 12/29/2016] [Indexed: 11/13/2022] Open
Abstract
Objective Nationwide initiatives have promoted greater adoption of health information technology as a means to reduce adverse drug events (ADEs). Hospital adoption of electronic health records with Meaningful Use (MU) capabilities expected to improve medication safety has grown rapidly. However, evidence that MU capabilities are associated with declines in in-hospital ADEs is lacking. Methods Data came from the 2010-2013 Medicare Patient Safety Monitoring System and the 2008-2013 Healthcare Information and Management Systems Society (HIMSS) Analytics Database. Two-level random intercept logistic regression was used to estimate the association of MU capabilities and occurrence of ADEs, adjusting for patient characteristics, hospital characteristics, and year of observation. Results Rates of in-hospital ADEs declined by 19% from 2010 to 2013. Adoption of MU capabilities was associated with 11% lower odds of an ADE (95% confidence interval [CI], 0.84-0.96). Interoperability capability was associated with 19% lower odds of an ADE (95% CI, 0.67- 0.98). Adoption of MU capabilities explained 22% of the observed reduction in ADEs, or 67,000 fewer ADEs averted by MU. Discussion Concurrent with the rapid uptake of MU and interoperability, occurrence of in-hospital ADEs declined significantly from 2010 to 2013. MU capabilities and interoperability were associated with lower occurrence of ADEs, but the effects did not vary by experience with MU. About one-fifth of the decline in ADEs from 2010 to 2013 was attributable to MU capabilities. Conclusion Findings support the contention that adoption of MU capabilities and interoperability spurred by the Health Information Technology for Economic and Clinical Health Act contributed in part to the recent decline in ADEs.
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Affiliation(s)
- Michael F Furukawa
- Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, MD, USA
| | - William D Spector
- Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, MD, USA
| | | | - William E Encinosa
- Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Department of Health and Human Services, Rockville, MD, USA
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Adler-Milstein J, Lin SC, Jha AK. The Number Of Health Information Exchange Efforts Is Declining, Leaving The Viability Of Broad Clinical Data Exchange Uncertain. Health Aff (Millwood) 2018; 35:1278-85. [PMID: 27385245 DOI: 10.1377/hlthaff.2015.1439] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The diffusion of health information exchange (HIE), in which clinical data are electronically linked to patients in many different care settings, is a top priority for policy makers. To drive HIE, community and state efforts were federally funded to broadly engage providers in exchanging data in ways that improved patient care. To assess the current landscape, we conducted a national survey of community and state HIE efforts soon after federal funding ended. We found 106 operational HIE efforts that, as a group, engaged more than one-third of all US providers in 2014. However, the number of operational HIE efforts is down from 119 in 2012, representing the first decline observed since the tracking of these efforts began in 2006. Only half of operational efforts reported being financially viable, and all efforts reported a variety of barriers to continuation. These findings raise important questions about whether the current vision for HIE efforts will allow for the broad exchange of clinical data, or whether alternative approaches would be more successful.
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Affiliation(s)
- Julia Adler-Milstein
- Julia Adler-Milstein is an assistant professor in the School of Information, University of Michigan, with a joint appointment in the Department of Health Management and Policy, School of Public Health, University of Michigan, in Ann Arbor
| | - Sunny C Lin
- Sunny C. Lin is a doctoral candidate in health management and policy at the University of Michigan
| | - Ashish K Jha
- Ashish K. Jha is the K. T. Li Professor of International Health at the Harvard T. H. Chan School of Public Health in Boston, and director of the Harvard Global Health Institute in Cambridge, both in Massachusetts
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Yang CY, Lo YS, Chen RJ, Liu CT. A Clinical Decision Support Engine Based on a National Medication Repository for the Detection of Potential Duplicate Medications: Design and Evaluation. JMIR Med Inform 2018; 6:e6. [PMID: 29351893 PMCID: PMC5797291 DOI: 10.2196/medinform.9064] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/23/2017] [Accepted: 12/23/2017] [Indexed: 11/21/2022] Open
Abstract
Background A computerized physician order entry (CPOE) system combined with a clinical decision support system can reduce duplication of medications and thus adverse drug reactions. However, without infrastructure that supports patients’ integrated medication history across health care facilities nationwide, duplication of medication can still occur. In Taiwan, the National Health Insurance Administration has implemented a national medication repository and Web-based query system known as the PharmaCloud, which allows physicians to access their patients’ medication records prescribed by different health care facilities across Taiwan. Objective This study aimed to develop a scalable, flexible, and thematic design-based clinical decision support (CDS) engine, which integrates a national medication repository to support CPOE systems in the detection of potential duplication of medication across health care facilities, as well as to analyze its impact on clinical encounters. Methods A CDS engine was developed that can download patients’ up-to-date medication history from the PharmaCloud and support a CPOE system in the detection of potential duplicate medications. When prescribing a medication order using the CPOE system, a physician receives an alert if there is a potential duplicate medication. To investigate the impact of the CDS engine on clinical encounters in outpatient services, a clinical encounter log was created to collect information about time, prescribed drugs, and physicians’ responses to handling the alerts for each encounter. Results The CDS engine was installed in a teaching affiliate hospital, and the clinical encounter log collected information for 3 months, during which a total of 178,300 prescriptions were prescribed in the outpatient departments. In all, 43,844/178,300 (24.59%) patients signed the PharmaCloud consent form allowing their physicians to access their medication history in the PharmaCloud. The rate of duplicate medication was 5.83% (1843/31,614) of prescriptions. When prescribing using the CDS engine, the median encounter time was 4.3 (IQR 2.3-7.3) min, longer than that without using the CDS engine (median 3.6, IQR 2.0-6.3 min). From the physicians’ responses, we found that 42.06% (1908/4536) of the potential duplicate medications were recognized by the physicians and the medication orders were canceled. Conclusions The CDS engine could easily extend functions for detection of adverse drug reactions when more and more electronic health record systems are adopted. Moreover, the CDS engine can retrieve more updated and completed medication histories in the PharmaCloud, so it can have better performance for detection of duplicate medications. Although our CDS engine approach could enhance medication safety, it would make for a longer encounter time. This problem can be mitigated by careful evaluation of adopted solutions for implementation of the CDS engine. The successful key component of a CDS engine is the completeness of the patient’s medication history, thus further research to assess the factors in increasing the PharmaCloud consent rate is required.
