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Jabour AM. Putting patients at the center of health information exchange design: An exploration of patient preferences for data sharing. Health Informatics J 2024; 30:14604582241277029. [PMID: 39142341 DOI: 10.1177/14604582241277029] [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] [Indexed: 08/16/2024]
Abstract
BACKGROUND Despite the many benefits of Health Information Exchange (HIE), Studies reported patients concerns about the privacy and security of sharing their health information. To address these concerns, it is important to understand their needs, preferences, and priorities in the design and implementing HIE systems. OBJECTIVE The aim of this study is to investigate patients' preferences for HIE consent option and examine the extent to which they are comfortable sharing the different parts of their medical records. METHOD A self-administered survey was conducted. The survey was administrated online and the total number of respondents was 660 participants. RESULTS The most popular option selected by participants for sharing HIE information was to share information with their permission once when they register (33.3%) followed by the option to share their information temporarily on demand during their clinical visit (23.8%). The types of information which participants were willing to share the most were general data such as age, weight, height, and gender, followed closely by data needed for medical emergency. In contrast, the information which participants were less likely to share were data related to financial status or income, followed by data related to sexual disease, and mental illnesses.
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Affiliation(s)
- Abdulrahman M Jabour
- Department of Health Informatics, Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Saudi Arabia
- Information Technology and Virial Care, Jazan University Hospital, Jazan, Saudi Arabia
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Seidman G, AlKasir A, Ricker K, Lane JT, Zink AB, Williams MA. Regulations and Funding to Create Enterprise Architecture for a Nationwide Health Data Ecosystem. Am J Public Health 2024; 114:209-217. [PMID: 38207252 PMCID: PMC10862221 DOI: 10.2105/ajph.2023.307477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 01/13/2024]
Abstract
The COVID-19 pandemic highlighted the United States' lack of a nationwide infrastructure for collecting, sharing, and using health data, especially for secondary uses (e.g., population health management and public health). The federal government is taking several important steps to upgrade the nation's health data ecosystem-notably, the Centers for Disease Control and Prevention's Data Modernization Initiative and the Office of the National Coordinator for Health Information Technology's Trusted Exchange Framework and Common Agreement. However, substantial barriers remain. Inconsistent regulations, infrastructure, and governance across federal and state levels and between states significantly impede the exchange and analysis of health data. Siloed systems and insufficient funding block effective integration of clinical, public health, and social determinants data within and between states. In this analytic essay, we propose strategies to develop a nationwide health data ecosystem. We focus on providing federal guidance and incentives to develop state-designated entities responsible for the collection, integration, and analysis of clinical, public health, social determinants of health, claims, administrative, and other relevant data. These recommendations include a regulatory clearinghouse, federal guidance, model legislation and templated regulation, funding to incentive enterprise architecture, regulatory sandboxes, and a 3-pronged research agenda. (Am J Public Health. 2024;114(2):209-217. https://doi.org/10.2105/AJPH.2023.307477).
