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Diaz MJ, Tran JT. Potential Benefits of Non-Fungible Tokens (NFTs) and Blockchain Technology in Dermatology. Dermatol Pract Concept 2024; 14:dpc.1401a61. [PMID: 38364421 PMCID: PMC10868896 DOI: 10.5826/dpc.1401a61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 02/18/2024] Open
Affiliation(s)
- Michael Joseph Diaz
- College of Medicine, University of Florida, Gainesville, Florida, United States
| | - Jasmine Thuy Tran
- School of Medicine, Indiana University, Indianapolis, Indiana, United States
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2
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Brunner J, Anderson E, Mohr DC, Cohen-Bearak A, Rinne ST. From "Local Control" to "Dependency": Transitions to Single-Vendor Integrated Electronic Health Record Systems and Their Implications for the EHR Workforce. J Gen Intern Med 2023; 38:1023-1030. [PMID: 37798579 PMCID: PMC10593658 DOI: 10.1007/s11606-023-08281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 06/13/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Healthcare systems that previously used either a single legacy electronic health record (EHR) system or a "best-of-breed" combination of products from multiple vendors are increasingly adopting integrated, single-vendor EHR systems. Though healthcare leaders are beginning to recognize the dramatic collateral consequences of these transitions, their impact on the EHR workforce - internal actors most closely involved in governing and supporting the EHR - is poorly understood. OBJECTIVE Identify perceived impacts of adopting single-vendor, integrated EHR systems on the institutional EHR workforce. DESIGN In this qualitative study, we conducted semi-structured phone interviews in four healthcare systems in the USA that had adopted an integrated EHR within the previous five years. PARTICIPANTS Forty-two staff members of four geographically and organizationally diverse healthcare systems, including 22 individuals with formal informatics roles. APPROACH Transcribed interviews were coded and analyzed using qualitative content analysis methods. KEY RESULTS Across organizations, participants described a loss of autonomy by the EHR workforce at the individual and institutional level following the adoption of an integrated EHR. We also identified references to transformations in four key professional functions of the EHR workforce: communication, governance, optimization, and education. CONCLUSIONS Transitions to integrated EHR systems can have important implications for the autonomy and professional functions of the EHR workforce. These findings may help institutions embarking on similar transitions better anticipate and prepare for these changes through such practices as revising job descriptions, strengthening EHR governance structures, and reinforcing pathways to engage frontline clinicians in supporting the EHR. Findings may also help institutions structure vendor contracts in a way that anticipates and mitigates loss of autonomy.
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Affiliation(s)
- Julian Brunner
- Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Health Care System, Los Angeles, CA, USA.
| | - Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - David C Mohr
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Adena Cohen-Bearak
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
| | - Seppo T Rinne
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA
- Pulmonary & Critical Care Medicine, School of Medicine, Boston University, Boston, MA, USA
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3
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Wang N, Chen J. Decreasing Racial Disparities in Preventable Emergency Department Visits Through Hospital Health Information Technology Patient Engagement Functionalities. Telemed J E Health 2023; 29:841-850. [PMID: 36374942 PMCID: PMC10277978 DOI: 10.1089/tmj.2022.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/17/2022] [Accepted: 10/04/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction: Hospitals are a major source of care for underserved populations in the United States. However, little is known about how hospital-based health information technology (HIT) can improve the efficiency of care and reduce disparities. Objective: We examined the variation of preventable emergency department (ED) visits and associated racial disparities by hospital adoption of HIT patient engagement (HIT-PE) functionalities. Methods: This was an observational study of 6,543,514 non-Hispanic Black (Black) and non-Hispanic White (White) adult patients using 2019 datasets of seven states (Arizona, Florida, Kentucky, Maryland, North Carolina, Vermont, Wisconsin) from the State Emergency Department Databases, American Hospital Association Annual Survey & Information Technology Supplement, and Area Health Resources File. Results: High HIT-PE adoption was associated with lower rates of preventable ED (odds ratio [OR] = 0.992, p < 0.001). Specific HIT-PE functions such as importing medical records from other organizations into the patient portal (OR = 0.977, p < 0.001), electronically sending medical information to a third party (OR = 0.970, p < 0.001), and scheduling appointments online (OR = 0.987, p < 0.001) were also associated with reduced preventable ED rates. Black patients had higher rates of preventable ED compared with Whites (OR = 1.386, p < 0.001); however, the interaction of Black patients and high HIT-PE adoption was associated with lower rates of preventable ED (OR = 0.977, p < 0.001). Our results also showed that higher HIT-PE adoption was associated with a reduction in preventable ED visits among Black patients with comorbidities and Black patients living in low-income areas. Conclusions: The results of our study suggest that there is potential to reduce preventable ED rates and racial disparities through hospital-based HIT-PE functionalities.
