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Born C, Schwarz R, Böttcher TP, Hein A, Krcmar H. The role of information systems in emergency department decision-making-a literature review. J Am Med Inform Assoc 2024; 31:1608-1621. [PMID: 38781289 PMCID: PMC11187435 DOI: 10.1093/jamia/ocae096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES Healthcare providers employ heuristic and analytical decision-making to navigate the high-stakes environment of the emergency department (ED). Despite the increasing integration of information systems (ISs), research on their efficacy is conflicting. Drawing on related fields, we investigate how timing and mode of delivery influence IS effectiveness. Our objective is to reconcile previous contradictory findings, shedding light on optimal IS design in the ED. MATERIALS AND METHODS We conducted a systematic review following PRISMA across PubMed, Scopus, and Web of Science. We coded the ISs' timing as heuristic or analytical, their mode of delivery as active for automatic alerts and passive when requiring user-initiated information retrieval, and their effect on process, economic, and clinical outcomes. RESULTS Our analysis included 83 studies. During early heuristic decision-making, most active interventions were ineffective, while passive interventions generally improved outcomes. In the analytical phase, the effects were reversed. Passive interventions that facilitate information extraction consistently improved outcomes. DISCUSSION Our findings suggest that the effectiveness of active interventions negatively correlates with the amount of information received during delivery. During early heuristic decision-making, when information overload is high, physicians are unresponsive to alerts and proactively consult passive resources. In the later analytical phases, physicians show increased receptivity to alerts due to decreased diagnostic uncertainty and information quantity. Interventions that limit information lead to positive outcomes, supporting our interpretation. CONCLUSION We synthesize our findings into an integrated model that reveals the underlying reasons for conflicting findings from previous reviews and can guide practitioners in designing ISs in the ED.
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Affiliation(s)
- Cornelius Born
- School of Computation, Information and Technology, Technical University of Munich, 85748 Garching bei München, Germany
| | - Romy Schwarz
- School of Computation, Information and Technology, Technical University of Munich, 85748 Garching bei München, Germany
| | - Timo Phillip Böttcher
- School of Computation, Information and Technology, Technical University of Munich, 85748 Garching bei München, Germany
| | - Andreas Hein
- Institute of Information Systems and Digital Business, University of St. Gallen, 9000 St. Gallen, Switzerland
| | - Helmut Krcmar
- School of Computation, Information and Technology, Technical University of Munich, 85748 Garching bei München, Germany
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Petrova M, Barclay S. From "wading through treacle" to "making haste slowly": A comprehensive yet parsimonious model of drivers and challenges to implementing patient data sharing projects based on an EPaCCS evaluation and four pre-existing literature reviews. PLOS DIGITAL HEALTH 2024; 3:e0000470. [PMID: 38557799 PMCID: PMC10984410 DOI: 10.1371/journal.pdig.0000470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/19/2024] [Indexed: 04/04/2024]
Abstract
Conceptually, this study aimed to 1) identify the challenges and drivers encountered by England's Electronic Palliative Care Coordination System (EPaCCS) projects in the context of challenges and drivers in other projects on data sharing for individual care (also referred to as Health Information Exchange, HIE) and 2) organise them in a comprehensive yet parsimonious framework. The study also had a strong applied goal: to derive specific and non-trivial recommendations for advancing data sharing projects, particularly ones in early stages of development and implementation. Primary data comprised 40 in-depth interviews with 44 healthcare professionals, patients, carers, project team members and decision makers in Cambridgeshire, UK. Secondary data were extracted from four pre-existing literature reviews on Health Information Exchange and Health Information Technology implementation covering 135 studies. Thematic and framework analysis underpinned by "pluralist" coding were the main analytical approaches used. We reduced an initial set of >1,800 parameters into >500 challenges and >300 drivers to implementing EPaCCS and other data sharing projects. Less than a quarter of the 800+ parameters were associated primarily with the IT solution. These challenges and drivers were further condensed into an action-guiding, strategy-informing framework of nine types of "pure challenges", four types of "pure drivers", and nine types of "oppositional or ambivalent forces". The pure challenges draw parallels between patient data sharing and other broad and complex domains of sociotechnical or social practice. The pure drivers differ in how internal or external to the IT solution and project team they are, and thus in the level of control a project team has over them. The oppositional forces comprise pairs of challenges and drivers where the driver is a factor serving to resolve or counteract the challenge. The ambivalent forces are factors perceived simultaneously as a challenge and a driver depending on context, goals and perspective. The framework is distinctive in its emphasis on: 1) the form of challenges and drivers; 2) ambivalence, ambiguity and persistent tensions as fundamental forces in the field of innovation implementation; and 3) the parallels it draws with a variety of non-IT, non-health domains of practice as a source of fruitful learning. Teams working on data sharing projects need to prioritise further the shaping of social interactions and structural and contextual parameters in the midst of which their IT tools are implemented. The high number of "ambivalent forces" speaks of the vital importance for data sharing projects of skills in eliciting stakeholders' assumptions; managing conflict; and navigating multiple needs, interests and worldviews.
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Affiliation(s)
- Mila Petrova
- Palliative and End of Life Care Group in Cambridge (PELiCam), Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom
| | - Stephen Barclay
- Palliative and End of Life Care Group in Cambridge (PELiCam), Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, United Kingdom
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Li S, Felix Gomez GG, Xu H, Rajapuri AS, Dixon BE, Thyvalikakath T. Dentists' Information Needs and Opinions on Accessing Patient Information via Health Information Exchange: Survey Study. JMIR Form Res 2024; 8:e51200. [PMID: 38206667 PMCID: PMC10811575 DOI: 10.2196/51200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/18/2023] [Accepted: 11/22/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The integration of medical and dental records is gaining significance over the past 2 decades. However, few studies have evaluated the opinions of practicing dentists on patient medical histories. Questions remain on dentists' information needs; their perception of the reliability of patient-reported medical history; satisfaction with the available information and the methods to gather this information; and their attitudes to other options, such as a health information exchange (HIE) network, to collect patient medical history. OBJECTIVE This study aims to determine Indiana dentists' information needs regarding patients' medical information and their opinions about accessing it via an HIE. METHODS We administered a web-based survey to Indiana Dental Association members to assess their current medical information-retrieval approaches, the information critical for dental care, and their willingness to access or share information via an HIE. We used descriptive statistics to summarize survey results and multivariable regression to examine the associations between survey respondents' characteristics and responses. RESULTS Of the 161 respondents (161/2148, 7.5% response rate), 99.5% (n=160) respondents considered patients' medical histories essential to confirm no contraindications, including allergies or the need for antibiotic prophylaxis during dental care and other adverse drug events. The critical information required were medical conditions or diagnosis, current medications, and allergies, which were gathered from patient reports. Furthermore, 88.2% (n=142) of respondents considered patient-reported histories reliable; however, they experienced challenges obtaining information from patients and physicians. Additionally, 70.2% (n=113) of respondents, especially those who currently access an HIE or electronic health record, were willing to use an HIE to access or share their patient's information, and 91.3% (n=147) shared varying interests in such a service. However, usability, data accuracy, data safety, and cost are the driving factors in adopting an HIE. CONCLUSIONS Patients' medical histories are essential for dentists to optimize dental care, especially for those with chronic conditions. In addition, most dentists are interested in using an HIE to access patient medical histories. The findings from this study can provide an alternative option for improving communications between dental and medical professionals and help the health information technology system or tool developers identify critical requirements for more user-friendly designs.