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Affiliation(s)
- Gabriel Seidman
- Gabriel Seidman and Ahmad AlKasir are with the Ellison Institute of Technology, Los Angeles, CA. Kate Ricker is with Amelia Mayme Consulting, Denver, CO. J. T. Lane is with the Association of State and Territorial Health Officials (ASTHO), Arlington, VA. Anne Zink is with the Alaska Department of Health, Anchorage, and ASTHO. Michelle Williams is with Harvard T. H. Chan School of Public Health, Boston, MA
| | - Ahmad AlKasir
- Gabriel Seidman and Ahmad AlKasir are with the Ellison Institute of Technology, Los Angeles, CA. Kate Ricker is with Amelia Mayme Consulting, Denver, CO. J. T. Lane is with the Association of State and Territorial Health Officials (ASTHO), Arlington, VA. Anne Zink is with the Alaska Department of Health, Anchorage, and ASTHO. Michelle Williams is with Harvard T. H. Chan School of Public Health, Boston, MA
| | - Kate Ricker
- Gabriel Seidman and Ahmad AlKasir are with the Ellison Institute of Technology, Los Angeles, CA. Kate Ricker is with Amelia Mayme Consulting, Denver, CO. J. T. Lane is with the Association of State and Territorial Health Officials (ASTHO), Arlington, VA. Anne Zink is with the Alaska Department of Health, Anchorage, and ASTHO. Michelle Williams is with Harvard T. H. Chan School of Public Health, Boston, MA
| | - J T Lane
- Gabriel Seidman and Ahmad AlKasir are with the Ellison Institute of Technology, Los Angeles, CA. Kate Ricker is with Amelia Mayme Consulting, Denver, CO. J. T. Lane is with the Association of State and Territorial Health Officials (ASTHO), Arlington, VA. Anne Zink is with the Alaska Department of Health, Anchorage, and ASTHO. Michelle Williams is with Harvard T. H. Chan School of Public Health, Boston, MA
| | - Anne B Zink
- Gabriel Seidman and Ahmad AlKasir are with the Ellison Institute of Technology, Los Angeles, CA. Kate Ricker is with Amelia Mayme Consulting, Denver, CO. J. T. Lane is with the Association of State and Territorial Health Officials (ASTHO), Arlington, VA. Anne Zink is with the Alaska Department of Health, Anchorage, and ASTHO. Michelle Williams is with Harvard T. H. Chan School of Public Health, Boston, MA
| | - Michelle A Williams
- Gabriel Seidman and Ahmad AlKasir are with the Ellison Institute of Technology, Los Angeles, CA. Kate Ricker is with Amelia Mayme Consulting, Denver, CO. J. T. Lane is with the Association of State and Territorial Health Officials (ASTHO), Arlington, VA. Anne Zink is with the Alaska Department of Health, Anchorage, and ASTHO. Michelle Williams is with Harvard T. H. Chan School of Public Health, Boston, MA
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Holmgren AJ, Esdar M, Hüsers J, Coutinho-Almeida J. Health Information Exchange: Understanding the Policy Landscape and Future of Data Interoperability. Yearb Med Inform 2023; 32:184-194. [PMID: 37414031 PMCID: PMC10751121 DOI: 10.1055/s-0043-1768719] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
OBJECTIVES To review recent literature on health information exchange (HIE), focusing on the policy approach of five case study nations: the United States of America, the United Kingdom, Germany, Israel, and Portugal, as well as synthesize lessons learned across countries and provide recommendations for future research. METHODS A narrative review of each nation's HIE policy frameworks, current state, and future HIE strategy. RESULTS Key themes that emerged include the importance of both central decision-making as well as local innovation, the multiple and complex challenges of broad HIE adoption, and the varying role of HIE across different national health system structures. CONCLUSION HIE is an increasingly important capability and policy priority as electronic health record (EHR) adoption becomes more common and care delivery is increasingly digitized. While all five case study nations have adopted some level of HIE, there are significant differences across their level of data sharing infrastructure and maturity, and each nation took a different policy approach. While identifying generalizable strategies across disparate international systems is challenging, there are several common themes across successful HIE policy frameworks, such as the importance of central government prioritization of data sharing. Finally, we make several recommendations for future research to expand the breadth and depth of the literature on HIE and guide future decision-making by policymakers and practitioners.