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Affiliation(s)
- Nianyang Wang
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Jie Chen
- Department of Health Policy and Management, University of Maryland School of Public Health, College Park, Maryland, USA
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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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5
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Kotevski DP, Smee RI, Field M, Broadley K, Vajdic CM. The Utility of Oncology Information Systems for Prognostic Modelling in Head and Neck Cancer. J Med Syst 2023; 47:9. [PMID: 36640212 PMCID: PMC9840592 DOI: 10.1007/s10916-023-01907-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023]
Abstract
Cancer centres rely on electronic information in oncology information systems (OIS) to guide patient care. We investigated the completeness and accuracy of routinely collected head and neck cancer (HNC) data sourced from an OIS for suitability in prognostic modelling and other research. Three hundred and fifty-three adults diagnosed from 2000 to 2017 with head and neck squamous cell carcinoma, treated with radiotherapy, were eligible. Thirteen clinically relevant variables in HNC prognosis were extracted from a single-centre OIS and compared to that compiled separately in a research dataset. These two datasets were compared for agreement using Cohen's kappa coefficient for categorical variables, and intraclass correlation coefficients for continuous variables. Research data was 96% complete compared to 84% for OIS data. Agreement was perfect for gender (κ = 1.000), high for age (κ = 0.993), site (κ = 0.992), T (κ = 0.851) and N (κ = 0.812) stage, radiotherapy dose (κ = 0.889), fractions (κ = 0.856), and duration (κ = 0.818), and chemotherapy treatment (κ = 0.871), substantial for overall stage (κ = 0.791) and vital status (κ = 0.689), moderate for grade (κ = 0.547), and poor for performance status (κ = 0.110). Thirty-one other variables were poorly captured and could not be statistically compared. Documentation of clinical information within the OIS for HNC patients is routine practice; however, OIS data was less correct and complete than data collected for research purposes. Substandard collection of routine data may hinder advancements in patient care. Improved data entry, integration with clinical activities and workflows, system usability, data dictionaries, and training are necessary for OIS data to generate robust research. Data mining from clinical documents may supplement structured data collection.
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Affiliation(s)
- Damian P Kotevski
- Department of Radiation Oncology, Prince of Wales Hospital, Level 1, Bright Building, Barker St, Randwick, NSW, 2031, Australia.
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia.
| | - Robert I Smee
- Department of Radiation Oncology, Prince of Wales Hospital, Level 1, Bright Building, Barker St, Randwick, NSW, 2031, Australia
- Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
- Department of Radiation Oncology, Tamworth Base Hospital, Tamworth, NSW, Australia
| | - Matthew Field
- South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Kathryn Broadley
- Cancer and Haematology Services, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Claire M Vajdic
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
- Kirby Institute, Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia
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Cassidy M, Doucet S, Luke A, Goudreau A, MacNeill L. Improving the transition from paediatric to adult healthcare: a scoping review on the recommendations of young adults with lived experience. BMJ Open 2022; 12:e051314. [PMID: 36572498 PMCID: PMC9806082 DOI: 10.1136/bmjopen-2021-051314] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The goal of this review was to identify recommendations within the literature on how to improve the transition from paediatric to adult healthcare from the perspective of young adults (YAs) living with chronic conditions who have gone through the process. DESIGN This review was conducted in accordance with JBI methodology for scoping reviews. SEARCH STRATEGY We searched MEDLINE (Ovid), CINAHL (EBSCO), PsycINFO (EBSCO) and EMBASE (Elsevier) databases, and conducted a grey literature search for relevant material. The databases were searched in December 2019, and re-searched June 2020 and September 2020, while the grey literature was searched in April 2020. This scoping review focused on the recommendations of YAs with chronic conditions who have transitioned from paediatric to adult healthcare, in any setting (eg, hospital, clinic or community), and across all sectors (eg, health, education and social services). RESULTS Eighteen studies met inclusion criteria for this review. These studies included YAs with 14 different chronic conditions, receiving primary health services in North America (67%) and Europe (33%). YAs' recommendations for improving the transition from paediatric to adult healthcare (n=number of studies reported) included: improving continuity of care (n=12); facilitating patient-centred care (n=9); building strong support networks (n=11) and implementing transition education preparedness training (n=7). CONCLUSION Review findings can benefit service delivery by addressing important barriers to health, education, and social services for youth transitioning to adult healthcare.
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Affiliation(s)
- Monique Cassidy
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
| | - Shelley Doucet
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Alison Luke
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
| | - Alex Goudreau
- UNB Libraries, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
| | - Lillian MacNeill
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, New Brunswick, Canada
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, New Brunswick, Canada
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Vemulakonda VM, Janzen N, Hittelman AB, Deakyne Davies S, Sevick C, Richardson AC, Schissel J, Dash D, Hintz R, Grider R, Adams P, Buck M, King J, Ewing E, Beltran G, Corbett S, Chiang G. Feasibility of establishing a multi-center research database using the electronic health record: The PURSUIT network. J Pediatr Urol 2022; 18:788.e1-788.e8. [PMID: 35644792 DOI: 10.1016/j.jpurol.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/21/2022] [Accepted: 05/06/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although multi-center research is needed in pediatric urology, collaboration is impeded by differences in physician documentation and research resources. Electronic health record (EHR) tools offer a promising avenue to overcome these barriers. OBJECTIVE To assess the accuracy, completeness, and utilization of structured data elements across multiple practices. STUDY DESIGN A standardized template was developed and implemented at five academic pediatric urology practices to document clinic visits for patients with congenital hydronephrosis and/or vesicoureteral reflux. Data from standardized elements in the template and from pre-existing EHR fields were extracted into a secure database. A 20% random sample of infants with data from structured elements from 1/1/2020 and 4/30/2021 were identified and compared to manual chart review at sites with >100 charts; all other sites reviewed at least 20 charts. Manual chart review was standardized across sites and included: clinic and operative notes, orders linked to the clinic encounter, radiology results, and active medications. Accuracy of data extraction was evaluated by computing the kappa statistic and percentage agreement. For sites that had adopted the templates prior to 6/1/2019 (early adopters), a list of eligible patients with an initial clinic visit from 1/1/2020-7/27/2020 was generated using standardized reporting techniques and confirmed by manual chart review. Physician utilization of the template was then calculated by comparing patients with data obtained from the note template to the generated list of eligible patients. RESULTS 230 patient records met study criteria. Agreement between manual chart review and data extracted from the EHR was high (>85%). Race, ethnicity and insurance data were misclassified in about 10-15% of cases; this was due to site-specific differences in how these fields were coded. Renal ultrasound was misclassified 12% of the time; this was primarily due to outside images documented in radiology results but not included in the clinical note. All other data elements had >90% agreement (Figure). Template utilization for early adopters was >75% (75.5-87.5%). DISCUSSION This is the first study in urology to demonstrate that use of structured data elements can support multi-center research. Limitations include: inclusion of only academic sites with the Epic EHR and lack of data on utilization and sustainability at sites without a prior history of structured template use. CONCLUSIONS Multi-center research collaboration using EHR-based data collection tools is feasible with generally high accuracy compared to manual chart review. Additionally, sites with a long history of template adoption have high levels of provider utilization.