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Affiliation(s)
- Shuning Li
- Department of Dental Public Health and Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
| | - Grace Gomez Felix Gomez
- Department of Dental Public Health and Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
- Regenstrief Institute, Inc, Center for Biomedical Informatics, Indianapolis, IN, United States
| | - Huiping Xu
- Department of Biostatistics and Health Data Sciences, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Anushri Singh Rajapuri
- Department of Dental Public Health and Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
| | - Brian E Dixon
- Regenstrief Institute, Inc, Center for Biomedical Informatics, Indianapolis, IN, United States
- Department of Epidemiology, Indiana University Richard M Fairbanks School of Public Health, Indianapolis, IN, United States
| | - Thankam Thyvalikakath
- Department of Dental Public Health and Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
- Regenstrief Institute, Inc, Center for Biomedical Informatics, Indianapolis, IN, United States
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Boockvar KS, Koufacos NS, May J, Schwartzkopf AL, Guerrero VM, Judon KM, Schubert CC, Franzosa E, Dixon BE. Effect of Health Information Exchange Plus a Care Transitions Intervention on Post-Hospital Outcomes Among VA Primary Care Patients: a Randomized Clinical Trial. J Gen Intern Med 2022; 37:4054-4061. [PMID: 35199262 PMCID: PMC9708976 DOI: 10.1007/s11606-022-07397-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/04/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Health information exchange (HIE) notifications when patients experience cross-system acute care encounters offer an opportunity to provide timely transitions interventions to improve care across systems. OBJECTIVE To compare HIE notification followed by a post-hospital care transitions intervention (CTI) with HIE notification alone. DESIGN Cluster-randomized controlled trial with group assignment by primary care team. PATIENTS Veterans 65 or older who received primary care at 2 VA facilities who consented to HIE and had a non-VA hospital admission or emergency department visit between 2016 and 2019. INTERVENTIONS For all subjects, real-time HIE notification of the non-VA acute care encounter was sent to the VA primary care provider. Subjects assigned to HIE plus CTI received home visits and telephone calls from a VA social worker for 30 days after arrival home, focused on patient activation, medication and condition knowledge, patient-centered record-keeping, and follow-up. MEASURES Primary outcome: 90-day hospital admission or readmission. SECONDARY OUTCOMES emergency department visits, timely VA primary care team telephone and in-person follow-up, patients' understanding of their condition(s) and medication(s) using the Care Transitions Measure, and high-risk medication discrepancies. KEY RESULTS A total of 347 non-VA acute care encounters were included and assigned: 159 to HIE plus CTI and 188 to HIE alone. Veterans were 76.9 years old on average, 98.5% male, 67.8% White, 17.1% Black, and 15.1% other (including Hispanic). There was no difference in 90-day hospital admission or readmission between the HIE-plus-CTI and HIE-alone groups (25.8% vs. 20.2%, respectively; risk diff 5.6%; 95% CI - 3.3 to 14.5%, p = .25). There was also no difference in secondary outcomes. CONCLUSIONS A care transitions intervention did not improve outcomes for veterans after a non-VA acute care encounter, as compared with HIE notification alone. Additional research is warranted to identify transitions services across systems that are implementable and could improve outcomes.
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Affiliation(s)
- Kenneth S Boockvar
- James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA.
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- The New Jewish Home, New York, NY, USA.
| | - Nicholas S Koufacos
- James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA
| | - Justine May
- Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA
| | - Ashley L Schwartzkopf
- Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA
| | - Vivian M Guerrero
- James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA
| | - Kimberly M Judon
- James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA
| | - Cathy C Schubert
- Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Emily Franzosa
- James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brian E Dixon
- Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA
- Department of Epidemiology, Indiana University Fairbanks School of Public Health, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
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Li S, Williams KS, Medam JK, Patel JS, Gonzalez T, Thyvalikakath TP. Retrospective Study of the Reasons and Time Involved for Dental Providers' Medical Consults. Front Digit Health 2022; 4:838538. [PMID: 35633738 PMCID: PMC9133325 DOI: 10.3389/fdgth.2022.838538] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/12/2022] [Indexed: 11/19/2022] Open
Abstract
Background Patient-reported medical histories and medical consults are primary approaches to obtaining patients' medical histories in dental settings. While patient-reported medical histories are reported to have inconsistencies, sparse information exists regarding the completeness of medical providers' responses to dental providers' medical consults. This study examined records from a predoctoral dental student clinic to determine the reasons for medical consults; the medical information requested, the completeness of returned responses, and the time taken to receive answers for medical consult requests. Methods A random sample of 240 medical consult requests for 179 distinct patients were selected from patient encounters between 1 January 2015 and 31 December 2017. Descriptive statistics and summaries were calculated to determine the reasons for the consult, the type of information requested and returned, and the time interval for each consult. Results The top two reasons for medical consults were to obtain more information (46.1%) and seek medical approval to proceed with treatment (30.3%). Laboratory and diagnostic reports (56.3%), recommendations/medical clearances (39.6%), medication information (38.3%), and current medical conditions (19.2%) were the frequent requests. However, medical providers responded fewer times to dental providers' laboratory and diagnostic report requests (41.3%), recommendations/medical clearances (19.2%), and current medical conditions (13.3%). While 86% of consults were returned in 30 days and 14% were completed after 30 days. Conclusions The primary reasons for dental providers' medical consults are to obtain patient information and seek recommendations for dental care. Laboratory/diagnostic reports, current medical conditions, medication history, or modifications constituted the frequently requested information. Precautions for dental procedures, antibiotic prophylaxis, and contraindications included reasons to seek medical providers' recommendations. The results also highlight the challenges they experience, such as requiring multiple attempts to contact medical providers, the incompleteness of information shared, and the delays experienced in completing at least 25% of the consults. Practical Implications The study results call attention to the importance of interdisciplinary care to provide optimum dental care and the necessity to establish systems such as integrated electronic dental record-electronic health record systems and health information exchanges to improve information sharing and communication between dental and medical providers.
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Affiliation(s)
- Shuning Li
- Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
| | - Karmen S. Williams
- Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
- Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis (IUPUI), Indianapolis, IN, United States
- Population Health Informatics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Jayanth Kumar Medam
- Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
- ELLKAY LLC, Elmwood Park, NJ, United States
| | - Jay S. Patel
- Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
- Temple University, Philadelphia, PA, United States
| | - Theresa Gonzalez
- Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
| | - Thankam P. Thyvalikakath
- Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
- Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, IN, United States
- *Correspondence: Thankam P. Thyvalikakath
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Li S, Rajapuri AS, Felix Gomez GG, Schleyer T, Mendonca EA, Thyvalikakath TP. How Do Dental Clinicians Obtain Up-To-Date Patient Medical Histories? Modeling Strengths, Drawbacks, and Proposals for Improvements. Front Digit Health 2022; 4:847080. [PMID: 35419556 PMCID: PMC8995974 DOI: 10.3389/fdgth.2022.847080] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAccess to up-to-date patient medical history is essential for dental clinicians (DCs) to avoid potential harm to patients and to improve dental treatment outcomes. The predominant approach for dental clinicians (DCs) to gather patients' medical history is through patient-reported medical histories and medical consults. However, studies reported varied concordance and reliability of patient-reported medical conditions and medication histories compared to the patient medical records and this process also places a significant burden on patients. Information technology tools/platforms such as an integrated electronic health record containing an electronic dental record module may address these issues. However, these integrated systems are expensive and technically complex and may not be easily adopted by DCs in solo and small group practice who provide the most dental care. The recent expansion of regional healthcare information exchange (HIE) provides another approach, but to date, studies on connecting DCs with HIE are very limited. Our study objectives were to model different aspects of the current approaches to identify the strengths and weaknesses, and then model the HIE approach that addresses the weaknesses and retain the strengths of current approaches. The models of current approaches identified the people, resources, organizational aspects, workflow, and areas for improvement; while models of the HIE approach identified system requirements, functions, and processes that may be shared with software developers and other stakeholders for future development.MethodsThere are three phases in this study. In Phase 1, we retrieved peer-reviewed PubMed indexed manuscripts published between January 2013 and November 2020 and extracted modeling related data from selected manuscripts. In Phase 2, we built models for the current approaches by using the Integrated DEFinition Method 0 function modeling method (IDEF0), the Unified Modeling Language (UML) Use Case Diagram, and Business Process Model and Notation (BPMN) methods. In Phase 3, we created three conceptual models for the HIE approach.ResultsFrom the 47 manuscripts identified, three themes emerged: 1) medical consult process following patient-reported medical history, 2) integrated electronic dental record-electronic health record (EDR-EHR), and 3) HIE. Three models were built for each of the three themes. The use case diagrams described the actions of the dental patients, DCs, medical providers and the use of information systems (EDR-EHR/HIE). The IDEF0 models presented the major functions involved. The BPMN models depicted the detailed steps of the process and showed how the patient's medical history information flowed through different steps. The strengths and weaknesses revealed by the models of the three approaches were also compared.ConclusionsWe successfully modeled the DCs' current approaches of accessing patient medical history and designed an HIE approach that addressed the current approaches' weaknesses as well as leveraged their strengths. Organizational management and end-users can use this information to decide the optimum approach to integrate dental and medical care. The illustrated models are comprehensive and can also be adopted by EHR and EDR vendors to develop a connection between dental systems and HIEs.