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Affiliation(s)
| | - Moritz Esdar
- University of Applied Sciences Osnabrueck, Germany
| | - Jens Hüsers
- University of Applied Sciences Osnabrueck, Germany
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Acceptability of Health Information Exchange and Patient Portal Use in Depression Care Among Underrepresented Patients. J Gen Intern Med 2022; 37:3947-3955. [PMID: 35132548 PMCID: PMC8821856 DOI: 10.1007/s11606-022-07427-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/19/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Depression is often untreated or undertreated, particularly among underrepresented groups, such as racial and ethnic minorities, and individuals of lower socioeconomic status. Electronic health information exchange (HIE) is a recommended practice to improve care coordination and encourage patient engagement in services, but it remains underutilized in depression care. Understanding factors affecting acceptance and adoption of this technology among underrepresented patient populations is needed to increase dissemination of HIE within mental health treatment. OBJECTIVE The present study aims to identify patient barriers and facilitators towards the acceptance of HIE within the context of depression treatment and to examine how HIE impacts depression-related care coordination and patient activation. DESIGN Semi-structured qualitative interviews were conducted with 27 patients. PARTICIPANTS Respondents were English-speaking adults (> 18) receiving depression treatment within a large, safety-net primary care clinic. APPROACH A grounded theory approach was used to code and analyze data for emergent themes. Thematic analysis was guided by the Unified Theory of Acceptance and Use of Technology, a leading informatics theory used to predict end-user adoption of technology. KEY RESULTS Respondents reported that HIE made depression care more convenient, transparent, and trustworthy. Though respondents desired greater access to their health records, stigma surrounding depression inhibited acceptance of electronic communication and information sharing. Confusing electronic interface also diminished perceived benefits of HIE. CONCLUSION(S) Respondents desire greater transparency in their depression care. While HIE was perceived to improve the overall quality of depression care, stigma associated with mental illness undermined more robust adoption of this technology among underserved populations.
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Bayard S, Fasano G, Tamimi RM, Oh PS. Leveraging Electronic Health Records to Address Breast Cancer Disparities. CURRENT BREAST CANCER REPORTS 2022; 14:199-204. [PMID: 36091940 PMCID: PMC9440449 DOI: 10.1007/s12609-022-00457-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 01/09/2023]
Abstract
Purpose of Review Breast cancer is the most commonly diagnosed cancer in women, and the leading cause of cancer death. However, racial and ethnic minority groups, as well as rural and underserved populations, face disparities that limit their access to specialty care for breast cancer. To address these disparities, health care providers can leverage an electronic health record (EHR). Recent Findings Few studies have evaluated the potential benefits of using EHRs to address breast cancer disparities, and none of them outlines a standard approach for this effort. However, these studies outline that EHRs can be used to identify and notify patients at risk for breast cancer. These systems can also automate referrals and scheduling for screening and genetic testing, as well as recruit eligible patients for clinical trials. EHRs can also provide educational materials to reduce risks associated with modifiable risk factors, such as physical activity, obesity, and smoking. These systems can also support telemedicine visits and centralize inter-institutional communication to improve treatment adherence and the quality of care. Summary EHRs have tremendous potential to increase accessibility and communication for patients with breast cancer by augmenting patient engagement, improving communication between patients and providers, and strengthening communication among providers. These efforts can reduce breast cancer disparities by increasing breast cancer screening, improving treatment adherence, expanding access to specialty care, and promoting risk-reducing habits among racial and ethnic minority groups and other underserved populations.
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Affiliation(s)
- Solange Bayard
- Division of Pediatric Surgery, Department of Surgery, New York-Presbyterian, Weill Cornell Medicine, 525 E 68th Street, New York, NY 10065 USA
| | - Genevieve Fasano
- Division of Pediatric Surgery, Department of Surgery, New York-Presbyterian, Weill Cornell Medicine, 525 E 68th Street, New York, NY 10065 USA
| | - Rulla M. Tamimi
- Department of Population Health Sciences, New York-Presbyterian, Weill Cornell Medicine, 525 E 68th Street, New York, NY 10065 USA
| | - Pilyung Stephen Oh
- Division of Pediatric Surgery, Department of Surgery, New York-Presbyterian, Weill Cornell Medicine, 525 E 68th Street, New York, NY 10065 USA
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Bloomrosen M, Berner ES. Findings from the 2021 Yearbook Section on Health Information Management. Yearb Med Inform 2021; 30:84-90. [PMID: 34479381 PMCID: PMC8416205 DOI: 10.1055/s-0041-1726501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objectives:
To summarize the recent literature and research and present a selection of the best papers published in 2020 in the field of Health Information Management (HIM) and Health Informatics.