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Affiliation(s)
- Cheng-Yi Yang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,Department of Medical Informatics, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Yu-Sheng Lo
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Ray-Jade Chen
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Taipei Medical University Hospital, Taipei, Taiwan
| | - Chien-Tsai Liu
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
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47
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Levine DM, Healey MJ, Wright A, Bates DW, Linder JA, Samal L. Changes in the quality of care during progress from stage 1 to stage 2 of Meaningful Use. J Am Med Inform Assoc 2017; 24:394-397. [PMID: 27567000 DOI: 10.1093/jamia/ocw127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 07/26/2016] [Indexed: 11/13/2022] Open
Abstract
Background The Centers for Medicare and Medicaid Services (CMS) canceled Meaningful Use (MU), replacing it with Advancing Care Information, which preserves many MU elements. Therefore, transitioning from MU stage 1 to MU stage 2 has important implications for the new policy, yet the quality of care provided by physicians transitioning from MU1 to MU2 is unknown. Methods Retrospective longitudinal evaluation of the quality of care delivered by outpatient physicians at an academic medical center in the transition between MU1 and MU2. Results Between MU1 and MU2, 4 measures improved: hypertension control (35% vs 40%), influenza immunization (63% vs 68%), tobacco use assessment/counseling (86% vs 96%), and diabetes control (93% vs 96%; P all <.01). One worsened: senior weight screening/follow-up (54% vs 49%; P < .01). Two were unchanged: chlamydia screening and adult weight screening/follow-up. Conclusion In this single-site study, when clinicians progressed from MU1 to MU2, 4 quality measures improved, 2 were unchanged, and 1 worsened. Analysis of national data should guide policy decisions about the content of MU's successor.
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Affiliation(s)
- David M Levine
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, USA
| | - Michael J Healey
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Adam Wright
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, USA
| | - David W Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, USA
| | - Jeffrey A Linder
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, USA
| | - Lipika Samal
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, USA
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Adler-Milstein J, Holmgren AJ, Kralovec P, Worzala C, Searcy T, Patel V. Electronic health record adoption in US hospitals: the emergence of a digital "advanced use" divide. J Am Med Inform Assoc 2017; 24:1142-1148. [PMID: 29016973 PMCID: PMC7651985 DOI: 10.1093/jamia/ocx080] [Citation(s) in RCA: 207] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 06/22/2017] [Accepted: 07/05/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE While most hospitals have adopted electronic health records (EHRs), we know little about whether hospitals use EHRs in advanced ways that are critical to improving outcomes, and whether hospitals with fewer resources - small, rural, safety-net - are keeping up. MATERIALS AND METHODS Using 2008-2015 American Hospital Association Information Technology Supplement survey data, we measured "basic" and "comprehensive" EHR adoption among hospitals to provide the latest national numbers. We then used new supplement questions to assess advanced use of EHRs and EHR data for performance measurement and patient engagement functions. To assess a digital "advanced use" divide, we ran logistic regression models to identify hospital characteristics associated with high adoption in each advanced use domain. RESULTS We found that 80.5% of hospitals adopted at least a basic EHR system, a 5.3 percentage point increase from 2014. Only 37.5% of hospitals adopted at least 8 (of 10) EHR data for performance measurement functions, and 41.7% of hospitals adopted at least 8 (of 10) patient engagement functions. Critical access hospitals were less likely to have adopted at least 8 performance measurement functions (odds ratio [OR] = 0.58; P < .001) and at least 8 patient engagement functions (OR = 0.68; P = 0.02). DISCUSSION While the Health Information Technology for Economic and Clinical Health Act resulted in widespread hospital EHR adoption, use of advanced EHR functions lags and a digital divide appears to be emerging, with critical-access hospitals in particular lagging behind. This is concerning, because EHR-enabled performance measurement and patient engagement are key contributors to improving hospital performance. CONCLUSION Hospital EHR adoption is widespread and many hospitals are using EHRs to support performance measurement and patient engagement. However, this is not happening across all hospitals.