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Affiliation(s)
- Shuning Li
- Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
- *Correspondence: Shuning Li
| | - Anushri Singh Rajapuri
- Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
- Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, IN, United States
| | - Grace Gomez Felix Gomez
- Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
- Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, IN, United States
| | - Titus Schleyer
- Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, IN, United States
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Eneida A. Mendonca
- Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, IN, United States
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Thankam P. Thyvalikakath
- Dental Informatics, Indiana University School of Dentistry, Indianapolis, IN, United States
- Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, IN, United States
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Mullins A, O'Donnell R, Mousa M, Rankin D, Ben-Meir M, Boyd-Skinner C, Skouteris H. Health Outcomes and Healthcare Efficiencies Associated with the Use of Electronic Health Records in Hospital Emergency Departments: a Systematic Review. J Med Syst 2020; 44:200. [PMID: 33078276 DOI: 10.1007/s10916-020-01660-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/16/2020] [Indexed: 01/28/2023]
Abstract
Healthcare organisations and governments have invested heavily in electronic health records in anticipation that they will deliver improved health outcomes for consumers and efficiencies across emergency departments. Despite such investment, electronic health records designed to support emergency care have been poorly evaluated. Given the accelerated development and adoption of information technology across healthcare, it is timely that a systematic review of this evidence base is updated in order to drive improvements to design, interoperability and overall clinical utility of electronic health record systems implemented in emergency departments. To assess the impact of electronic health records on healthcare outcomes and efficiencies in the emergency department we carried out a systematic review of published studies on this topic. This is the first review to summarise the cost efficiencies associated with electronic health record use outside of just the United States of America. A systematic search was performed in three scientific databases (MEDLINE, EMcare and EMBASE), of literature published between January 2000 and September 2019. Studies were included in this review if they evaluated electronic health records or health information exchanges (and synonyms for these terms), reported patient outcome and/or healthcare efficiency benefits, were peer-reviewed and published in English. Out of 6635 articles, 23 studies met our inclusion criteria. Wide variation regarding electronic health record access in the emergency department was reported (1.46-56.6%), yet was most frequently reported as less than 20%. Seven different types of health outcomes and three different types of efficiency improvements associated with electronic health record use in the emergency department were identified. The most frequently reported findings were efficiencies, including reductions in diagnostic tests, imaging and costs. This review is the first to report moderate to significant increases in admission rates are associated with electronic health record use in the emergency department, contrasting the findings of previous reviews. Diversity in the methodology employed across the included studies emphasises the need for further research to examine the impact of electronic health record implementation and system design on the findings reported, in order to ensure return on investment for stakeholders and optimised consumer care.
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Affiliation(s)
- Alexandra Mullins
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Renee O'Donnell
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mariam Mousa
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | | | | | - Helen Skouteris
- Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Warwick Business School, University of Warwick, Coventry, United Kingdom
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Bowden T, Lyell D, Coiera E. Emergency care access to primary care records: an observational study. BMJ Health Care Inform 2020; 27:bmjhci-2020-100153. [PMID: 32830108 PMCID: PMC7445344 DOI: 10.1136/bmjhci-2020-100153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/18/2020] [Accepted: 07/08/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To measure lookup rates of externally held primary care records accessed in emergency care and identify patient characteristics, conditions and potential consequences associated with access. MEASURES Rates of primary care record access and re-presentation to the emergency department (ED) within 30 days and hospital admission. DESIGN A retrospective observational study of 77 181 ED presentations over 4 years and 9 months, analysing 8184 index presentations in which patients' primary care records were accessed from the ED. Data were compared with 17 449 randomly selected index control presentations. Analysis included propensity score matching for age and triage categories. RESULTS 6.3% of overall ED presentations triggered a lookup (rising to 8.3% in year 5); 83.1% of patients were only looked up once and 16.9% of patients looked up on multiple occasions. Lookup patients were on average 25 years older (z=-9.180, p<0.001, r=0.43). Patients with more urgent triage classifications had their records accessed more frequently (z=-36.47, p<0.001, r=0.23). Record access was associated with a significant but negligible increase in hospital admission (χ2 (1, n=13 120)=98.385, p<0.001, phi=0.087) and readmission within 30 days (χ2 (1, n=13 120)=86.288, p<0.001, phi=0.081). DISCUSSION Emergency care clinicians access primary care records more frequently for older patients or those in higher triage categories. Increased levels of inpatient admission and re-presentation within 30 days are likely linked to age and triage categories. CONCLUSION Further studies should focus on the impact of record access on clinical and process outcomes and which record elements have the most utility to shape clinical decisions.
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Affiliation(s)
- Thomas Bowden
- HREC, Macquarie University, Sydney, New South Wales, Australia
| | - David Lyell
- HREC, Macquarie University, Sydney, New South Wales, Australia
| | - Enrico Coiera
- HREC, Macquarie University, Sydney, New South Wales, Australia
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Vest JR, Unruh MA, Shapiro JS, Casalino LP. The associations between query-based and directed health information exchange with potentially avoidable use of health care services. Health Serv Res 2019; 54:981-993. [PMID: 31112303 PMCID: PMC6736925 DOI: 10.1111/1475-6773.13169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To quantify the impact of two approaches (directed and query-based) to health information exchange (HIE) on potentially avoidable use of health care services. DATA SOURCES/STUDY SETTING Data on ambulatory care providers' adoption of HIE were merged with Medicare fee-for-service claims from 2008 to 2014. Providers were from 13 counties in New York served by the Rochester Regional Health Information Organization (RHIO). STUDY DESIGN Linear regression models with provider and year fixed effects were used to estimate changes in the probability of utilization outcomes for Medicare beneficiaries attributed to providers adopting directed and/or query-based HIE compared with beneficiaries attributed to providers who had not adopted HIE. DATA COLLECTION Providers' HIE adoption status was determined through Rochester RHIO registration records. RHIO and claims data were linked via National Provider Identifiers. PRINCIPAL FINDINGS Query-based HIE adoption was associated with a 0.2 percentage point reduction in the probability of an ambulatory care sensitive hospitalization and a 1.1 percentage point decrease in the likelihood of an unplanned readmission. Directed HIE adoption was not associated with any outcome. CONCLUSIONS The Centers for Medicare & Medicaid Services' (CMS) EHR certification criteria includes requirements for directed HIE, but not query-based HIE. Pending further research, certification criteria should place equal weight on facilitating query-based and directed exchange.
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Affiliation(s)
- Joshua R. Vest
- Center for Health PolicyIndianapolisIndiana
- Health Policy and ManagementIndiana University Richard M Fairbanks School of Public Health at IUPUIIndianapolisIndiana
- Regenstrief Institute, Inc.IndianapolisIndiana
| | - Mark Aaron Unruh
- Department of Healthcare Policy and ResearchWeill Cornell Medical CollegeNew YorkNew York
| | - Jason S. Shapiro
- Department of Emergency MedicineIcahn School of Medicine at Mout SinaiNew YorkNew York
| | - Lawrence P. Casalino
- Division of Health Policy and EconomicsThe Livingston Farrand Professor of Public HealthNew YorkNew York
- Weill Cornell Graduate School of Medical SciencesWeill Cornell Medical CollegeNew YorkNew York
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Dixon BE, Schwartzkopf AL, Guerrero VM, May J, Koufacos NS, Bean AM, Penrod JD, Schubert CC, Boockvar KS. Regional data exchange to improve care for veterans after non-VA hospitalization: a randomized controlled trial. BMC Med Inform Decis Mak 2019; 19:125. [PMID: 31272427 PMCID: PMC6611045 DOI: 10.1186/s12911-019-0849-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/24/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Coordination of care, especially after a patient experiences an acute care event, is a challenge for many health systems. Event notification is a form of health information exchange (HIE) which has the potential to support care coordination by alerting primary care providers when a patient experiences an acute care event. While promising, there exists little evidence on the impact of event notification in support of reengagement into primary care. The objectives of this study are to 1) examine the effectiveness of event notification on health outcomes for older adults who experience acute care events, and 2) compare approaches to how providers respond to event notifications. METHODS In a cluster randomized trial conducted across two medical centers within the U.S. Veterans Health Administration (VHA) system, we plan to enroll older patients (≥ 65 years of age) who utilize both VHA and non-VHA providers. Patients will be enrolled into one of three arms: 1) usual care; 2) event notifications only; or 3) event notifications plus a care transitions intervention. In the event notification arms, following a non-VHA acute care encounter, an HIE-based intervention will send an event notification to VHA providers. Patients in the event notification plus care transitions arm will also receive 30 days of care transition support from a social worker. The primary outcome measure is 90-day readmission rate. Secondary outcomes will be high risk medication discrepancies as well as care transitions processes within the VHA health system. Qualitative assessments of the intervention will inform VHA system-wide implementation. DISCUSSION While HIE has been evaluated in other contexts, little evidence exists on HIE-enabled event notification interventions. Furthermore, this trial offers the opportunity to examine the use of event notifications that trigger a care transitions intervention to further support coordination of care. TRIAL REGISTRATION ClinicalTrials.gov NCT02689076. "Regional Data Exchange to Improve Care for Veterans After Non-VA Hospitalization." Registered 23 February 2016.