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Affiliation(s)
- Vijaya M Vemulakonda
- Pediatric Urology Research Enterprise, Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA; Division of Urology, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.
| | - Nicolette Janzen
- Department of Pediatric Urology, Texas Children's Hospital, Houston, TX, USA; Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Adam B Hittelman
- Department of Pediatric Urology, Yale New Haven Children's Hospital, New Haven, CT, USA; Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | | | - Carter Sevick
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Andrew C Richardson
- Research Informatics, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Josiah Schissel
- Clinical Informatics, Rady Children's Hospital San Diego, San Diego, CA, USA
| | - Debasis Dash
- Department of Pediatric Urology, Texas Children's Hospital, Houston, TX, USA; Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Richard Hintz
- Department of Pediatric Urology, Yale New Haven Children's Hospital, New Haven, CT, USA; Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | - Ron Grider
- Department of Pediatric Urology, University of Virginia Children's Hospital, Charlottesville, VA, USA; Department of Urology, University of Virginia Health Sciences Center, Charlottesville, VA, USA
| | - Parker Adams
- Pediatric Urology Research Enterprise, Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA; Division of Urology, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Matt Buck
- Department of Pediatric Urology, Yale New Haven Children's Hospital, New Haven, CT, USA; Department of Urology, Yale School of Medicine, New Haven, CT, USA
| | - Jordon King
- Department of Pediatric Urology, Texas Children's Hospital, Houston, TX, USA; Department of Urology, Baylor College of Medicine, Houston, TX, USA
| | - Emily Ewing
- Department of Pediatric Urology, Rady Children's Hospital San Diego, San Diego, CA, USA; Department of Urology, University of California San Diego, San Diego, CA, USA
| | - Gemma Beltran
- Pediatric Urology Research Enterprise, Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA; Division of Urology, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Sean Corbett
- Department of Pediatric Urology, University of Virginia Children's Hospital, Charlottesville, VA, USA; Department of Urology, University of Virginia Health Sciences Center, Charlottesville, VA, USA
| | - George Chiang
- Department of Pediatric Urology, Rady Children's Hospital San Diego, San Diego, CA, USA; Department of Urology, University of California San Diego, San Diego, CA, USA
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Bardhan IR, Bao C, Ayabakan S. Value Implications of Sourcing Electronic Health Records: The Role of Physician Practice Integration. INFORMATION SYSTEMS RESEARCH 2022. [DOI: 10.1287/isre.2022.1183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Should hospitals source electronic health records (EHR) systems from a single vendor or multiple vendors to deliver high-value care? We study hospitals’ EHR sourcing strategies based on their degree of integration with physician practices and its impact on the value of healthcare delivered. We propose a novel framework to define healthcare value as the extent to which a hospital effectively expends clinical resources to deliver services that improve patient outcomes. Drawing on modular systems and transaction cost economics theories, we propose a moderated-mediation model that explores the pathways through which EHR sourcing strategies can create value in healthcare. We test our research hypotheses on a large, longitudinal sample of U.S. hospitals and observe that hospitals with EHR configurations closer to single sourcing strategies exhibit greater health information sharing compared with hospitals with multisourced EHR systems. Furthermore, we find that hospital-physician practice integration moderates the impact of single sourcing on health information sharing, which in turn, improves value. Specifically, tighter integration between hospitals and physician practices can create greater value if it is aligned with hospitals’ EHR sourcing strategies. As the healthcare industry moves toward value-based payment reform, our findings provide a useful roadmap to practitioners and policy makers to improve the performance of hospitals and healthcare providers. History: Rajiv Kohli, Senior Editor; Sunil Wattal, Associate Editor. Funding: I.R. Bardhan thanks the Foster Parker Centennial Professorship and the Dean’s Research Excellence Grant at the McCombs School of Business at UT Austin for generous financial support. C. Bao thanks the Spears Fellowship at Oklahoma State University for financial support. Supplemental Material: The online appendix is available at https://doi.org/10.1287/isre.2022.1183 .