Methods:
A systematic review of the literature for the IMIA Yearbook HIM section was performed by the two section editors with the help of a medical librarian. We searched bibliographic databases for HIM-related papers using both MeSH headings and keywords in titles and abstracts. A shortlist of the fifteen best candidate papers was first selected by section editors before being peer-reviewed by independent external reviewers.
Results:
The three major themes of Health Information Exchange (transmitting, sharing, and accessing patient health-related data and information) (HIE), Data Quality, and Privacy and Security make up 80% of the fifteen papers, with individual papers on personal health records, information governance and the professionalism of the HIM field.
Conclusions:
Traditional HIM concerns about HIM practice and workforce as well as issues about the data in electronic health records (EHRs) including data quality, coding, health information exchange among entities within the healthcare systems and privacy and confidentiality continue to be a large part of the HIM research literature. Although there was little research applying these themes to pandemic concerns, HIM professionals have the expertise to make ccontributions to public health informatics research and this research would benefit from their involvement.
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Affiliation(s)
| | - Eta S Berner
- Graduate Programs in Health Informatics, Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA
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Apathy NC, Vest JR, Adler-Milstein J, Blackburn J, Dixon BE, Harle CA. Practice and market factors associated with provider volume of health information exchange. J Am Med Inform Assoc 2021; 28:1451-1460. [PMID: 33674854 DOI: 10.1093/jamia/ocab024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/26/2021] [Accepted: 02/01/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess the practice- and market-level factors associated with the amount of provider health information exchange (HIE) use. MATERIALS AND METHODS Provider and practice-level data was drawn from the Meaningful Use Stage 2 Public Use Files from the Centers for Medicare and Medicaid Services, the Physician Compare National Downloadable File, and the Compendium of US Health Systems, among other sources. We analyzed the relationship between provider HIE use and practice and market factors using multivariable linear regression and compared primary care providers (PCPs) to non-PCPs. Provider volume of HIE use is measured as the percentage of referrals sent with electronic summaries of care (eSCR) reported by eligible providers attesting to the Meaningful Use electronic health record (EHR) incentive program in 2016. RESULTS Providers used HIE in 49% of referrals; PCPs used HIE in fewer referrals (43%) than non-PCPs (57%). Provider use of products from EHR vendors was negatively related to HIE use, while use of Athenahealth and Greenway Health products were positively related to HIE use. Providers treating, on average, older patients and greater proportions of patients with diabetes used HIE for more referrals. Health system membership, market concentration, and state HIE consent policy were unrelated to provider HIE use. DISCUSSION HIE use during referrals is low among office-based providers with the capability for exchange, especially PCPs. Practice-level factors were more commonly associated with greater levels of HIE use than market-level factors. CONCLUSION This furthers the understanding that market forces, like competition, may be related to HIE adoption decisions but are less important for use once adoption has occurred.
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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
| | - Joshua R Vest
- Regenstrief Institute, Indianapolis, Indiana, USA.,Health Policy & Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Julia Adler-Milstein
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Justin Blackburn
- Health Policy & Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Brian E Dixon
- Regenstrief Institute, Indianapolis, Indiana, USA.,Health Policy & Management, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Christopher A Harle
- Regenstrief Institute, Indianapolis, Indiana, USA.,Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA
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Martin TR, Gasoyan H, Pirrotta G, Mathew R. A NATIONAL SURVEY ASSESSING HEALTH INFORMATION EXCHANGE: READINESS FOR CHANGES TO VETERANS AFFAIRS ACCESS STANDARDS. PERSPECTIVES IN HEALTH INFORMATION MANAGEMENT 2021; 18:1i. [PMID: 34858121 PMCID: PMC8580464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We conducted a national survey of Health Information Exchanges (HIEs), targeting both not-for profit geographic and enterprise or federated exchanges. The aim of this study is to identify current best practices when exchanging information between Veterans Affairs (VA) systems and non-VA health systems. We identified and classified current interactions between HIEs and VA systems given recent passage of the MISSION Act. The MISSION Act allows veterans to seek care outside the VA health system, necessitating the need to reconcile care planning between VA systems and private care settings. We identified several differing best practices concerning information exchange between VA health systems and HIEs and assessed capabilities for HIEs to appropriately identify eligible VA participants within extant databases.