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Affiliation(s)
- Brian E. Dixon
- Department of Veterans Affairs, Health Services Research & Development Service, Center for Health Information and Communication, 1481 W. 10th St, 11H, Indianapolis, IN 46202 USA
- Indiana University, Fairbanks School of Public Health, 1050 Wishard Blvd, Indianapolis, IN 46202 USA
- Regenstrief Institute, Center for Biomedical Informatics, 1101 W 10th St, Indianapolis, IN 46202 USA
| | - Ashley L. Schwartzkopf
- Department of Veterans Affairs, Health Services Research & Development Service, Center for Health Information and Communication, 1481 W. 10th St, 11H, Indianapolis, IN 46202 USA
| | - Vivian M. Guerrero
- Department of Veterans Affairs, James J. Peters VA Medical Center, 130 W Kingsbridge Rd, Bronx, NY 10468 USA
| | - Justine May
- Department of Veterans Affairs, Health Services Research & Development Service, Center for Health Information and Communication, 1481 W. 10th St, 11H, Indianapolis, IN 46202 USA
| | - Nicholas S. Koufacos
- Department of Veterans Affairs, James J. Peters VA Medical Center, 130 W Kingsbridge Rd, Bronx, NY 10468 USA
| | - Andrew M. Bean
- Department of Veterans Affairs, James J. Peters VA Medical Center, 130 W Kingsbridge Rd, Bronx, NY 10468 USA
| | - Joan D. Penrod
- Department of Veterans Affairs, James J. Peters VA Medical Center, 130 W Kingsbridge Rd, Bronx, NY 10468 USA
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 USA
| | - Cathy C. Schubert
- Department of Veterans Affairs, Health Services Research & Development Service, Center for Health Information and Communication, 1481 W. 10th St, 11H, Indianapolis, IN 46202 USA
- Indiana University, School of Medicine, 1101 W. 10th St, Indianapolis, IN 46202 USA
| | - Kenneth S. Boockvar
- Department of Veterans Affairs, James J. Peters VA Medical Center, 130 W Kingsbridge Rd, Bronx, NY 10468 USA
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 USA
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11
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Whealin JM, Omizo R, Lopez C. Usage of and Attitudes Toward Health Information Exchange Before and After System Implementation in a VA Medical Center. Fed Pract 2019; 36:322-326. [PMID: 31384121 PMCID: PMC6654168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A quality improvement project demonstrated a meaningful improvement in VA staff satisfaction regarding access to community-based health records after implementation of an externally developed health information exchange system.
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Affiliation(s)
- Julia M Whealin
- is an Informatics Research Psychologist, is a Physician Informaticist, and is an Associate Chief of Staff, all at the VA Pacific Islands Healthcare System in Honolulu, Hawaii. Julia Whealin is an Associate Clinical Professor at the University of Hawaii School of Medicine in Manoa
| | - Reese Omizo
- is an Informatics Research Psychologist, is a Physician Informaticist, and is an Associate Chief of Staff, all at the VA Pacific Islands Healthcare System in Honolulu, Hawaii. Julia Whealin is an Associate Clinical Professor at the University of Hawaii School of Medicine in Manoa
| | - Christopher Lopez
- is an Informatics Research Psychologist, is a Physician Informaticist, and is an Associate Chief of Staff, all at the VA Pacific Islands Healthcare System in Honolulu, Hawaii. Julia Whealin is an Associate Clinical Professor at the University of Hawaii School of Medicine in Manoa
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12
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Chen M, Guo S, Tan X. Does Health Information Exchange Improve Patient Outcomes? Empirical Evidence From Florida Hospitals. Health Aff (Millwood) 2019; 38:197-204. [DOI: 10.1377/hlthaff.2018.05447] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Min Chen
- Min Chen is an assistant professor in the Department of Information Systems and Business Analytics, College of Business, Florida International University, in Miami
| | - Sheng Guo
- Sheng Guo is an instructor in the Department of Economics, Steven J. Green School of International and Public Affairs, Florida International University
| | - Xuan Tan
- Xuan Tan is a doctoral student in the Department of Information Systems and Business Analytics, College of Business, Florida International University
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13
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Sadoughi F, Nasiri S, Ahmadi H. The impact of health information exchange on healthcare quality and cost-effectiveness: A systematic literature review. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2018; 161:209-232. [PMID: 29852963 DOI: 10.1016/j.cmpb.2018.04.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/07/2018] [Accepted: 04/26/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE Health Information Exchange (HIE) is known as a technology that electronically shares all clinical and administrative data throughout healthcare settings. Despite this technology has a great potential in the healthcare industry, there is a limited and sparse evidence of articles which illustrated the impact of HIE on quality of care and cost-effectiveness. This work presents a systematic review that evaluates the impact of HIE on quality and cost-effectiveness, and the rates of HIE adoption and participation in healthcare organizations. METHODS We systematically searched all English papers that were indexed in four major databases (Science Direct, PubMed, IEEE and Web of Science) between 2005 and 2016. Consequently, 32 identified papers appeared in 21 international journals and conferences. Eligible studies independently were critically appraised, collected within data extraction form and then thematically analyzed by two reviewers and if necessary, the third author. The selected papers have been classified based on 11 main categories including publication year, journal and conference names, country and study design, types of data exchanged, healthcare levels, disease or disorder, participants in organizations and individuals, settings characteristics and HIE types, the impact of HIE on quality and cost-effectiveness, and the rates of HIE adoption and participation. RESULTS Of the 32 articles, 25 studies investigated the financial and clinical impact of HIE. Overwhelmingly, HIE studies have reported positive findings for quality and cost-effectiveness of care. 15 of HIE studies (60%) demonstrated positive financial effects and 16 studies (64%) reported positive effects on quality improvement of patient care. However, the overall quality of the evidences was low. In this regard, cohort study (59.38%) was the most common used study design. Nine studies presented the rates of HIE adoption and participation. The lowest and highest participation rates were 15.7% and 79%, respectively. CONCLUSIONS HIE can be considered as a superior potential for healthcare information system, resulting to promote patient care quality and reduce costs related to resource utilization. However, further researches are needed in order to provide a better understanding of this domain and accordingly attain new opportunities to increase users' participation and motivation for successfully adopting this technology.
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Affiliation(s)
- Farahnaz Sadoughi
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Somayeh Nasiri
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Hossein Ahmadi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
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14
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Adjerid I, Adler-Milstein J, Angst C. Reducing Medicare Spending Through Electronic Health Information Exchange: The Role of Incentives and Exchange Maturity. INFORMATION SYSTEMS RESEARCH 2018. [DOI: 10.1287/isre.2017.0745] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Idris Adjerid
- Mendoza College of Business, University of Notre Dame, Notre Dame, Indiana 46556
| | - Julia Adler-Milstein
- School of Information and School of Public Health, University of Michigan, Ann Arbor, Michigan 48109
| | - Corey Angst
- Mendoza College of Business, University of Notre Dame, Notre Dame, Indiana 46556
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15
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Motulsky A, Weir DL, Couture I, Sicotte C, Gagnon MP, Buckeridge DL, Tamblyn R. Usage and accuracy of medication data from nationwide health information exchange in Quebec, Canada. J Am Med Inform Assoc 2018; 25:722-729. [PMID: 29590350 DOI: 10.1093/jamia/ocy015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/02/2018] [Indexed: 11/14/2022] Open
Abstract
Objective (1) To describe the usage of medication data from the Health Information Exchange (HIE) at the health care system level in the province of Quebec; (2) To assess the accuracy of the medication list obtained from the HIE. Methods A descriptive study was conducted utilizing usage data obtained from the Ministry of Health at the individual provider level from January 1 to December 31, 2015. Usage patterns by role, type of site, and tool used to access the HIE were investigated. The list of medications of 111 high risk patients arriving at the emergency department of an academic healthcare center was obtained from the HIE and compared with the list obtained through the medication reconciliation process. Results There were 31 022 distinct users accessing the HIE 11 085 653 times in 2015. The vast majority of pharmacists and general practitioners accessed it, compared to a minority of specialists and nurses. The top 1% of users was responsible of 19% of access. Also, 63% of the access was made using the Viewer application, while using a certified electronic medical record application seemed to facilitate usage. Among 111 patients, 71 (64%) had at least one discrepancy between the medication list obtained from the HIE and the reference list. Conclusions Early adopters were mostly in primary care settings, and were accessing it more frequently when using a certified electronic medical record. Further work is needed to investigate how to resolve accuracy issues with the medication list and how certain tools provide different features.