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Affiliation(s)
- Indranil R. Bardhan
- McCombs School of Business, The University of Texas at Austin, Austin, Texas 78705
| | - Chenzhang Bao
- Spears School of Business, Oklahoma State University, Tulsa, Oklahoma 74106
| | - Sezgin Ayabakan
- Fox School of Business, Temple University, Philadelphia, Pennsylvania 19122
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Wowak KD, Handley S, Kelley K, Angst CM. Strategic sourcing of multicomponent software systems: The case of electronic medical records. DECISION SCIENCES 2022. [DOI: 10.1111/deci.12576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kaitlin D. Wowak
- Department of IT, Analytics, and Operations, Mendoza College of Business University of Notre Dame Notre Dame Indiana
| | - Sean Handley
- Department of Management Science, Darla Moore School of Business University of South Carolina Columbia South Carolina
| | - Ken Kelley
- Department of IT, Analytics, and Operations, Mendoza College of Business University of Notre Dame Notre Dame Indiana
| | - Corey M. Angst
- Department of IT, Analytics, and Operations, Mendoza College of Business University of Notre Dame Notre Dame Indiana
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10
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Hamadi HY, Niazi SK, Zhao M, Spaulding A. Single-Vendor Electronic Health Record Use Is Associated With Greater Opportunities for Organizational and Clinical Care Improvements. Mayo Clin Proc Innov Qual Outcomes 2022; 6:269-278. [PMID: 35669522 PMCID: PMC9163586 DOI: 10.1016/j.mayocpiqo.2022.05.001] [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] [Indexed: 11/30/2022] Open
Abstract
Objective To compare how hospitals that use single-vendor vs best-of-breed electronic health record (EHR) vendors utilize clinical and organizational evaluation capabilities. Methods Data from the 2018 (June 1, 2016, to December 31, 2017) American Hospital Association Information Technology Supplement Survey and Medicare Final Rule Standardizing File were used. Multinomial logistic regression analysis of hospitals (n=1902) was conducted to identify hospital characteristics associated with the use of EHRs for (1) clinical care evaluation capabilities and (2) organizational evaluation capabilities. Results Single-vendor EHR hospitals were more likely (relative risk ratio, 3.37; 95% confidence interval, 1.97-5.76) to use EHRs for clinical care and organizational evaluation capabilities. Not-for-profit hospitals were more likely to use EHRs for all organizational evaluation capabilities than government nonfederal hospitals. For-profit hospitals were less likely to use EHRs for organizational or clinical evaluation capabilities than government nonfederal hospitals. Conclusion Hospitals using the single-vendor EHR system were more likely to engage in clinical care and organizational evaluation than hospitals using best-of-breed EHR systems.
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Affiliation(s)
- Hanadi Y Hamadi
- Department of Health Administration, University of North Florida, Jacksonville, FL
| | - Shehzad K Niazi
- Department of Psychiatry and Psychology, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
| | - Mei Zhao
- Department of Health Administration, University of North Florida, Jacksonville, FL
| | - Aaron Spaulding
- Division of Health Care Delivery, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
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11
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Srivastava A, Ayyalasomayajula S, Bao C, Ayabakan S, Delen D. Relationship between electronic health records strategy and user satisfaction: a longitudinal study using clinicians' online reviews. J Am Med Inform Assoc 2022; 29:1577-1583. [PMID: 35640010 DOI: 10.1093/jamia/ocac082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/03/2022] [Accepted: 05/13/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE We investigated how the electronic health records (EHRs) strategies concerning EHR sourcing and vendor switching impact user satisfaction over time. MATERIALS AND METHODS This study used a novel longitudinal dataset created by scraping clinicians' Glassdoor.com reviews on 109 US health systems from 2012 to 2017 and combining it with the Healthcare Information and Management Systems Society (HIMSS) database. We performed sentiment analysis of clinician reviews to construct our main dependent variable, user satisfaction. Our main independent variables, EHR single sourcing and vendor switching, were constructed using the HIMSS database. RESULTS Our fixed effects model showed that as health systems gain more experience with EHR, a single vendor sourcing strategy was associated with higher user satisfaction. Further, there was no significant impact of vendor switching on user satisfaction. CONCLUSION This work adds to the current understanding of EHR-driven clinician burnout using a novel longitudinal dataset. We show how organizational-level EHR strategy can impact user satisfaction and that providers and EHR vendors can mine clinician reviews online to understand their evolving needs and sentiments.
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Affiliation(s)
- Ankita Srivastava
- Department of Information and Process Management, Bentley University, Waltham, Massachusetts, USA
| | - Surya Ayyalasomayajula
- Department of Management Science and Information Systems, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Chenzhang Bao
- Department of Management Science and Information Systems, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Sezgin Ayabakan
- Department of Management Information Systems, Temple University, Philadelphia, Pennsylvania, USA
| | - Dursun Delen
- Department of Management Science and Information Systems, Oklahoma State University, Stillwater, Oklahoma, USA.,Department of Industrial Engineering, Faculty of Engineering and Natural Sciences, Istinye University, Istanbul, Turkey
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12
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Rasmussen LV, Connolly JJ, Del Fiol G, Freimuth RR, Pet DB, Peterson JF, Shirts BH, Starren JB, Williams MS, Walton N, Taylor CO. Infobuttons for Genomic Medicine: Requirements and Barriers. Appl Clin Inform 2021; 12:383-390. [PMID: 33979874 DOI: 10.1055/s-0041-1729164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES The study aimed to understand potential barriers to the adoption of health information technology projects that are released as free and open source software (FOSS). METHODS We conducted a survey of research consortia participants engaged in genomic medicine implementation to assess perceived institutional barriers to the adoption of three systems: ClinGen electronic health record (EHR) Toolkit, DocUBuild, and MyResults.org. The survey included eight barriers from the Consolidated Framework for Implementation Research (CFIR), with additional barriers identified from a qualitative analysis of open-ended responses. RESULTS We analyzed responses from 24 research consortia participants from 18 institutions. In total, 14 categories of perceived barriers were evaluated, which were consistent with other observed barriers to FOSS adoption. The most frequent perceived barriers included lack of adaptability of the system, lack of institutional priority to implement, lack of trialability, lack of advantage of alternative systems, and complexity. CONCLUSION In addition to understanding potential barriers, we recommend some strategies to address them (where possible), including considerations for genomic medicine. Overall, FOSS developers need to ensure systems are easy to trial and implement and need to clearly articulate benefits of their systems, especially when alternatives exist. Institutional champions will remain a critical component to prioritizing genomic medicine projects.