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Chung SA, Snitzer M, Prioli KM, Pizzi LT, Zhang Q, Levin AV. Reducing the Costs of an Eye Care Adherence Program for Underserved Children Referred Through Inner-City Vision Screenings. Am J Ophthalmol 2021; 227:18-24. [PMID: 33582091 DOI: 10.1016/j.ajo.2021.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 01/24/2021] [Accepted: 02/09/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE We previously reported costs and outcomes of the Children's Eye Care Adherence Program (CECAP1), a social worker intervention designed to improve adherence to eye care for underserved children in urban Philadelphia. Using cost findings from CECAP1, we revised the intervention to reduce costs. The aim of this study was to evaluate costs and effectiveness of the revised intervention (CECAP2). DESIGN Retrospective cohort study. METHODS Records of children needing ophthalmic follow-up after 2 community-based vision screening programs were reviewed. We modified CECAP1 to prioritize children more likely to visit, decreased phone calls and scheduling attempts, better documented children already followed by other doctors, and constricted our geographic catchment area for better accessibility. Cost was calculated using time spent executing CECAP2 by our salaried social worker. Effectiveness was defined as the percentage of patients completing at least 1 follow-up visit within the recommended time frame. RESULTS Of 462 children referred to CECAP2 from our in-school and on-campus screening programs, 242 (52.4%) completed subsequent recommended eye examinations, a proportion identical to our prior report (52.3%). Social worker time per patient was 0.8 hours; a significant reduction from the previous 2.6 hours (P < .01). Cost per patient was $32.73; a significant reduction compared to the previous $77.20 (P < .01). CONCLUSIONS Programmatic changes to reduce social worker intervention time and target potential patients by likelihood to attend along with constriction of the catchment area led to reduced costs by more than 50%, without impairing CECAP effectiveness.
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Nakayama M, Inoue R, Miyata S, Shimizu H. Health Information Exchange between Specialists and General Practitioners Benefits Rural Patients. Appl Clin Inform 2021; 12:564-572. [PMID: 34107543 DOI: 10.1055/s-0041-1731287] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Health information exchange (HIE) may improve diagnostic accuracy, treatment efficacy, and safety by providing treating physicians with expert advice. However, most previous studies on HIE have been observational in nature. OBJECTIVES To examine whether collaboration between specialists and general practitioners (GPs) in rural areas via HIE can improve outcomes among patients at low-to-moderate risk of cardiovascular disease, kidney disease, and stroke. METHODS In this randomized controlled trial, the Miyagi Medical and Welfare Information Network was used for HIE. We evaluated the clinical data of 1,092 patients aged ≥65 years living in the rural areas of the Miyagi Prefecture and receiving care from GPs only. High-risk patients were immediately referred to specialists, whereas low-to-moderate risk patients were randomly assigned to an intervention group in which GPs were advised by specialists through HIE (n = 518, 38% male, mean age = 76 ± 7 years) or a control group in which GPs received no advice by specialists (n = 521, 39% male, mean age = 75 ± 7 years). RESULTS In the intention-to-treat analysis, all-cause mortality and cumulative incidence of serious adverse events (e.g., hospital admission or unexpected referral to specialists) did not differ between the groups. However, per-protocol analysis controlling for GP adherence with specialist recommendations revealed significantly reduced all-cause mortality (p = 0.04) and cumulative serious adverse event incidence (p = 0.04) in the intervention group compared with the control group. CONCLUSION HIE systems may improve outcomes among low-to-moderate risk patients by promoting greater collaboration between specialists and GPs, particularly in rural areas with few local specialists.
