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Walker DM, Tarver WL, Jonnalagadda P, Ranbom L, Ford EW, Rahurkar S. Perspectives on Challenges and Opportunities for Interoperability: Findings From Key Informant Interviews With Stakeholders in Ohio. JMIR Med Inform 2023; 11:e43848. [PMID: 36826979 PMCID: PMC10007006 DOI: 10.2196/43848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/11/2023] [Accepted: 01/19/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Interoperability-the exchange and integration of data across the health care system-remains a challenge despite ongoing policy efforts aimed at promoting interoperability. OBJECTIVE This study aimed to identify current challenges and opportunities to advancing interoperability across stakeholders. METHODS Primary data were collected through qualitative, semistructured interviews with stakeholders (n=24) in Ohio from July to October 2021. Interviewees were sampled using a stratified purposive sample of key informants from 4 representative groups as follows: acute care and children's hospital leaders, primary care providers, behavioral health providers, and regional health information exchange networks. Interviews focused on key informant perspectives on electronic health record implementation, the alignment of public policy with organizational strategy, interoperability implementation challenges, and opportunities for health information technology. The interviews were transcribed verbatim followed by rigorous qualitative analysis using directed content analysis. RESULTS The findings illuminate themes related to challenges and opportunities for interoperability that align with technological (ie, implementation challenges, mismatches in interoperability capabilities across stakeholders, and opportunities to leverage new technology and integrate social determinants of health data), organizational (ie, facilitators of interoperability and strategic alignment of participation in value-based payment programs with interoperability), and environmental (ie, policy) domains. CONCLUSIONS Interoperability, although technically feasible for most providers, remains challenging for technological, organizational, and environmental reasons. Our findings suggest that the incorporation of end user considerations into health information technology development, implementation, policy, and standard deployment may support interoperability advancement.
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Affiliation(s)
- Daniel M Walker
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States.,The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Willi L Tarver
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Pallavi Jonnalagadda
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Lorin Ranbom
- Government Resource Center, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Eric W Ford
- Department of Healthcare Organization and Policy, School of Public Health, University of Alabama, Birmingham, AL, United States
| | - Saurabh Rahurkar
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH, United States.,Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, United States
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Cross DA, Adler-Milstein J. Progress toward Digital Transformation in an Evolving Post-acute Landscape. Innov Aging 2022; 6:igac021. [PMID: 35712324 PMCID: PMC9196682 DOI: 10.1093/geroni/igac021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
Digitization has been a central pillar of structural investments to promote organizational capacity for transformation, and yet skilled nursing facilities (SNFs) and other post-acute providers have been excluded and/or delayed in benefitting from the past decade of substantial public and private sector investment in information technology (IT). These settings have limited internal capacity and resources to invest in digital capabilities on their own, propagating a limited infrastructure that may only further sideline SNFs and their role in an ever-evolving healthcare landscape that needs to be focused on age-friendly, high-value care. Meaningful progress will require continuous refinement of supportive policy, financial investment, and scalable organizational best practices specific to the SNF context. In this essay, we lay out an action agenda to move from age-agnostic to age-friendly digital transformation. Key to the value proposition of these efforts is a focus on interoperability- the seamless exchange of electronic health information across settings that is critical for care coordination and for providers to have the information they need to make safe and appropriate care decisions. Interoperability is not synonymous with digital transformation, but a foundational building block for its potential. We characterize the current state of digitization in SNFs in the context of key health IT policy advancements over the past decade, identifying ongoing and emergent policy work where the digitization needs of SNFs and other post-acute settings can be better addressed. We also discuss accompanying implementation considerations and strategies for optimally translating policy efforts into impactful practice change across an ever-evolving post-acute landscape. Acting on these insights at the policy and practice level provides cautious optimism that nursing home care – and care for older adults across the care continuum – may benefit more equitably from the promise of future digitization.