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Affiliation(s)
- Luke V Rasmussen
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, United Sates
| | - John J Connolly
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United Sates
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, United Sates
| | - Robert R Freimuth
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, United Sates
| | - Douglas B Pet
- Department of Neurology, University of California San Francisco, San Francisco, California, United Sates
| | - Josh F Peterson
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, United Sates
| | - Brian H Shirts
- Department of Laboratory Medicine, University of Washington, Seattle, Washington, United Sates
| | - Justin B Starren
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, United Sates
| | - Marc S Williams
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania, United Sates
| | - Nephi Walton
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania, United Sates.,Intermountain Precision Genomics, Intermountain Healthcare, St George, Utah, United Sates
| | - Casey Overby Taylor
- Genomic Medicine Institute, Geisinger, Danville, Pennsylvania, United Sates.,Department of Medicine and Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, Maryland, United Sates
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13
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McCarthy N, Dahlan A, Cook TS, Hare NO, Ryan ML, St John B, Lawlor A, Curran KM. Enterprise imaging and big data: A review from a medical physics perspective. Phys Med 2021; 83:206-220. [DOI: 10.1016/j.ejmp.2021.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/24/2021] [Accepted: 04/06/2021] [Indexed: 02/04/2023] Open
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Vest JR, Unruh MA, Freedman S, Simon K. Health systems' use of enterprise health information exchange vs single electronic health record vendor environments and unplanned readmissions. J Am Med Inform Assoc 2021; 26:989-998. [PMID: 31348514 DOI: 10.1093/jamia/ocz116] [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: 02/13/2019] [Revised: 05/28/2019] [Accepted: 06/11/2019] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Enterprise health information exchange (HIE) and a single electronic health record (EHR) vendor solution are 2 information exchange approaches to improve performance and increase the quality of care. This study sought to determine the association between adoption of enterprise HIE vs a single vendor environment and changes in unplanned readmissions. MATERIALS AND METHODS The association between unplanned 30-day readmissions among adult patients and adoption of enterprise HIE or a single vendor environment was measured in a panel of 211 system-member hospitals from 2010 through 2014 using fixed-effects regression models. Sample hospitals were members of health systems in 7 states. Enterprise HIE was defined as self-reported ability to exchange information with other members of the same health system who used different EHR vendors. A single EHR vendor environment reported exchanging information with other health system members, but all using the same EHR vendor. RESULTS Enterprise HIE adoption was more common among the study sample than EHR (75% vs 24%). However, adoption of a single EHR vendor environment was associated with a 0.8% reduction in the probability of a readmission within 30 days of discharge. The estimated impact of adopting an enterprise HIE strategy on readmissions was smaller and not statically significant. CONCLUSION Reductions in the probability of an unplanned readmission after a hospital adopts a single vendor environment suggests that HIE technologies can better support the aim of higher quality care. Additionally, health systems may benefit more from a single vendor environment approach than attempting to foster exchange across multiple EHR vendors.
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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, Center for Biomedical Informatics, Indianapolis, Indiana, USA
| | - Mark Aaron Unruh
- Weill Cornell Medical College, Department of Healthcare Policy and Research, New York, New York, USA
| | - Seth Freedman
- Indiana University O'Neill School of Public & Environmental Affairs, Bloomington, Indiana, USA
| | - Kosali Simon
- Indiana University O'Neill School of Public & Environmental Affairs, Bloomington, Indiana, USA.,National Bureau of Economic Research
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15
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Do data security measures, privacy regulations, and communication standards impact the interoperability of patient health information? A cross-country investigation. Int J Med Inform 2021; 148:104401. [PMID: 33571743 DOI: 10.1016/j.ijmedinf.2021.104401] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/19/2021] [Accepted: 01/23/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The lack of interoperability is one of the biggest obstacles to the complete digitalization of patient health information in electronic medical records (EMR). The high volume of data breaches has put pressure on care providers to adopt data protection measures to remain compliant with legal requirements. Extreme data protection measures can impede information flow, but they also instill confidence in secure information sharing. This study investigates how the adoption of security measures, privacy regulations, and communication standards has impacted patient health information interoperability at technical (TI), semantic (SI), and organizational (OI) levels within the hospitals. METHODS The study utilizes a quasi-experimental research design to probe the relationships of interest. Secondary data from a survey of randomly selected 773 hospitals conducted by the European Commission in over 30 countries in Europe is used to understand the relationships. The study counters selection bias and accounts for systematic differences in adopting treatments of interest in the hospitals using the propensity score-based approaches for the observational data. RESULTS The empirical models that account for selection bias explain more observational data variations than those that did not. Access control measures on workstations are linked to 44 % lesser odds of experiencing TI problems. However, hospitals with regional and organizational level privacy regulations have 85 % and 76 % higher odds of experiencing SI and OI problems, respectively. On the other hand, hospitals with a single hospital-wide EMR are 53 % and 43 % less likely to experience TI and SI problems, respectively, in comparison to those with multiple EMR systems. CONCLUSION The study highlights the differential impacts of data protection measures on the hospitals' three key types of interoperability problems (i.e., TI, SI, and OI). Homogenous EMR systems type and substantial investment in technology are critical to supporting health information interoperability within the hospitals. The study findings inform policy considerations for improving specific aspects of health information's interoperability while preserving patient data privacy and security.