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Affiliation(s)
- Aude Motulsky
- Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada.,Department of Management, Evaluation & Health Policy, School of Public Health, Université de Montréal, Montreal, Canada
| | - Daniala L Weir
- Department of Epidemiology, Biostatistics and Occupational Health & Department of Medicine, McGill University, Montreal, Canada
| | | | - Claude Sicotte
- Department of Management, Evaluation & Health Policy, School of Public Health, Université de Montréal, Montreal, Canada.,Healthcare organization management host team (EA7348 MOS - Management des organisations de santé - Healthcare Organization Management), EHESP - École des hautes études en santé publique, France
| | | | - David L Buckeridge
- Department of Epidemiology, Biostatistics and Occupational Health & Department of Medicine, McGill University, Montreal, Canada
| | - Robyn Tamblyn
- Department of Epidemiology, Biostatistics and Occupational Health & Department of Medicine, McGill University, Montreal, Canada
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16
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Raymond L, Paré G, Maillet É, Ortiz de Guinea A, Trudel MC, Marsan J. Improving performance in the ED through laboratory information exchange systems. Int J Emerg Med 2018. [PMID: 29532186 PMCID: PMC5847633 DOI: 10.1186/s12245-018-0179-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background The accessibility of laboratory test results is crucial to the performance of emergency departments and to the safety of patients. This study aims to develop a better understanding of which laboratory information exchange (LIE) systems emergency care physicians (ECPs) are using to consult their patients’ laboratory test results and which benefits they derive from such use. Methods A survey of 163 (36%) ECPs in Quebec was conducted in collaboration with the Quebec’s Department of Health and Social Services. Descriptive statistics, chi-square tests, cluster analyses, and ANOVAs were conducted. Results The great majority of respondents indicated that they use several LIE systems including interoperable electronic health record (iEHR) systems, laboratory results viewers (LRVs), and emergency department information systems (EDIS) to consult their patients’ laboratory results. Three distinct profiles of LIE users were observed. The extent of LIE usage was found to be primarily determined by the functional design differences between LIE systems available in the EDs. Our findings also indicate that the more widespread LIE usage, the higher the perceived benefits. More specifically, physicians who make extensive use of iEHR systems and LRVs obtain the widest range of benefits in terms of efficiency, quality, and safety of emergency care. Conclusions Extensive use of LIE systems allows ECPs to better determine and monitor the health status of their patients, verify their diagnostic assumptions, and apply evidence-based practices in laboratory medicine. But for such benefits to be possible, ECPs must be provided with LIE systems that produce accurate, up-to-date, complete, and easy-to-interpret information.
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Affiliation(s)
- Louis Raymond
- Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Guy Paré
- HEC Montréal, 3000, Cote-Sainte-Catherine Road, Montreal, Quebec, H3T 2A7, Canada.
| | | | - Ana Ortiz de Guinea
- HEC Montréal, 3000, Cote-Sainte-Catherine Road, Montreal, Quebec, H3T 2A7, Canada
| | - Marie-Claude Trudel
- HEC Montréal, 3000, Cote-Sainte-Catherine Road, Montreal, Quebec, H3T 2A7, Canada
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17
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Boockvar KS, Ho W, Pruskowski J, DiPalo KE, Wong JJ, Patel J, Nebeker JR, Kaushal R, Hung W. Effect of health information exchange on recognition of medication discrepancies is interrupted when data charges are introduced: results of a cluster-randomized controlled trial. J Am Med Inform Assoc 2017; 24:1095-1101. [PMID: 28505367 PMCID: PMC7651981 DOI: 10.1093/jamia/ocx044] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/22/2017] [Accepted: 04/06/2017] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To determine the effect of health information exchange (HIE) on medication prescribing for hospital inpatients in a cluster-randomized controlled trial, and to examine the prescribing effect of availability of information from a large pharmacy insurance plan in a natural experiment. METHODS Patients admitted to an urban hospital received structured medication reconciliation by an intervention pharmacist with (intervention) or without (control) access to a regional HIE. The HIE contained prescribing information from the largest hospitals and pharmacy insurance plan in the region for the first 10 months of the study, but only from the hospitals for the last 21 months, when data charges were imposed by the insurance plan. The primary endpoint was discrepancies between preadmission and inpatient medication regimens, and secondary endpoints included adverse drug events (ADEs) and proportions of rectified discrepancies. RESULTS Overall, 186 and 195 patients were assigned to intervention and control, respectively. Patients were 60 years old on average and took a mean of 7 medications before admission. There was no difference between intervention and control in number of risk-weighted discrepancies (6.4 vs 5.8, P = .452), discrepancy-associated ADEs (0.102 vs 0.092 per admission, P = .964), or rectification of discrepancies (0.026 vs 0.036 per opportunity, P = .539). However, patients who received medication reconciliation with pharmacy insurance data available had more risk-weighted medication discrepancies identified than those who received usual care (8.0 vs 5.9, P = .038). DISCUSSION AND CONCLUSION HIE may improve outcomes of medication reconciliation. Charging for access to medication information interrupts this effect. Efforts are needed to understand and increase prescribers' rectification of medication discrepancies.
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Affiliation(s)
- Kenneth S Boockvar
- Geriatrics Research Education and Clinical Center, James J Peters VA Medical Center, Bronx, NY, USA and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - William Ho
- Pharmacy Department, James J Peters VA Medical Center, Bronx, NY, USA
| | - Jennifer Pruskowski
- Department of Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA
| | - Katherine E DiPalo
- Department of Pharmacy, Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY, USA
| | - Jane J Wong
- Pharmacy Department, James J Peters VA Medical Center, Bronx, NY, USA
| | - Jessica Patel
- Pharmacy Department, St Joseph’s Hospital, Tampa, FL, USA
| | - Jonathan R Nebeker
- Informatics and Computing, Veterans Health Administration, Washington, DC, USA and University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Rainu Kaushal
- Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - William Hung
- Geriatrics Research Education and Clinical Center, James J Peters VA Medical Center, Bronx, NY, USA and Icahn School of Medicine at Mount Sinai, New York, NY, USA
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18
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Lyons TW, Olson KL, Palmer NP, Horwitz R, Mandl KD, Fine AM. Patients Visiting Multiple Emergency Departments: Patterns, Costs, and Risk Factors. Acad Emerg Med 2017; 24:1349-1357. [PMID: 28861915 DOI: 10.1111/acem.13304] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/23/2017] [Accepted: 08/27/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We sought to characterize the population of patients seeking care at multiple emergency departments (EDs) and to quantify the proportion of all ED visits and costs accounted for by these patients. METHODS We performed a retrospective, cohort study of deidentified insurance claims for privately insured patients with one of more ED visits between 2010 and 2016. We measured the number of EDs visited by each patient and determined the overall proportion of all ED visits and ED costs accounted for by patients who visit multiple EDs. We identified factors associated with visiting multiple EDs. RESULTS A total of 8,651,716 patients made 16,390,676 ED visits over the study period, accounting for $26,102,831,740 in ED costs. A significant minority (20.5%) of patients visited more than one ED over the study period. However, these patients accounted for a disproportionate amount of all ED visits (41.4%) and all ED costs (39.2%). A small proportion (0.4%) of patients visited five or more EDs but accounted for 2.8% of ED visits and costs. Among patients with two ED visits within 30 days, 32% were to different EDs. Having at least one ED visit for mental health or substance abuse-related diagnosis was associated with increased odds of visiting multiple EDs. CONCLUSIONS A substantial minority of patients visit multiple EDs, but account for a disproportionate burden of overall ED utilization and costs. Future work should evaluate the impact of visiting multiple EDs on care utilization and outcomes and explore systems for improving access to patient records across care centers.
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Affiliation(s)
- Todd W. Lyons
- Computational Health Informatics Program; Boston Children's Hospital; Boston MA
- Division of Emergency Medicine; Boston Children's Hospital; Boston MA
| | - Karen L. Olson
- Computational Health Informatics Program; Boston Children's Hospital; Boston MA
- Division of Emergency Medicine; Boston Children's Hospital; Boston MA
| | - Nathan P. Palmer
- Department of Biomedical Informatics; Harvard Medical School; Boston MA
| | - Reed Horwitz
- Computational Health Informatics Program; Boston Children's Hospital; Boston MA
| | - Kenneth D. Mandl
- Computational Health Informatics Program; Boston Children's Hospital; Boston MA
- Division of Emergency Medicine; Boston Children's Hospital; Boston MA
- Department of Biomedical Informatics; Harvard Medical School; Boston MA
| | - Andrew M. Fine
- Division of Emergency Medicine; Boston Children's Hospital; Boston MA
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19
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Kash BA, Baek J, Davis E, Champagne-Langabeer T, Langabeer JR. Review of successful hospital readmission reduction strategies and the role of health information exchange. Int J Med Inform 2017; 104:97-104. [PMID: 28599821 DOI: 10.1016/j.ijmedinf.2017.05.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/17/2017] [Accepted: 05/19/2017] [Indexed: 11/18/2022]
Abstract
CONTEXT The United States has invested substantially in technologies that enable health information exchange (HIE), which in turn can be deployed to reduce avoidable hospital readmission rates in many communities. With avoidable hospital readmissions as the primary focus, this study profiles successful hospital readmission rate reduction initiatives that integrate HIE as a strategy. We hypothesized that the use of HIE is associated with decreased hospital readmissions beyond other observed population health benefits. Results of this systematic review are used to describe and profile successful readmission reduction programs that integrate HIE as a tool. METHODS A systematic review of literature provided an understanding of the use of HIE as a strategy to reduce hospital readmission rates. We conducted a review of 4,862 citations written in English about readmission reduction strategies from January 2006 to September 2016 in the MEDLINE-PubMed database. Of these, 106 studies reported 30-day readmission rates as an outcome and only 13 articles reported using HIE. RESULTS Only a very small number (12%) of hospitals incorporated HIE as a primary tool for evidence-based readmission reduction initiatives. Information exchange between providers has been suggested to play a key role in reducing avoidable readmission rates, yet there is not currently evidence supporting current HIE-enabled readmission initiatives. Most successful readmission reduction programs demonstrate collaboration with primary care providers to augment transitions of care to existing care management functions without additional staff while using effective information exchange capabilities. CONCLUSIONS This research confirms there is very little integration of HIE into health systems readmissions initiatives. There is a great opportunity to achieve population health targets using the HIE infrastructure. Hospitals should consider partnering with primary care clinics to implement multifaceted transitions of care programs to significantly reduce 30-day readmission rates.