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Affiliation(s)
- Dori A Cross
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, 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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Cohen CC, Powell K, Dick AW, Deroche CB, Agarwal M, Stone PW, Alexander GL. Examining Nursing Home Information Technology Maturity and Antibiotic Use Among Long-Term Care Residents. J Am Med Dir Assoc 2022; 23:1019-1024.e2. [DOI: 10.1016/j.jamda.2022.01.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 12/27/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022]
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Shields MC, Horgan CM, Ritter GA, Busch AB. Use of Electronic Health Information Technology in a National Sample of Hospitals That Provide Specialty Substance Use Care. Psychiatr Serv 2021; 72:1370-1376. [PMID: 33853380 PMCID: PMC8517030 DOI: 10.1176/appi.ps.202000816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Most U.S. acute care hospitals have adopted basic electronic health record (EHR) functionality and health information exchange (HIE) (84% and 88%, respectively, in 2017). This study examined whether rates of EHR and HIE adoption by hospital-based substance use disorder programs are lower than rates by acute care hospitals. METHODS Data from the 2017 National Survey on Substance Abuse Treatment Services were analyzed to examine adoption of basic EHR functionality (i.e., assessment, progress monitoring, discharge, labs, and prescription dispensing) and use of HIE by hospital-based programs. Analyses used weighted multivariable models of EHR and HIE outcomes, adjusted for nonresponse. RESULTS Of 894 hospital-based substance use disorder programs with EHR information, two-thirds (N=606, 68%) reported use of basic EHR functionality. Psychiatric hospitals were less likely than acute care hospitals to have adopted EHR (odds ratio [OR]=0.49, 95% confidence interval [CI]=0.35-0.71). Compared with nonprofit hospitals, for-profit (OR=0.23, 95% CI=0.16-0.35) and government-owned (OR=0.52, 95% CI=0.33-0.83) hospitals were less likely to use basic EHR functionality. Hospital-based programs providing medications for alcohol or opioid use disorders were more likely than those not providing such medications to use basic EHR (OR=1.95, 95% CI=1.31-2.90). Of 839 hospitals with information on HIE use, 598 (71%) reported using electronic HIE. Adoption of basic EHR functionality was the strongest predictor of HIE use (OR=4.73, 95% CI=3.29-6.79). CONCLUSIONS Hospital-based substance use disorder programs trail behind U.S. acute care hospitals in adoption of basic EHR and electronic HIE. Findings raise concerns about missed opportunities to improve hospital-based substance use disorder care quality and performance measurement.
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Affiliation(s)
- Morgan C Shields
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Horgan, Ritter); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Harvard University, Boston (Busch)
| | - Constance M Horgan
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Horgan, Ritter); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Harvard University, Boston (Busch)
| | - Grant A Ritter
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Horgan, Ritter); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Harvard University, Boston (Busch)
| | - Alisa B Busch
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields); Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Horgan, Ritter); McLean Hospital, Belmont, Massachusetts, and Department of Health Care Policy, Harvard Medical School, Harvard University, Boston (Busch)
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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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Exploring association between certified EHRs adoption and patient experience in U.S. psychiatric hospitals. PLoS One 2020; 15:e0234607. [PMID: 32555623 PMCID: PMC7299381 DOI: 10.1371/journal.pone.0234607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 05/31/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Certified Electronic Health Records (EHR) have been shown to improve the health service quality in some health settings, but there is scant evidence related to its adoption in psychiatric hospitals. This paper aimed to examine the relationship between certified EHR adoption and patient experience across psychiatric hospitals in the United States. METHODS A cross-sectional study design compared the difference in patient experience measures between psychiatric hospitals with and without certified EHR. Data were drawn from the American Hospital Association (AHA) Annual Survey Database and Hospital Compare datasets. Eleven publicly reported measures for patient experience from the Consumer Assessment of Healthcare Providers and Systems Hospital Survey (HCAHPS) were applied for analysis. Independent relationship of certified EHR adoption and patient experience was explored with multiple linear regression models adjusted for hospital organizational characteristics. RESULTS Positive associations were identified between certified EHR adoption and five patient perception measures-"recommend hospital" (β = 0.66, 95% CI = [0.16,1.16]; t = 2.68, p = 0.010), "overall hospital rating" (β = 0.39, 95% CI = [0.03,0.75]; t = 2.11, p = 0.035), "discharge information" (β = 0.45, 95% CI = [0.03,0.86]; t = 2.09, p = 0.037), "care transition" (β = 0.44, 95% CI = [0.14, 0.75]; t = 2.84, p = 0.005), and "responsiveness of hospital staff" (β = 0.47, 95% CI = [0.04, 0.90]; t = 2.13, p = 0.033). CONCLUSION Our results suggest the positive association between certified EHR adoption and patient experience. More studies are needed to explore impacts of certified EHR adoption and potential improvement in patient experience to quality of care.