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16
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Payne TH, Lovis C, Gutteridge C, Pagliari C, Natarajan S, Yong C, Zhao LP. Status of health information exchange: a comparison of six countries. J Glob Health 2020; 9:0204279. [PMID: 31673351 PMCID: PMC6815656 DOI: 10.7189/jogh.09.020427] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Health information exchange (HIE) is frequently cited as an important objective of health information technology investment because of its potential to improve quality, reduce cost, and increase patient satisfaction. In this paper we examine the status and practices of HIE in six countries, drawn from a range of higher and lower income regions. Methods For each of the countries represented – China, England, India, Scotland, Switzerland, and the United States – we describe the state of current practice of HIE with reference to two scenarios: transfer of care and referral. For each country we discuss national objectives, barriers and plans for further advancing clinical information exchange. Results The countries vary widely in levels of adoption of EHRs, availability of health information in electronic form suitable for HIE, and in the information technology infrastructure to be used for transmission. Common themes emerged, however, including an expectation that information will be exchanged rather than gathered anew, the need for incentives to promote information exchange, and concerns about data security and patient confidentiality. Conclusions Although the ability to transfer health information to where it is most needed is nearly always mentioned as an advantage of HIE adoption, there are wide differences in the degree to which this has been achieved to support the scenarios used in this study. Nevertheless, these differences indicate varying stages of progress along a comparable pathway, with similar barriers being identified in the countries described. In some cases, these have been partially surmounted while elsewhere work is needed. We reflect on contextual factors influencing the status and direction of HIE efforts in different global regions and their implications for progress.
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Affiliation(s)
| | - Christian Lovis
- University of Geneva and University hospitals of Geneva, Switzerland
| | | | | | | | - Cui Yong
- Peking University Medical Informatics Center, Beijing, Peoples' Republic of China
| | - Lue-Ping Zhao
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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17
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Pavlic D, Burns HH, Wong A, Lehmer J. Comparative health systems immersion in South Korea: A constructivist competency-based approach to educating master's nursing students. J Prof Nurs 2019; 36:92-97. [PMID: 32044060 DOI: 10.1016/j.profnurs.2019.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 06/28/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
Nursing education is being challenged to rapidly evolve in order to meet the complex and systemic health care demands facing societies globally. International immersion is one educational strategy promoted to help prepare nursing students to meet these challenges. The Comparative Health Care Immersion Course in South Korea was created to educate entry-level master of science in nursing (MSN) students studying to become Clinical Nurse Leaders (CNL) to meet the complex systems level challenges facing health care organizations in the United States. Teaching adults in a cross-cultural setting required a complex philosophical and andragogical approach weaving together cultural constructivism, cultural attunement, anti-imperialism, critical theory, and experiential learning.
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Affiliation(s)
- Danijela Pavlic
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA.
| | - Harold H Burns
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Alex Wong
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
| | - Joshua Lehmer
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
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18
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Weaver MS, Anderson B, Cole A, Lyon ME. Documentation of Advance Directives and Code Status in Electronic Medical Records to Honor Goals of Care. J Palliat Care 2019; 35:217-220. [PMID: 31280659 DOI: 10.1177/0825859719860129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Advance care planning is a process that supports conversations about the values that matter most to patients and their family members. The documentation of advance directives and code status in a patient's electronic health record (EHR) is a critical step to ensure treatment preferences are honored in the medical care received. The current approach to advanced care planning documentation in electronic medical records often remains disparate within and across EHR systems. Without a standardized format for documentation or centralized location for documentation, advance directives and even code status content are often difficult to access within electronic medical records. This case report launched our palliative care team into partnership with the Information Technology team for implementation of a centralized, standardized, longitudinal, functional documentation of advance care planning and code status in the electronic medical record system.
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Affiliation(s)
- Meaghann S Weaver
- Division of Pediatric Palliative Care, 20635Children's Hospital and Medical Center Omaha, Omaha, NE, USA [Advocacy project took place in the location Division of Pediatric Palliative Care, Children's Hospital and Medical Center Omaha, Omaha, NE, USA.]
| | - Betty Anderson
- Department of Information Technology, 20635Children's Hospital and Medical Center Omaha, Omaha, NE, USA
| | - Anne Cole
- Department of Information Technology, 20635Children's Hospital and Medical Center Omaha, Omaha, NE, USA
| | - Maureen E Lyon
- 233494Children's National Health System, Washington, DC, USA.,Division of Adolescent and Young Adult Medicine, Center for Translational Science/Children's Research Institute, Children's National Health System, Washington, DC, USA.,Department of Pediatrics, 233494Children's National Health System, George Washington School of Medicine and Health Sciences, Washington, DC, USA
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19
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Martin G, Arora S, Shah N, King D, Darzi A. A regulatory perspective on the influence of health information technology on organisational quality and safety in England. Health Informatics J 2019; 26:897-910. [PMID: 31203707 DOI: 10.1177/1460458219854602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Health information technology can transform and enhance the quality and safety of care, but it may also introduce new risks. This study analysed 130 healthcare regulator inspection reports and organisational digital maturity scores in order to characterise the impact of health information technology on quality and safety from a regulatory perspective. Although digital maturity and the positive use of health information technology are significantly associated with overall organisational quality, the negative effects of health information technology are frequently and more commonly identified by regulators. The poor usability of technology, lack of easy access to systems and data and the incorrect use of health information technology are the most commonly identified areas adversely affecting quality and safety. There is a need to understand the full risks and benefits of health information technology from the perspective of all stakeholders, including patients, end-users, providers and regulators in order to best inform future practice and regulation.