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Affiliation(s)
- Bita A Kash
- Texas A&M School of Public Health, College Station, TX, USA.
| | - Juha Baek
- Texas A&M School of Public Health, College Station, TX, USA.
| | - Elise Davis
- Texas A&M School of Public Health, College Station, TX, USA.
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20
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Rowland T, Nielsen-Farrell J, Church K, Riddell B. Technology-Enabled Population Health Management: Two Communities' Use of an Electronic Care Alert System. PM R 2017; 9:S75-S84. [DOI: 10.1016/j.pmrj.2017.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/25/2017] [Accepted: 02/07/2017] [Indexed: 10/19/2022]
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21
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Petrova M, Barclay M, Barclay SS, Barclay SIG. Between "the best way to deliver patient care" and "chaos and low clinical value": General Practitioners' and Practice Managers' views on data sharing. Int J Med Inform 2017; 104:74-83. [PMID: 28599819 DOI: 10.1016/j.ijmedinf.2017.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 05/08/2017] [Accepted: 05/13/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE In the UK, General Practitioners and Practice Managers are key to enabling health information exchange (typically referred to as 'data sharing'). This study aimed to survey GPs and PMs for familiarity, engagement with and perceptions of patient data sharing. METHODS Cross-sectional survey. All 107 general practices in England's second largest Clinical Commissioning Group, Cambridgeshire & Peterborough CCG. Descriptive statistics; hierarchical logistic regression; thematic analysis. RESULTS 405 (64%) responses were received - from 338 (62%) GPs and 67 (71%) PMs. Familiarity and engagement were highest for local frail elderly and end of life care projects (>76% had used). The greatest difference in use concerned the now suspended national care.data initiative: PMs had odds of reporting use 75 times higher than GP partners (95% CI 27-211). Patient confusion was the most pronounced challenge and improved coordination the most pronounced expected benefit. Frequency of discussions with patients varied with IT competence (OR 4.2 for most competent users relative to least, 95% CI 1.7-10.7) and clinical system (OR 0.3, 95% CI 0.1-0.5). Patient reservations were reported more frequently by respondents who rated their IT competence as highest (OR 3.3, 95% CI 1.5-7.6), perceived more data sharing challenges (OR for a 1-point increase in challenges perception score 3.4, 95% CI 2.1-5.6) and by PMs (relative to GP partners, OR 18.0, 95% CI 7.9-41.3). CONCLUSIONS Familiarity with and use of data sharing projects was high among GPs and PMs. Both their individual and organisational characteristics were associated with the reported frequency of discussions and patients' responses. Improved awareness of the impact of provider characteristics and attitudes on patients' decisions about data sharing may enhance the equity and autonomy of those decisions.
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Affiliation(s)
- Mila Petrova
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
| | - Matthew Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sam S Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen I G Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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22
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Lehmann CU, Kressly S, Hart WWC, Johnson KB, Frisse ME. Barriers to Pediatric Health Information Exchange. Pediatrics 2017; 139:peds.2016-2653. [PMID: 28557727 DOI: 10.1542/peds.2016-2653] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Christoph U Lehmann
- Departments of Biomedical Informatics and .,Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Kevin B Johnson
- Departments of Biomedical Informatics and.,Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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23
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Everson J, Kocher KE, Adler-Milstein J. Health information exchange associated with improved emergency department care through faster accessing of patient information from outside organizations. J Am Med Inform Assoc 2017; 24:e103-e110. [PMID: 27521368 PMCID: PMC7651934 DOI: 10.1093/jamia/ocw116] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/25/2016] [Accepted: 07/09/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To assess whether electronic health information exchange (HIE) is associated with improved emergency department (ED) care processes and utilization through more timely clinician viewing of information from outside organizations. MATERIALS AND METHODS Our data included 2163 patients seen in the ED of a large academic medical center for whom clinicians requested and viewed outside information from February 14, 2014, to February 13, 2015. Outside information requests w.ere fulfilled via HIE (Epic's Care Everywhere) or fax/scan to the electronic health record (EHR). We used EHR audit data to capture the time between the information request and when a clinician accessed the data. We assessed whether the relationship between method of information return and ED outcomes (length of visit, odds of imaging [computed tomography (CT), magnetic resonance imaging (MRI), radiographs] and hospitalization, and total charges) was mediated by request-to-access time, controlling for patient demographics, case mix, and acuity. RESULTS In multivariate analysis, there was no direct association between return of information via HIE vs fax/scan and ED outcomes. HIE was associated with faster outside information access (58.5 minutes on average), and faster access was associated with changes in ED care. For each 1-hour reduction in access time, visit length was 52.9 minutes shorter, the likelihood of imaging was lower (by 2.5, 1.6, and 2.4 percentage points for CT, MRI, and radiographs, respectively), the likelihood of admission was 2.4 percentage points lower, and average charges were $1187 lower ( P ≤ .001 for all). CONCLUSION The relationship between HIE and improved care processes and reduced utilization in the ED is mediated by faster accessing of information from outside organizations.
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Affiliation(s)
- Jordan Everson
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
| | - Keith E Kocher
- Department of Emergency Medicine, School of Medicine, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Julia Adler-Milstein
- School of Information and Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor
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Everson J. The implications and impact of 3 approaches to health information exchange: community, enterprise, and vendor-mediated health information exchange. Learn Health Syst 2017; 1:e10021. [PMID: 31245558 PMCID: PMC6508570 DOI: 10.1002/lrh2.10021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/24/2016] [Accepted: 12/01/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Electronic health information exchange (HIE) is considered essential to establishing a learning health system, reducing medical errors, and improving efficiency, but establishment of widespread, high functioning HIE has been challenging. Healthcare organizations now have considerable flexibility in selecting among several HIE strategies, most prominently community HIE, enterprise HIE (led by a healthcare organization), and electronic health record vendor-mediated HIE. Each of these strategies is characterized by different conveners, capabilities, and motivations and may have different abilities to facilitate improved patient care. METHODS I reviewed the available scholarly literature to draw conceptual distinctions between these types of HIE, to assess the current evidence on each type of HIE, and to indicate important areas of future research. RESULTS While community HIE seems to offer the most open approach to HIE allowing for high levels of connectivity, both enterprise HIE and vendor-mediated HIE face lower barriers to formation and sustainability. Most existing evidence is focused on community HIE and points towards low overall use, challenges to usability, and ambiguous impact. To better guide organizational leaders and policymakers in the expansion of beneficial HIE and anticipate future trends, future research should work to better capture the prevalence of other forms of HIE, and to adopt common methods to allow comparisons of rate of use, usability, and impact on patient care across studies and types of HIE. CONCLUSIONS Healthcare organizations' choice of HIE strategy influences the set of partners the organization is connected to and may influence the benefit that efforts supported by HIE can offer to patients. Current research is not fully capturing the diversity of approaches to HIE and their potentially varying impact on providers and patients.
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Affiliation(s)
- Jordan Everson
- Department of Health Management and Policy, School of Public HealthUniversity of MichiganAnn ArborMichigan
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Mäenpää T, Asikainen P, Suominen T. Views of patient, healthcare professionals and administrative staff on flow of information and collaboration in a regional health information exchange: a qualitative study. Scand J Caring Sci 2017; 31:939-947. [PMID: 28144972 DOI: 10.1111/scs.12417] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 11/22/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Nowadays, patients can be more involved in developing healthcare services with their healthcare professionals. Patient-centred information is a key part of improving regional health information exchange (HIE), giving patients an active role in care management. AIM The aim was to get a deeper understanding of the flow of information and collaboration in one hospital district area from the viewpoint of patients, healthcare professionals and administrative staff. METHODS The data were collected by themed interviews and analysed using both deductive and inductive content analyses. The interview themes were the flow of information and collaboration after 5 years of HIE usage in one hospital district area in Finland. FINDINGS Health information exchange usage had changed the regional flow of information after the 5-year period. The patients were satisfied that their primary care physician was able to access their special care information. The experiences of healthcare professionals and administrative staff also showed that information availability and information exchange had improved regionally. HIE usage was also found to have improved regional collaboration between different organisations in patient health care. CONCLUSIONS It was recognised that patients had taken on more responsibility for transferring their follow-up treatment information. Healthcare information exchange between professionals not only improves patient care or patient involvement in their own care, but it also requires that patient self-care or self-care management is integrated into HIE systems to share information not only among professionals, but also between patients and professionals. This information will be used in the development of healthcare systems to meet more the developing of the continuity of care the patient's point of view.