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7
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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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Alexander GL, Powell K, Deroche CB, Popejoy L, Mosa ASM, Koopman R, Pettit L, Dougherty M. Building consensus toward a national nursing home information technology maturity model. J Am Med Inform Assoc 2019; 26:495-505. [PMID: 30889245 DOI: 10.1093/jamia/ocz006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 12/27/2018] [Accepted: 01/07/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We describe the development of a nursing home information technology (IT) maturity model designed to capture stages of IT maturity. MATERIALS AND METHODS This study had 2 phases. The purpose of phase I was to develop a preliminary nursing home IT maturity model. Phase II involved 3 rounds of questionnaires administered to a Delphi panel of expert nursing home administrators to evaluate the validity of the nursing home IT maturity model proposed in phase I. RESULTS All participants (n = 31) completed Delphi rounds 1-3. Over the 3 Delphi rounds, the nursing home IT maturity staging model evolved from a preliminary, 5-stage model (stages 1-5) to a 7-stage model (stages 0-6). DISCUSSION Using innovative IT to improve patient outcomes has become a broad goal across healthcare settings, including nursing homes. Understanding the relationship between IT sophistication and quality performance in nursing homes relies on recognizing the spectrum of nursing home IT maturity that exists and how IT matures over time. Currently, no universally accepted nursing home IT maturity model exists to trend IT adoption and determine the impact of increasing IT maturity on quality. CONCLUSIONS A 7-stage nursing home IT maturity staging model was successfully developed with input from a nationally representative sample of U.S. based nursing home experts. The model incorporates 7-stages of IT maturity ranging from stage 0 (nonexistent IT solutions or electronic medical record) to stage 6 (use of data by resident or resident representative to generate clinical data and drive self-management).
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Affiliation(s)
| | - Kimberly Powell
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA.,College of Nursing, University of Tennessee, Knoxville, Tennessee, USA
| | - Chelsea B Deroche
- Biostatistics & Research Design Unit, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Lori Popejoy
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA
| | | | - Richelle Koopman
- Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
| | - Lorren Pettit
- Healthcare Information and Management Systems Society, Chicago, Illinois, USA
| | - Michelle Dougherty
- Research Triangle Institute, Research Triangle Park, North Carolina, USA
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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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Lee SA, Park EC, Shin J, Ju YJ, Choi Y, Lee HY. Patient and hospital factors associated with 30-day unplanned readmission in patients with stroke. J Investig Med 2018; 67:52-58. [DOI: 10.1136/jim-2018-000748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/23/2018] [Accepted: 06/23/2018] [Indexed: 11/03/2022]
Abstract
Stroke is frequently associated with readmission; moreover, readmission is regarded as an important indicator of the quality of stroke care. Thus, we investigated factors associated with 30-day readmission in patients with stroke in South Korea. We used claims data from 2013 for stroke (I60–I62) patients (n=44 729) in 94 hospitals and classified unplanned readmission according to the Centers for Medicare and Medicaid guidelines. We used multilevel models to investigate patient (age, gender, type of insurance, admission via emergency room, length of stay, type of stroke, Elixhauser Index Score) and hospital (stroke care quality grade, location of hospital, type of hospital, number of doctors and nurses per 100 beds) factors associated with readmission within 30 days of discharge. Among the 44 729 patients admitted due to stroke, 9.2% (n=4124) were readmitted to hospital and 7.6% (n=3379) had unplanned readmissions. Regarding patient characteristics, medical aid and longer hospital stay were associated with 30-day readmission rate. Among hospital factors, patients admitted to a low-grade hospital or a non-capital area hospital were more likely to be readmitted within 30 days of discharge. We identified patient and hospital factors associated with 30-day readmission among stroke patients. In particular, patients admitted to hospitals with higher quality stroke care showed lower readmission rates.