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20
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Ahmed Z, Jani Y, Franklin BD. Qualitative study exploring the phenomenon of multiple electronic prescribing systems within single hospital organisations. BMC Health Serv Res 2018; 18:969. [PMID: 30547779 PMCID: PMC6295095 DOI: 10.1186/s12913-018-3750-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 11/21/2018] [Indexed: 11/15/2022] Open
Abstract
Background A previous census of electronic prescribing (EP) systems in England showed that more than half of hospitals with EP reported more than one EP system within the same hospital. Our objectives were to describe the rationale for having multiple EP systems within a single hospital, and to explore perceptions of stakeholders about the advantages and disadvantages of multiple systems including any impact on patient safety. Methods Hospitals were selected from previous census respondents. A decision matrix was developed to achieve a maximum variation sample, and snowball sampling used to recruit stakeholders of different professional backgrounds. We then used an a priori framework to guide and analyse semi-structured interviews. Results Ten participants, comprising pharmacists and doctors and a nurse, were interviewed from four hospitals. The findings suggest that use of multiple EP systems was not strategically planned. Three co-existing models of EP systems adoption in hospitals were identified: organisation-led, clinician-led and clinical network-led, which may have contributed to multiple systems use. Although there were some perceived benefits of multiple EP systems, particularly in niche specialities, many disadvantages were described. These included issues related to access, staff training, workflow, work duplication, and system interfacing. Fragmentation of documentation of the patient’s journey was a major safety concern. Discussion The complexity of EP systems’ adoption and deficiencies in IT strategic planning may have contributed to multiple EP systems use in the NHS. In the near to mid-term, multiple EP systems may remain in place in many English hospitals, which may create challenges to quality and patient safety. Electronic supplementary material The online version of this article (10.1186/s12913-018-3750-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zamzam Ahmed
- Research Department of Practice and Policy, UCL School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX, UK. .,The Centre for Medication Safety and Service Quality, Pharmacy Department, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK. .,Department of Clinical and Pharmaceutical Sciences, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK.
| | - Yogini Jani
- Research Department of Practice and Policy, UCL School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX, UK.,Centre for Medicines Optimisation Research and Education, Pharmacy Department, University College London Hospitals NHS Foundation Trust, 235 Euston Rd, London, NW1 2BU, UK
| | - Bryony Dean Franklin
- Research Department of Practice and Policy, UCL School of Pharmacy, 29-39 Brunswick Square, London, WC1N 1AX, UK.,The Centre for Medication Safety and Service Quality, Pharmacy Department, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK
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21
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Narus SP, Rahman N, Mann DK, He S, Haug PJ. Enhancing a Commercial EMR with an Open, Standards-Based Publish-Subscribe Infrastructure. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2018; 2018:799-806. [PMID: 30815122 PMCID: PMC6371354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Intermountain Healthcare has designed and implemented a publish-subscribe (PubSub) infrastructure to support essential event processing workflows across our organization. A recent implementation of a commercial EMR highlighted the need to provide this capability on top of the EMR to support external applications and services that require access to triggering events within the EMR. A description of the PubSub architecture is presented. Use cases for health information exchange, public health reporting, and pulmonary embolism diagnosis that utilize PubSub are described, along with benefits of using the paradigm. Besides providing support for these external applications, the PubSub infrastructure allows additional event handling functionality not available in the commercial EMR. The open, standards-based nature of the design should allow other organizations to implement the system in their information systems environment.
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Affiliation(s)
| | | | | | - Shan He
- Intermountain Healthcare, Salt Lake City, UT
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22
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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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Abstract
OBJECTIVES Describe the state of Electronic Health Records (EHRs) in 1992 and their evolution by 2015 and where EHRs are expected to be in 25 years. Further to discuss the expectations for EHRs in 1992 and explore which of them were realized and what events accelerated or disrupted/derailed how EHRs evolved. METHODS Literature search based on "Electronic Health Record", "Medical Record", and "Medical Chart" using Medline, Google, Wikipedia Medical, and Cochrane Libraries resulted in an initial review of 2,356 abstracts and other information in papers and books. Additional papers and books were identified through the review of references cited in the initial review. RESULTS By 1992, hardware had become more affordable, powerful, and compact and the use of personal computers, local area networks, and the Internet provided faster and easier access to medical information. EHRs were initially developed and used at academic medical facilities but since most have been replaced by large vendor EHRs. While EHR use has increased and clinicians are being prepared to practice in an EHR-mediated world, technical issues have been overshadowed by procedural, professional, social, political, and especially ethical issues as well as the need for compliance with standards and information security. There have been enormous advancements that have taken place, but many of the early expectations for EHRs have not been realized and current EHRs still do not meet the needs of today's rapidly changing healthcare environment. CONCLUSION The current use of EHRs initiated by new technology would have been hard to foresee. Current and new EHR technology will help to provide international standards for interoperable applications that use health, social, economic, behavioral, and environmental data to communicate, interpret, and act intelligently upon complex healthcare information to foster precision medicine and a learning health system.