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Affiliation(s)
- Masaharu Nakayama
- Department of Medical Informatics, Tohoku University Graduate School of Medicine, Sendai, Japan.,Medical Information Technology Center, Tohoku University Hospital, Sendai, Japan
| | - Ryusuke Inoue
- Medical Information Technology Center, Tohoku University Hospital, Sendai, Japan
| | - Satoshi Miyata
- Department of Biostatistics, Teikyo University Graduate School of Public Health, Tokyo, Japan
| | - Hiroaki Shimizu
- Department of Neurosurgery, Akita University Hospital, Akita, Japan
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Gleiss A, Lewandowski S. Removing barriers for digital health through organizing ambidexterity in hospitals. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01532-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Aim
Hospitals noticeably struggle with maintaining hundreds of IT systems and applications in compliance with the latest IT standards and regulations. Thus, hospitals search for efficient opportunities to discover and integrate useful digital health innovations into their existing IT landscapes. In addition, although a multitude of digital innovations from digital health startups enter the market, numerous barriers impede their successful implementation and adoption. Against this background, the aim of this study was to explore typical digital innovation barriers in hospitals, and to assess how a hospital data management platform (HDMP) architecture might help hospitals to extract such innovative capabilities.
Subject and methods
Based on the concept of organizational ambidexterity (OA), we pursued a qualitative mixed-methods approach. First, we explored and consolidated innovation barriers through a systematic literature review, interviews with 20 startup representatives, and a focus group interview with a hospital IT team and the CEO of an HDMP provider. Finally, we conducted a case-study analysis of 36 digital health startups to explore and conceptualize the potential impact of DI and apply the morphological method to synthesize our findings from a multi-level perspective.
Results
We first provide a systematic and conceptual overview of typical barriers for digital innovation in hospitals. Hereupon, we explain how an HDMP might enable hospitals to mitigate such barriers and extract value from digital innovations at both individual and organizational level.
Conclusion
Our results imply that an HDMP can help hospitals to approach organizational ambidexterity through integrating and maintaining hundreds of systems and applications, which allows for a structured and controlled integration of external digital innovations.
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Walker DM, Yeager VA, Lawrence J, McAlearney AS. Identifying Opportunities to Strengthen the Public Health Informatics Infrastructure: Exploring Hospitals' Challenges with Data Exchange. Milbank Q 2021; 99:393-425. [PMID: 33783863 DOI: 10.1111/1468-0009.12511] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Policy Points Even though most hospitals have the technological ability to exchange data with public health agencies, the majority continue to experience challenges. Most challenges are attributable to the general resources of public health agencies, although workforce limitations, technology issues such as a lack of data standards, and policy uncertainty around reporting requirements also remain prominent issues. Ongoing funding to support the adoption of technology and strengthen the development of the health informatics workforce, combined with revising the promotion of the interoperability scoring approach, will likely help improve the exchange of electronic data between hospitals and public health agencies. CONTEXT The novel coronavirus 2019 (COVID-19) pandemic has highlighted significant barriers in the exchange of essential information between hospitals and local public health agencies. Thus it remains important to clarify the specific issues that hospitals may face in reporting to public health agencies to inform focused approaches to improve the information exchange for the current pandemic as well as ongoing public health activities and population health management. METHODS This study uses cross-sectional data of acute-care, nonfederal hospitals from the 2017 American Hospital Association Annual Survey and Information Technology supplement. Guided by the technology-organization-environment framework, we coded the responses to a question regarding the challenges that hospitals face in submitting data to public health agencies by using content analysis according to the type of challenge (i.e., technology, organization, or environment), responsible entity (i.e., hospital, public health agency, vendor, multiple), and the specific issue described. We used multivariable logistic and multinomial regression to identify characteristics of hospitals associated with experiencing the types of challenges. FINDINGS Our findings show that of the 2,794 hospitals in our analysis, 1,696 (61%) reported experiencing at least one challenge in reporting health data to a public health agency. Organizational issues were the most frequently reported type of challenge, noted by 1,455 hospitals. The most common specific issue, reported by 1,117 hospitals, was the general resources of public health agencies. An advanced EHR system and participation in a health information exchange both decreased the likelihood of not reporting experiencing a challenge and increased the likelihood of reporting an organizational challenge. CONCLUSIONS Our findings inform policy recommendations such as improving data standards, increasing funding for public health agencies to improve their technological capabilities, offering workforce training programs, and increasing clarity of policy specifications and reporting. These approaches can improve the exchange of information between hospitals and public health agencies.