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Walker DM, Sieck CJ, Menser T, Huerta TR, Scheck McAlearney A. Information technology to support patient engagement: where do we stand and where can we go? J Am Med Inform Assoc 2018; 24:1088-1094. [PMID: 28460042 DOI: 10.1093/jamia/ocx043] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 03/31/2017] [Indexed: 01/13/2023] Open
Abstract
Objective Given the strong push to empower patients and make them partners in their health care, we evaluated the current capability of hospitals to offer health information technology that facilitates patient engagement (PE). Materials and Methods Using an ontology mapping approach, items from the American Hospital Association Information Technology Supplement were mapped to defined levels and categories within the PE Framework. Points were assigned for each health information technology function based upon the level of engagement it encompassed to create a PE-information technology (PE-IT) score. Scores were divided into tertiles, and hospital characteristics were compared across tertiles. An ordered logit model was used to estimate the effect of characteristics on the adjusted odds of being in the highest tertile of PE-IT scores. Results Thirty-six functions were mapped to specific levels and categories of the PE Framework, and adoption of each item ranged from 23.5 to 96.7%. Hospital characteristics associated with being in the highest tertile of PE-IT scores included medium and large bed size (relative to small), nonprofit (relative to government nonfederal), teaching hospital, system member, Midwest and South regions, and urban location. Discussion Hospital adoption of PE-oriented technology remains varied, suggesting that hospitals are considering how technology can create partnerships with patients. However, PE functionalities that facilitate higher levels of engagement are lacking, suggesting room for improvement. Conclusion While hospitals have reached modest levels of adoption of PE technologies, consistent monitoring of this capacity can identify opportunities to use technology to facilitate engagement.
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Affiliation(s)
- Daniel M Walker
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, OH, USA
| | - Cynthia J Sieck
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, OH, USA
| | - Terri Menser
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, OH, USA
| | - Timothy R Huerta
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, OH, USA.,Department of Bioinformatics, College of Medicine, Ohio State University
| | - Ann Scheck McAlearney
- Department of Family Medicine, College of Medicine, Ohio State University, Columbus, OH, USA
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12
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Health IT and inappropriate utilization of outpatient imaging: A cross-sectional study of U.S. hospitals. Int J Med Inform 2018; 109:87-95. [DOI: 10.1016/j.ijmedinf.2017.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 10/24/2017] [Accepted: 10/29/2017] [Indexed: 11/23/2022]
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13
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Menchik DA. Interdependent Career Types and Divergent Standpoints on the Use of Advanced Technology in Medicine. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2017; 58:488-502. [PMID: 29172765 DOI: 10.1177/0022146517738088] [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: 06/07/2023]
Abstract
This paper uses the case of the uneven use of a robotic technology to explain how physicians with similar training come to engage in different medical practices. I develop a conceptual framework in which their decisions to use advanced technologies are informed by "interdependent career types," a concept that incorporates features of the professional social context of physicians' work and the expertise they use, and reflects how medicine distributes expertise via formal and informal referral structures. I draw on data regarding specialized physicians' differentiated use of this technology over five years as well as interviews with those who continue to use the technology and those who have abandoned it. I argue that interdependent career types stratify physicians' standpoints on multiple dimensions of medical work-including those related to their concerns about reputation, inclinations toward risk, and preferences regarding the use of their bodies.