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Affiliation(s)
| | - Paula Asikainen
- Satakunta Hospital District, Pori, Finland.,University of Tampere, Tampere, Finland
| | - Tarja Suominen
- School of Health Sciences, Nursing Science, University of Tampere, Tampere, Finland
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Slovis BH, Lowry T, Delman BN, Beitia AO, Kuperman G, DiMaggio C, Shapiro JS. Patient crossover and potentially avoidable repeat computed tomography exams across a health information exchange. J Am Med Inform Assoc 2017; 24:30-38. [PMID: 27178985 PMCID: PMC5201178 DOI: 10.1093/jamia/ocw035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 02/02/2016] [Accepted: 02/17/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The purpose of this study was to measure the number of repeat computed tomography (CT) scans performed across an established health information exchange (HIE) in New York City. The long-term objective is to build an HIE-based duplicate CT alerting system to reduce potentially avoidable duplicate CTs. METHODS This retrospective cohort analysis was based on HIE CT study records performed between March 2009 and July 2012. The number of CTs performed, the total number of patients receiving CTs, and the hospital locations where CTs were performed for each unique patient were calculated. Using a previously described process established by one of the authors, hospital-specific proprietary CT codes were mapped to the Logical Observation Identifiers Names and Codes (LOINC®) standard terminology for inter-site comparison. The number of locations where there was a repeated CT performed with the same LOINC code was then calculated for each unique patient. RESULTS There were 717 231 CTs performed on 349 321 patients. Of these patients, 339 821 had all of their imaging studies performed at a single location, accounting for 668 938 CTs. Of these, 9500 patients had 48 293 CTs performed at more than one location. Of these, 6284 patients had 24 978 CTs with the same LOINC code performed at multiple locations. The median time between studies with the same LOINC code was 232 days (range of 0 to 1227); however, 1327 were performed within 7 days and 5000 within 30 days. CONCLUSIONS A small proportion (3%) of our cohort had CTs performed at more than one location, however this represents a large number of scans (48 293). A noteworthy portion of these CTs (51.7%) shared the same LOINC code and may represent potentially avoidable studies, especially those done within a short time frame. This represents an addressable issue, and future HIE-based alerts could be utilized to reduce potentially avoidable CT scans.
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Affiliation(s)
- Benjamin H Slovis
- The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, NY 10029, USA
- The Department of Biomedical Informatics, Columbia University, NY 10032, USA
| | - Tina Lowry
- The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, NY 10029, USA
| | - Bradley N Delman
- The Department of Radiology, Icahn School of Medicine at Mount Sinai, NY 10029, USA
| | - Anton Oscar Beitia
- The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, NY 10029, USA
| | - Gilad Kuperman
- The Department of Biomedical Informatics, New York-Presbyterian Hospital, NY 10032, USA
| | - Charles DiMaggio
- The Department of Surgery, New York University Medical School, NY 10016, USA
| | - Jason S Shapiro
- The Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, NY 10029, USA
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Lammers EJ, McLaughlin CG, Barna M. Physician EHR Adoption and Potentially Preventable Hospital Admissions among Medicare Beneficiaries: Panel Data Evidence, 2010-2013. Health Serv Res 2016; 51:2056-2075. [PMID: 27766628 DOI: 10.1111/1475-6773.12586] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To test for correlation between the growth in adoption of ambulatory electronic health records (EHRs) in the United States during 2010-2013 and hospital admissions and readmissions for elderly Medicare beneficiaries with at least one of four common ambulatory care-sensitive conditions (ACSCs). DATA SOURCES SK&A Information Services Survey of Physicians, American Hospital Association General Survey and Information Technology Supplement; and the Centers for Medicare & Medicaid Services Chronic Conditions Data Warehouse Geographic Variation Database for 2010 through 2013. STUDY DESIGN Fixed effects model estimated the relationship between hospital referral region (HRR) level measures of physician EHR adoption and ACSC admissions and readmissions. Analyzed rates of admissions and 30-day readmissions per beneficiary at the HRR level (restricting the denominator to beneficiaries in our sample), adjusted for differences across HRRs in Medicare beneficiary age, gender, and race. Calculated physician EHR adoption rates as the percentage of physicians in each HRR who report using EHR in ambulatory care settings. PRINCIPAL FINDINGS Each percentage point increase in market-level EHR adoption by physicians is correlated with a statistically significant decline of 1.06 ACSC admissions per 10,000 beneficiaries over the study period, controlling for the overall time trend as well as market fixed effects and characteristics that changed over time. This finding implies 26,689 fewer ACSC admissions in our study population during 2010 to 2013 that were related to physician ambulatory EHR adoption. This represents 3.2 percent fewer ACSC admissions relative to the total number of such admissions in our study population in 2010. We found no evidence of a correlation between EHR use, by either physicians or hospitals, and hospital readmissions at either the market level or hospital level. CONCLUSIONS This study extends knowledge about EHRs' relationship with quality of care and utilization. The results suggest a significant association between EHR use in ambulatory care settings and ACSC admissions that is consistent with policy goals to improve the quality of ambulatory care for patients with chronic conditions. The null findings for readmissions support the need for improved interoperability between ambulatory care EHRs and hospital EHRs to realize improvements in readmissions.
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Kern LM, Grinspan Z, Shapiro JS, Kaushal R. Patients' Use of Multiple Hospitals in a Major US City: Implications for Population Management. Popul Health Manag 2016; 20:99-102. [PMID: 27268133 DOI: 10.1089/pop.2016.0021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Understanding how often patients seek care from multiple hospitals is important for care of individuals and populations, but it is not routinely measured because of lack of data. This study used data from a health information exchange (HIE) to measure the frequency with which patients seek care from multiple hospitals. This was a retrospective cohort study (2010-2011) of all patients who sought emergency department (ED) or inpatient care at 6 participating hospitals in Manhattan. The study found that all 6 hospitals shared patients with each of the other hospitals and that 10.0% of all ED visits and 9.1% of all admissions were for patients who had been seen in a different hospital in the past 12 months. Patients are frequently seen by multiple hospitals, which poses a challenge for clinical care and population management. By capturing which patients are seen where and when, HIEs are well suited for facilitating population management.
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Affiliation(s)
- Lisa M Kern
- 1 Department of Healthcare Policy and Research, Weill Cornell Medicine , New York, New York.,2 Department of Medicine, Weill Cornell Medicine , New York, New York.,3 Health Information Technology Evaluation Collaborative , New York, New York
| | - Zachary Grinspan
- 1 Department of Healthcare Policy and Research, Weill Cornell Medicine , New York, New York.,3 Health Information Technology Evaluation Collaborative , New York, New York.,4 Department of Pediatrics, Weill Cornell Medicine , New York, New York.,5 New York-Presbyterian Hospital , New York, New York
| | - Jason S Shapiro
- 6 Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Rainu Kaushal
- 1 Department of Healthcare Policy and Research, Weill Cornell Medicine , New York, New York.,2 Department of Medicine, Weill Cornell Medicine , New York, New York.,3 Health Information Technology Evaluation Collaborative , New York, New York.,4 Department of Pediatrics, Weill Cornell Medicine , New York, New York.,5 New York-Presbyterian Hospital , New York, New York
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Flaks-Manov N, Shadmi E, Hoshen M, Balicer RD. Health information exchange systems and length of stay in readmissions to a different hospital. J Hosp Med 2016; 11:401-6. [PMID: 26714040 DOI: 10.1002/jhm.2535] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 11/29/2015] [Accepted: 12/04/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND Readmission to a different hospital than the original discharge hospital may result in breakdowns in continuity of care. In different-hospital readmissions (DHRs), continuity can be maintained when hospitals are connected through health information exchange (HIE) systems. OBJECTIVE To examine whether length of readmission stay (LORS) differs between same-hospital readmissions and DHRs, and whether in DHRs the LORS differs by the availability of HIE. DESIGN A retrospective cohort study of all internal medicine 30-day readmissions in 27 Israeli hospitals between January 1, 2010 and December 31, 2010. SETTING Clalit Health Services-Israel's largest integrated healthcare provider and payer. POPULATION Adult Clalit members (aged 18 and older) with at least 1 readmission during the study period. METHODS A multivariate marginal Cox model tested the likelihood for discharge during each readmission day in same-hospital readmissions (SHRs), DHRs with HIE, and DHRs without HIE. RESULTS Of the 27,057 readmissions, 3130 (11.6%) were DHRs and 792 where DHRs with HIE in both the index and readmitting hospital. Partial continuity (DHRs with HIE) was associated with decreased likelihood of discharge on any given day compared with full continuity (SHRs) (hazard ratio [HR] = 0.85, 95% confidence interval [CI]: 0.79-0.91). Similar results were obtained for no continuity (DHRs without HIE) versus full continuity (HR = 0.90, 95% CI: 0.86-0.94). The difference between DHRs with and without HIE was not significant. CONCLUSIONS The prolonged LORS in DHRs versus SHRs was not mitigated by the existence of HIE systems. Future research is needed to further elucidate the effects of actual use of HIE on length of DHRs. Journal of Hospital Medicine 2016;11:401-406. © 2015 Society of Hospital Medicine.