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Affiliation(s)
- Daniel M Walker
- College of Medicine, The Ohio State University.,Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University
| | - Valerie A Yeager
- Richard M. Fairbanks School of Public Health, Indiana University
| | - John Lawrence
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University
| | - Ann Scheck McAlearney
- College of Medicine, The Ohio State University.,Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University
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Patients' Perceptions of Different Information Exchange Mechanisms: An Exploratory Study in the United States. Methods Inf Med 2021; 59:162-178. [PMID: 33618421 DOI: 10.1055/s-0040-1721784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients may seek health care services from various providers during treatment. These providers could serve in a network (affiliated) or practice separately (unaffiliated). Thus, using secure and reliable health information exchange (HIE) mechanisms would be critical to transfer sensitive personal health information (PHI) across distances. Studying patients' perceptions and opinions about exchange mechanisms could help health care providers build more complete HIEs' databases and develop robust privacy policies, consent processes, and patient education programs. OBJECTIVES Due to the exploratory nature of this study, we aim to shed more light on public perspectives (benefits, concerns, and risks) associated with the four data exchange practices in the health care sector. METHODS In this study, we compared public perceptions and expectations regarding four common types of exchange mechanisms used in the United States (i.e., traditional, direct, query-based, patient-mediated exchange mechanisms). Traditional is an exchange through fax, paper mailing, or phone calls, direct is a provider-to-provider exchange, query-based is sharing patient data with a central repository, and patient-mediated is an exchange mechanism in which patients can access data and monitor sharing. Data were collected from 1,624 subjects using an online survey to examine the benefits, risks, and concerns associated with the four exchange mechanisms from patients' perspectives. RESULTS Findings indicate that several concerns and risks such as privacy concerns, security risks, trust issues, and psychological risks are raised. Besides, multiple benefits such as access to complete information, communication improvement, timely and convenient information sharing, cost-saving, and medical error reduction are highlighted by respondents. Through consideration of all risks and benefits associated with the four exchange mechanisms, the direct HIE mechanism was selected by respondents as the most preferred mechanism of information exchange among providers. More than half of the respondents (56.18%) stated that overall they favored direct exchange over the other mechanisms. 42.70% of respondents expected to be more likely to share their PHI with health care providers who implemented and utilized a direct exchange mechanism. 43.26% of respondents believed that they would support health care providers to leverage a direct HIE mechanism for sharing their PHI with other providers. The results exhibit that individuals expect greater benefits and fewer adverse effects from direct HIE among health care providers. Overall, the general public sentiment is more in favor of direct data transfer. Our results highlight that greater public trust in exchange mechanisms is required, and information privacy and security risks must be addressed before the widespread implementation of such mechanisms. CONCLUSION This exploratory study's findings could be interesting for health care providers and HIE policymakers to analyze how consumers perceive the current exchange mechanisms, what concerns should be addressed, and how the exchange mechanisms could be modified to meet consumers' needs.