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14
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Kruse CS, Mileski M, Vijaykumar AG, Viswanathan SV, Suskandla U, Chidambaram Y. Impact of Electronic Health Records on Long-Term Care Facilities: Systematic Review. JMIR Med Inform 2017; 5:e35. [PMID: 28963091 PMCID: PMC5640822 DOI: 10.2196/medinform.7958] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/26/2017] [Accepted: 07/02/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Long-term care (LTC) facilities are an important part of the health care industry, providing care to the fastest-growing group of the population. However, the adoption of electronic health records (EHRs) in LTC facilities lags behind other areas of the health care industry. One of the reasons for the lack of widespread adoption in the United States is that LTC facilities are not eligible for incentives under the Meaningful Use program. Implementation of an EHR system in an LTC facility can potentially enhance the quality of care, provided it is appropriately implemented, used, and maintained. Unfortunately, the lag in adoption of the EHR in LTC creates a paucity of literature on the benefits of EHR implementation in LTC facilities. OBJECTIVE The objective of this systematic review was to identify the potential benefits of implementing an EHR system in LTC facilities. The study also aims to identify the common conditions and EHR features that received favorable remarks from providers and the discrepancies that needed improvement to build up momentum across LTC settings in adopting this technology. METHODS The authors conducted a systematic search of PubMed, Cumulative Index of Nursing and Allied Health (CINAHL), and MEDLINE databases. Papers were analyzed by multiple referees to filter out studies not germane to our research objective. A final sample of 28 papers was selected to be included in the systematic review. RESULTS Results of this systematic review conclude that EHRs show significant improvement in the management of documentation in LTC facilities and enhanced quality outcomes. Approximately 43% (12/28) of the papers reported a mixed impact of EHRs on the management of documentation, and 33% (9/28) of papers reported positive quality outcomes using EHRs. Surprisingly, very few papers demonstrated an impact on patient satisfaction, physician satisfaction, the length of stay, and productivity using EHRs. CONCLUSIONS Overall, implementation of EHRs has been found to be effective in the few LTC facilities that have implemented them. Implementation of EHRs in LTC facilities caused improved management of clinical documentation that enabled better decision making.
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Affiliation(s)
- Clemens Scott Kruse
- College of Health Professions, School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Michael Mileski
- College of Health Professions, School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Alekhya Ganta Vijaykumar
- College of Health Professions, School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Sneha Vishnampet Viswanathan
- College of Health Professions, School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Ujwala Suskandla
- College of Health Professions, School of Health Administration, Texas State University, San Marcos, TX, United States
| | - Yazhini Chidambaram
- College of Health Professions, School of Health Administration, Texas State University, San Marcos, TX, United States
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Challenges to Conducting Health Information Exchange Research and Evaluation: Reflections and Recommendations for Examining the Value of HIE. EGEMS 2017; 5:15. [PMID: 29881735 PMCID: PMC5983050 DOI: 10.5334/egems.217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Introduction: Health information exchange (HIE) promises cost and utilization reductions. To date, only a small number of HIE studies have demonstrated benefits to patients, providers, public health, or payers. This may be because evaluations of HIE are methodologically challenging. Indeed, the quality of HIE evaluations is often limited and authors frequently note unmet evaluation objectives. We provide a systematic identification of HIE research challenges that can be used to inform strategies for higher quality scientific evidence. Methods: We conducted qualitative interviews with 23 HIE researchers and leaders of HIE efforts representing experiences with more than 20 HIE efforts. We also conducted a six-person focus group to expand on and confirm individual interview findings. Qualitative analysis followed a grounded theory approach using multiple coders. Results: Participants experienced similar challenges across seven themes (i.e., HIE maturity, data quality, data availability, goal alignment, cooperation, methodology, and policy). Conclusion: Several options may exist to improve HIE research, including developing better conceptual models and methodological approaches to HIE research; formal partnerships between researchers and HIE entities; and establishing a nationwide database of HIE information. Our proposed approaches of promoting data availability, resource sharing, and new partnerships can help to overcome existing barriers and facilitate HIE research.