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Affiliation(s)
- R S Evans
- R. Scott Evans, MS, PhD, FACMI, Department of Medical Informatics, LDS Hospital, 8th Ave & C Street, Salt Lake City, Utah 84143, USA, Tel: +1 801 408-3029, Fax: +1 801 408-5802, E-mail:
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24
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Pageler NM, Grazier G'Sell MJ, Chandler W, Mailes E, Yang C, Longhurst CA. A rational approach to legacy data validation when transitioning between electronic health record systems. J Am Med Inform Assoc 2016; 23:991-4. [PMID: 26977100 DOI: 10.1093/jamia/ocv173] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/20/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The objective of this project was to use statistical techniques to determine the completeness and accuracy of data migrated during electronic health record conversion. METHODS Data validation during migration consists of mapped record testing and validation of a sample of the data for completeness and accuracy. We statistically determined a randomized sample size for each data type based on the desired confidence level and error limits. RESULTS The only error identified in the post go-live period was a failure to migrate some clinical notes, which was unrelated to the validation process. No errors in the migrated data were found during the 12- month post-implementation period. CONCLUSIONS Compared to the typical industry approach, we have demonstrated that a statistical approach to sampling size for data validation can ensure consistent confidence levels while maximizing efficiency of the validation process during a major electronic health record conversion.
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Affiliation(s)
- Natalie M Pageler
- Division of Critical Care Medicine Department of Pediatrics, Stanford University School of Medicine Division of Systems Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA Information Services Department, Stanford Children's Health, CA
| | | | - Warren Chandler
- Information Services Department, Stanford Children's Health, CA
| | - Emily Mailes
- Information Services Department, Stanford Children's Health, CA
| | - Christine Yang
- Information Services Department, Stanford Children's Health, CA
| | - Christopher A Longhurst
- Departments of Biomedical Informatics and Pediatrics, University of California San Diego, CA
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25
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Haux R, Lehmann CU. From bed to bench: bridging from informatics practice to theory: an exploratory analysis. Appl Clin Inform 2015; 5:907-15. [PMID: 25589906 DOI: 10.4338/aci-2014-10-ra-0095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 10/22/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In 2009, Applied Clinical Informatics (ACI)--focused on applications in clinical informatics--was launched as a companion journal to Methods of Information in Medicine (MIM). Both journals are official journals of the International Medical Informatics Association. OBJECTIVES To explore which congruencies and interdependencies exist in publications from theory to practice and from practice to theory and to determine existing gaps. Major topics discussed in ACI and MIM were analyzed. We explored if the intention of publishing companion journals to provide an information bridge from informatics theory to informatics practice and vice versa could be supported by this model. In this manuscript we will report on congruencies and interdependences from practice to theory and on major topics in MIM. METHODS Retrospective, prolective observational study on recent publications of ACI and MIM. All publications of the years 2012 and 2013 were indexed and analyzed. RESULTS Hundred and ninety-six publications were analyzed (ACI 87, MIM 109). In MIM publications, modelling aspects as well as methodological and evaluation approaches for the analysis of data, information, and knowledge in biomedicine and health care were frequently raised - and often discussed from an interdisciplinary point of view. Important themes were ambient-assisted living, anatomic spatial relations, biomedical informatics as scientific discipline, boosting, coding, computerized physician order entry, data analysis, grid and cloud computing, health care systems and services, health-enabling technologies, health information search, health information systems, imaging, knowledge-based decision support, patient records, signal analysis, and web science. Congruencies between journals could be found in themes, but with a different focus on content. Interdependencies from practice to theory, found in these publications, were only limited. CONCLUSIONS Bridging from informatics theory to practice and vice versa remains a major component of successful research and practice as well as a major challenge.
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Affiliation(s)
- R Haux
- Peter L. Reichertz Institute for Medical Informatics, University of Braunschweig and Hannover Medical School , Germany
| | - C U Lehmann
- Departments of Pediatrics and Biomedical Informatics, Vanderbilt University , Nashville, TN, USA
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26
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Lehmann CU, Haux R. From bench to bed: bridging from informatics theory to practice. An exploratory analysis. Methods Inf Med 2014; 53:511-5. [PMID: 25377761 DOI: 10.3414/me14-01-0098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND In 2009, the journal Applied Clinical Informatics (ACI) commenced publication. Focused on applications in clinical informatics, ACI was intended to be a companion journal to METHODS of Information in Medicine (MIM). Both journals are official journals of IMIA, the International Medical Informatics Association. OBJECTIVES To explore, after five years, which congruencies and interdependencies exist in publications of these journals and to determine if gaps exist. To achieve this goal, major topics discussed in ACI and in MIM had to be analysed. Finally, we wanted to explore, whether the intention of publishing these companion journals to provide an information bridge from informatics theory to informatics practice and from practice to theory could be supported by this model. In this manuscript we will report on congruencies and interdependencies from practise to theory and on major topis in ACI. Further results will be reported in a second paper. METHODS Retrospective, prolective observational study on recent publications of ACI and MIM. All publications of the years 2012 and 2013 from these journals were indexed and analysed. RESULTS Hundred and ninety-six publications have been analysed (87 ACI, 109 MIM). In ACI publications addressed care coordination, shared decision support, and provider communication in its importance for complex patient care and safety and quality. Other major themes included improving clinical documentation quality and efficiency, effectiveness of clinical decision support and alerts, implementation of health information technology systems including discussion of failures and succeses. An emerging topic in the years analyzed was a focus on health information technology to predict and prevent hospital admissions and managing population health including the application of mobile health technology. Congruencies between journals could be found in themes, but with different focus in its contents. Interdependencies from practise to theory found in these publications, were only limited. CONCLUSIONS Bridging from informatics theory to practise and vice versa remains a major component of successful research and practise as well as a major challenge.
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Affiliation(s)
- C U Lehmann
- Prof. Dr. Christoph U. Lehmann, Pediatrics and Biomedical Informatics, Vanderbilt University, 2200 Children's Way, 11111 Doctors' Office Tower, Nashville, TN 37232-9544, USA, E-mail:
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