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Chandrasekaran R, Sankaranarayanan B, Pendergrass J. Unfulfilled promises of health information exchange: What inhibits ambulatory clinics from electronically sharing health information? Int J Med Inform 2021; 149:104418. [PMID: 33640839 DOI: 10.1016/j.ijmedinf.2021.104418] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE This study seeks to understand the key inhibitors for health information exchange (HIE) by ambulatory (outpatient) clinics. We examine the key technological, organizational and environmental factors that inhibit an ambulatory clinic from electronically exchanging health information with external clinics and hospitals. METHODS We utilize survey data from 1285 ambulatory clinics in the US state of Minnesota. Using logistic regressions, we assess if the ambulatory clinic's HIE with external clinics and external hospitals are associated with fourteen inhibitors from technological, organizational and environmental contexts in which ambulatory clinics operate. RESULTS Among the technological inhibitors, we find lack of adequate technological infrastructure, difficulties in integrating external data with electronic medical record systems, and security concerns to inhibit ambulatory clinics' HIE with both clinics and hospitals. Inadequate technical support was a barrier for HIE with hospitals, whereas inadequate training of staff was an inhibitor for clinic-to-clinic HIE. Of the environmental variables, legal concerns and complexity in framing HIE agreements with partners were found to inhibit ambulatory clinics' HIE with both external clinics and hospitals. Lack of partner readiness and ability was an inhibiting factor for clinic-to-hospital HIE whereas issues in patient consent, and problems in choosing the right vendor with a good fit were inhibiting ambulatory clinics' HIE with other clinics. Among the organizational variables, lack of adequate senior leadership support and complexity of workflow changes inhibited clinic-to-clinic health data sharing, whereas unclear return on investment (ROI) for HIE was a deterrent for ambulatory clinics' HIE with hospitals. CONCLUSIONS This study throws light on electronic HIE practices and its key inhibitors in ambulatory clinics, an understudied area in digital health. This paper provides unique insights into specific inhibitors that deter clinic-to-clinic health information sharing versus those that affect and clinic-to-hospital health information exchange.
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Affiliation(s)
| | - Balaji Sankaranarayanan
- Department of IT and Supply Chain Management, University of Wisconsin at Whitewater, United States.
| | - John Pendergrass
- Department of Operations Management and Information Systems, Northern Illinois University, United States.
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Wiley KK, Hilts KE, Ancker JS, Unruh MA, Jung HY, Vest JR. Organizational characteristics and perceptions of clinical event notification services in healthcare settings: a study of health information exchange. JAMIA Open 2020; 3:611-618. [PMID: 33623895 PMCID: PMC7886547 DOI: 10.1093/jamiaopen/ooaa065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/04/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Event notification systems are an approach to health information exchange (HIE) that notifies end-users of patient interactions with the healthcare system through real-time automated alerts. We examined associations between organizational capabilities and perceptions of event notification system use. MATERIALS AND METHODS We surveyed representatives (n = 196) from healthcare organizations (n = 96) that subscribed to 1 of 3 Health Information Organizations' event notification services in New York City (response rate = 27%). The survey was conducted in Fall 2017 and Winter 2018. Surveys measured respondent characteristics, perceived organizational capabilities, event notification use, care coordination, and care quality. Exploratory factor analysis was used to identify relevant independent and dependent variables. We examined the relationship between organizational capabilities, care coordination, and care quality using multilevel linear regression models with random effects. RESULTS Respondents indicated that the majority of their organizations provided follow-up care for emergency department visits (66%) and hospital admissions (73%). Perceptions of care coordination were an estimated 57.5% (β = 0.575; P < 0.001) higher among respondents who reported event notifications fit within their organization's existing workflows. Perceptions of care quality were 46.5% (β = 0.465; P < 0.001) higher among respondents who indicated event notifications fit within existing workflows and 23.8% (β = 0.238; P < 0.01) higher where respondents reported having supportive policies and procedures for timely response and coordination of event notifications. DISCUSSION AND CONCLUSION Healthcare organizations with specific workflow processes and positive perceptions of fit are more likely to use event notification services to improve care coordination and care quality. In addition, event notification capacity and patient consent procedures influence how end-users perceive event notification services.
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Affiliation(s)
- Kevin K Wiley
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd, Indianapolis, Indiana 46202-2872, USA
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Katy Ellis Hilts
- School of Nursing, Indiana University, Indianapolis, Indiana, USA
| | - Jessica S Ancker
- Division of Health Policy and Economics, Weill-Cornell Medicine, New York, New York, USA
| | - Mark A Unruh
- Division of Health Policy and Economics, Weill-Cornell Medicine, New York, New York, USA
| | - Hye-Young Jung
- Division of Health Policy and Economics, Weill-Cornell Medicine, New York, New York, USA
| | - Joshua R Vest
- Department of Health Policy and Management, Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Blvd, Indianapolis, Indiana 46202-2872, USA
- Regenstrief Institute, Inc., Indianapolis, Indiana, USA
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