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Adler-Milstein J, Jha AK. HITECH Act Drove Large Gains In Hospital Electronic Health Record Adoption. Health Aff (Millwood) 2017; 36:1416-1422. [DOI: 10.1377/hlthaff.2016.1651] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Julia Adler-Milstein
- Julia Adler-Milstein ( ) is an associate professor in the School of Information and School of Public Health (health management and policy) at the University of Michigan, in Ann Arbor
| | - 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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Thorpe JH, Gray EA, Cartwright-Smith L. Show Us the Data: The Critical Role Health Information Plays in Health System Transformation. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2016; 44:592-597. [PMID: 28661247 DOI: 10.1177/1073110516684800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Truly transforming the healthcare delivery and payment system turns on the ability to engage in the interoperable electronic exchange of patient health information across and beyond the care continuum. Achieving transformation requires a legal framework that supports information sharing with appropriate privacy and security protections and a trusted governance structure.
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Affiliation(s)
- Jane Hyatt Thorpe
- Jane Hyatt Thorpe, J.D., is an Associate Professor and Vice Chair for Academic Affairs in the Department of Health Policy and Management, Milken Institute School of Public Health and Director of the Healthcare Corporate Compliance Program at the George Washington University. She holds an A.B. from Princeton University (Princeton, NJ) and a Juris Doctor degree from the Vanderbilt University School of Law (Nashville, TN). Elizabeth A. Gray, J.D., M.H.A., is a Research Scientist and Professorial Lecturer in the Department of Health Policy and Management in the Milken Institute School of Public Health at the George Washington University. She holds a Bachelor of Science degree from Vanderbilt University (Nashville, TN), a Juris Doctor degree from the George Washington University Law School (Washington, D.C.), and a Master of Health Administration degree from the Milken Institute School of Public Health at the George Washington University (Washington, D.C.). Lara Cartwright-Smith, J.D., M.P.H., is an Associate Research Professor in the Department of Health Policy and Management in the Milken Institute School of Public Health at the George Washington University. She holds a Bachelor of Arts degree from Bates College (Lewiston, Maine), a Juris Doctor degree from Georgetown University School of Law (Washington, D.C.), and a Master of Public Health from the Milken Institute School of Public Health at the George Washington University (Washington, D.C.)
| | - Elizabeth A Gray
- Jane Hyatt Thorpe, J.D., is an Associate Professor and Vice Chair for Academic Affairs in the Department of Health Policy and Management, Milken Institute School of Public Health and Director of the Healthcare Corporate Compliance Program at the George Washington University. She holds an A.B. from Princeton University (Princeton, NJ) and a Juris Doctor degree from the Vanderbilt University School of Law (Nashville, TN). Elizabeth A. Gray, J.D., M.H.A., is a Research Scientist and Professorial Lecturer in the Department of Health Policy and Management in the Milken Institute School of Public Health at the George Washington University. She holds a Bachelor of Science degree from Vanderbilt University (Nashville, TN), a Juris Doctor degree from the George Washington University Law School (Washington, D.C.), and a Master of Health Administration degree from the Milken Institute School of Public Health at the George Washington University (Washington, D.C.). Lara Cartwright-Smith, J.D., M.P.H., is an Associate Research Professor in the Department of Health Policy and Management in the Milken Institute School of Public Health at the George Washington University. She holds a Bachelor of Arts degree from Bates College (Lewiston, Maine), a Juris Doctor degree from Georgetown University School of Law (Washington, D.C.), and a Master of Public Health from the Milken Institute School of Public Health at the George Washington University (Washington, D.C.)