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Affiliation(s)
- Julia Adler-Milstein
- Schools of Information and Public Health, University of Michigan, Ann Arbor, MI, USA
| | - A Jay Holmgren
- Schools of Information and Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Talisha Searcy
- Office of the National Coordinator for Health Information Technology, Washington, DC, USA
| | - Vaishali Patel
- Office of the National Coordinator for Health Information Technology, Washington, DC, USA
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Feblowitz J, Takhar SS, Ward MJ, Ribeira R, Landman AB. A Custom-Developed Emergency Department Provider Electronic Documentation System Reduces Operational Efficiency. Ann Emerg Med 2017; 70:674-682.e1. [PMID: 28712608 PMCID: PMC5653416 DOI: 10.1016/j.annemergmed.2017.05.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 05/13/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
STUDY OBJECTIVE Electronic health record implementation can improve care, but may also adversely affect emergency department (ED) efficiency. We examine how a custom, ED provider, electronic documentation system (eDoc), which replaced paper documentation, affects operational performance. METHODS We analyzed retrospective operational data for 1-year periods before and after eDoc implementation in a single ED. We computed daily operational statistics, reflecting 60,870 pre- and 59,337 postimplementation patient encounters. The prespecified primary outcome was daily mean length of stay; secondary outcomes were daily mean length of stay for admitted and discharged patients and daily mean arrival time to disposition for admitted patients. We used a prespecified multiple regression model to identify differences in outcomes while controlling for prespecified confounding variables. RESULTS The unadjusted change in length of stay was 8.4 minutes; unadjusted changes in secondary outcomes were length of stay for admitted patients 11.4 minutes, length of stay for discharged patients 1.8 minutes, and time to disposition 1.8 minutes. With a prespecified regression analysis to control for variations in operational characteristics, there were significant increases in length of stay (6.3 minutes [95% confidence interval 3.5 to 9.1 minutes]) and length of stay for discharged patients (5.1 minutes [95% confidence interval 1.9 to 8.3 minutes]). There was no statistically significant change in length of stay for admitted patients or time to disposition. CONCLUSION In our single-center study, the isolated implementation of eDoc was associated with increases in overall and discharge length of stay. Our findings suggest that a custom-designed electronic provider documentation may negatively affect ED throughput. Strategies to mitigate these effects, such as reducing documentation requirements or adding clinical staff, scribes, or voice recognition, would be a valuable area of future research.
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Affiliation(s)
- Joshua Feblowitz
- Harvard Medical School and the Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
| | - Sukhjit S Takhar
- Harvard Medical School and the Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
| | - Michael J Ward
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Ryan Ribeira
- Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA
| | - Adam B Landman
- Harvard Medical School and the Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA; Information Systems, Partners HealthCare, Somerville, MA.
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50
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Yen PY, McAlearney AS, Sieck CJ, Hefner JL, Huerta TR. Health Information Technology (HIT) Adaptation: Refocusing on the Journey to Successful HIT Implementation. JMIR Med Inform 2017; 5:e28. [PMID: 28882812 PMCID: PMC5608986 DOI: 10.2196/medinform.7476] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 08/04/2017] [Accepted: 08/04/2017] [Indexed: 11/26/2022] Open
Abstract
In past years, policies and regulations required hospitals to implement advanced capabilities of certified electronic health records (EHRs) in order to receive financial incentives. This has led to accelerated implementation of health information technologies (HIT) in health care settings. However, measures commonly used to evaluate the success of HIT implementation, such as HIT adoption, technology acceptance, and clinical quality, fail to account for complex sociotechnical variability across contexts and the different trajectories within organizations because of different implementation plans and timelines. We propose a new focus, HIT adaptation, to illuminate factors that facilitate or hinder the connection between use of the EHR and improved quality of care as well as to explore the trajectory of changes in the HIT implementation journey as it is impacted by frequent system upgrades and optimizations. Future research should develop instruments to evaluate the progress of HIT adaptation in both its longitudinal design and its focus on adaptation progress rather than on one cross-sectional outcome, allowing for more generalizability and knowledge transfer.
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Affiliation(s)
- Po-Yin Yen
- Washington University in St Louis, Institute for Informatics, St Louis, MO, United States.,Goldfarb School of Nursing, BJC Healthcare, St Louis, MO, United States
| | - Ann Scheck McAlearney
- The Ohio State University, Department of Family Medicine, Columbus, OH, United States
| | - Cynthia J Sieck
- The Ohio State University, Department of Family Medicine, Columbus, OH, United States
| | - Jennifer L Hefner
- The Ohio State University, Department of Family Medicine, Columbus, OH, United States
| | - Timothy R Huerta
- The Ohio State University, Department of Family Medicine, Columbus, OH, United States
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