| | - Lara Cartwright-Smith
- Jane Hyatt Thorpe, J.D., is an Associate Professor and Vice Chair for Academic Affairs in the Department of Health Policy and Management, Milken Institute School of Public Health and Director of the Healthcare Corporate Compliance Program at the George Washington University. She holds an A.B. from Princeton University (Princeton, NJ) and a Juris Doctor degree from the Vanderbilt University School of Law (Nashville, TN). Elizabeth A. Gray, J.D., M.H.A., is a Research Scientist and Professorial Lecturer in the Department of Health Policy and Management in the Milken Institute School of Public Health at the George Washington University. She holds a Bachelor of Science degree from Vanderbilt University (Nashville, TN), a Juris Doctor degree from the George Washington University Law School (Washington, D.C.), and a Master of Health Administration degree from the Milken Institute School of Public Health at the George Washington University (Washington, D.C.). Lara Cartwright-Smith, J.D., M.P.H., is an Associate Research Professor in the Department of Health Policy and Management in the Milken Institute School of Public Health at the George Washington University. She holds a Bachelor of Arts degree from Bates College (Lewiston, Maine), a Juris Doctor degree from Georgetown University School of Law (Washington, D.C.), and a Master of Public Health from the Milken Institute School of Public Health at the George Washington University (Washington, D.C.)
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Abstract
POLICY POINTS The expansive goals of the Health Information Technology for Economic and Clinical Health (HITECH) Act required the simultaneous development of a complex and interdependent infrastructure and a wide range of relationships, generating points of vulnerability. While federal legislation can be a powerful stimulus for change, its effectiveness also depends on its ability to accommodate state and local policies and private health care markets. Ambitious goals require support over a long time horizon, which can be challenging to maintain. The future of health information technology (health IT) support nationally is likely to depend on the ability of the technology to satisfy its users that its functionalities address the interests policymakers and other stakeholders have in using technology to promote better care, improved outcomes, and reduced costs. CONTEXT The Health Information Technology for Economic and Clinical Health (HITECH) Act set ambitious goals for developing electronic health information as one tool to reform health care delivery and improve health outcomes. With HITECH's grant funding now mostly exhausted but statutory authority for standards remaining, this article looks back at HITECH's experience in the first 5 years to assess its implementation, remaining challenges, and lessons learned. METHODS This review derives from a global assessment of the HITECH Act. Earlier, we examined the logic of HITECH and identified interdependencies critical to its ultimate success. In this article, we build on that framework to review what has and has not been accomplished in building the infrastructure authorized by HITECH since it was enacted. The review incorporates quantitative and qualitative evidence of progress from the global assessment and from the evaluations funded by the Office of the National Coordinator for Health Information Technology (ONC) of individual programs authorized by the HITECH Act. FINDINGS Our review of the evidence provides a mixed picture. Despite HITECH's challenging demands, its complex programs were implemented, and important changes sought by the act are now in place. Electronic health records (EHRs) now exist in some form in most professional practices and hospitals eligible for HITECH incentive payments, more information is being shared electronically, and the focus of attention has shifted from adoption of EHRs toward more fundamental issues associated with using health information technology (health IT) to improve health care delivery and outcomes. In some areas, HITECH's achievements to date have fallen short of the hopes of its proponents as it has proven challenging to move meaningful use beyond the initial low bar set by Meaningful Use Stage 1. EHR products vary in their ability to support more advanced functionalities, such as patient engagement and population-based care management. Many barriers to interoperability persist, limiting electronic communication across a diverse set of largely private providers and care settings. CONCLUSIONS Achieving the expansive goals of HITECH required the simultaneous development of a complex and interdependent infrastructure and a wide range of relationships, some better positioned to move forward than others. To date, it has proven easier to get providers to adopt EHRs, perhaps in response to financial incentives to do so, than to develop a robust infrastructure that allows the information in EHRs to be used effectively and shared not only within clinical practices but also across providers. Effective exchange of data is necessary to drive the kinds of delivery and payment reforms sought nationwide.
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