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Affiliation(s)
| | - Efrat Shadmi
- Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Moshe Hoshen
- Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel
| | - Ran D Balicer
- Clalit Research Institute, Clalit Health Services, Tel-Aviv, Israel
- Department of Public Health, Ben-Gurion University of the Negev, Beersheba, Israel
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Abstract
Policy makers and practitioners argue that electronic exchange of clinical data across the healthcare system is a key component of improving health service delivery in the United States. Provider administrators, however, question the strategic value of participation in health information exchanges (HIEs) and remain reluctant to participate. Existing research fails to adequately illuminate the potential value derived from HIEs by participating organizations. This paper addresses this gap by developing a conceptual model informed by the complementary theoretical perspectives of the relational view and systems theory to specify both a provider organizationʼs internal conditions and the HIE structure necessary for both financial accrual and quality improvement. This two-sided model can assist policymakers as they attempt to encourage HIE development, as well as provider and HIE leadership that seek to benefit from HIEs. The propositions developed from this model can also help guide researchers as they evaluate the impact of HIEs.
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Bahous MC, Shadmi E. Health information exchange and information gaps in referrals to a pediatric emergency department. Int J Med Inform 2015; 87:68-74. [PMID: 26806713 DOI: 10.1016/j.ijmedinf.2015.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/06/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE to assess the extent of information gaps between three information sources available at admission to a pediatric Emergency Department (ED): Health Information Exchange (HIE) system, physicians' referral letters and information collected from patients/parents at admission to the ED (patient's medical history). MATERIALS AND METHODS A retrospective cohort study of 170 medical records of children aged 6 months to 18 years referred to a pediatric ED for a common childhood disease. Each record was reviewed for information on lab and imaging tests, vaccinations, allergies, previous diagnoses, recent and chronic medical treatment in the HIE system and referral letter, or from the patient's medical history taken on admission to the ED. The percent overlap between information sources and information gaps was assessed. RESULTS The most informative source, in terms of addressing all key areas, was the patient's medical history, with an average of 73.5% indication of each information key area. Next was the HIE system, with 54.1% indication of each key area; the least informative was the referral letter (43.9%). The overall overlap in data availability among all information sources occurred on average in 23% of the cases. HIE's ability to provide data missing from other routinely available sources was mainly in the area of chronic medication dosages (37% of cases). CONCLUSIONS Each of the three major information sources available at admission to a pediatric ED lack important data and each makes its own unique contribution. Improving documentation in electronic health records, on which HIE systems feed from can narrow significant information gaps at the most critical time-point-admission to a pediatric ED.
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Affiliation(s)
- Marta Chacour Bahous
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, Haifa University, Mount Carmel 31905, Israel; Pediatric Emergency Department, The Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa 31096, Israel.
| | - Efrat Shadmi
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, Haifa University, Mount Carmel 31905, Israel
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Hersh WR, Totten AM, Eden KB, Devine B, Gorman P, Kassakian SZ, Woods SS, Daeges M, Pappas M, McDonagh MS. Outcomes From Health Information Exchange: Systematic Review and Future Research Needs. JMIR Med Inform 2015; 3:e39. [PMID: 26678413 PMCID: PMC4704923 DOI: 10.2196/medinform.5215] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/10/2015] [Accepted: 11/11/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Health information exchange (HIE), the electronic sharing of clinical information across the boundaries of health care organizations, has been promoted to improve the efficiency, cost-effectiveness, quality, and safety of health care delivery. OBJECTIVE To systematically review the available research on HIE outcomes and analyze future research needs. METHODS Data sources included citations from selected databases from January 1990 to February 2015. We included English-language studies of HIE in clinical or public health settings in any country. Data were extracted using dual review with adjudication of disagreements. RESULTS We identified 34 studies on outcomes of HIE. No studies reported on clinical outcomes (eg, mortality and morbidity) or identified harms. Low-quality evidence generally finds that HIE reduces duplicative laboratory and radiology testing, emergency department costs, hospital admissions (less so for readmissions), and improves public health reporting, ambulatory quality of care, and disability claims processing. Most clinicians attributed positive changes in care coordination, communication, and knowledge about patients to HIE. CONCLUSIONS Although the evidence supports benefits of HIE in reducing the use of specific resources and improving the quality of care, the full impact of HIE on clinical outcomes and potential harms are inadequately studied. Future studies must address comprehensive questions, use more rigorous designs, and employ a standard for describing types of HIE. TRIAL REGISTRATION PROSPERO Registry No CRD42014013285; http://www.crd.york.ac.uk/PROSPERO/ display_record.asp?ID=CRD42014013285 (Archived by WebCite at http://www.webcitation.org/6dZhqDM8t).
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Affiliation(s)
- William R Hersh
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, OR, United States.
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Gordon BD, Bernard K, Salzman J, Whitebird RR. Impact of Health Information Exchange on Emergency Medicine Clinical Decision Making. West J Emerg Med 2015; 16:1047-51. [PMID: 26759652 PMCID: PMC4703172 DOI: 10.5811/westjem.2015.9.28088] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/04/2015] [Accepted: 09/06/2015] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The objective of the study was to understand the immediate utility of health information exchange (HIE) on emergency department (ED) providers by interviewing them shortly after the information was retrieved. Prior studies of physician perceptions regarding HIE have only been performed outside of the care environment. METHODS Trained research assistants interviewed resident physicians, physician assistants and attending physicians using a semi-structured questionnaire within two hours of making a HIE request. The responses were recorded, then transcribed for qualitative analysis. The transcribed interviews were analyzed for emerging qualitative themes. RESULTS We analyzed 40 interviews obtained from 29 providers. Primary qualitative themes discovered included the following: drivers for requests for outside information; the importance of unexpected information; historical lab values as reference points; providing context when determining whether to admit or discharge a patient; the importance of information in refining disposition; improved confidence of provider; and changes in decisions for diagnostic imaging. CONCLUSION ED providers are driven to use HIE when they're missing a known piece of information. This study finds two additional impacts not previously reported. First, providers sometimes find additional unanticipated useful information, supporting a workflow that lowers the threshold to request external information. Second, providers sometimes report utility when no changes to their existing plan are made as their confidence is increased based on external records. Our findings are concordant with previous studies in finding exchanged information is useful to provide context for interpreting lab results, making admission decisions, and prevents repeat diagnostic imaging.
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Affiliation(s)
- Bradley D Gordon
- HealthPartners Institute for Education and Research, Bloomington, Minnesota; University of Minnesota Medical School, Academic Health Center, Minneapolis, Minnesota
| | - Kyle Bernard
- Advocate Christ Medical Center, Chicago, Illinois
| | - Josh Salzman
- Critical Care Research Center, Regions Hospital, Saint Paul, Minnesota
| | - Robin R Whitebird
- University of St. Thomas, School of Social Work, Saint Paul, Minnesota
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Lehmann CU, Gundlapalli AV. Improving Bridging from Informatics Practice to Theory. Methods Inf Med 2015; 54:540-5. [PMID: 26577504 DOI: 10.3414/me15-01-0138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 10/22/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND In 1962, Methods of Information in Medicine ( MIM ) began to publish papers on the methodology and scientific fundamentals of organizing, representing, and analyzing data, information, and knowledge in biomedicine and health care. Considered a companion journal, Applied Clinical Informatics ( ACI ) was launched in 2009 with a mission to establish a platform that allows sharing of knowledge between clinical medicine and health IT specialists as well as to bridge gaps between visionary design and successful and pragmatic deployment of clinical information systems. Both journals are official journals of the International Medical Informatics Association. OBJECTIVES As a follow-up to prior work, we set out to explore congruencies and interdependencies in publications of ACI and MIM. The objectives were to describe the major topics discussed in articles published in ACI in 2014 and to determine if there was evidence that theory in 2014 MIM publications was informed by practice described in ACI publications in any year. We also set out to describe lessons learned in the context of bridging informatics practice and theory and offer opinions on how ACI editorial policies could evolve to foster and improve such bridging. METHODS We conducted a retrospective observational study and reviewed all articles published in ACI during the calendar year 2014 (Volume 5) for their main theme, conclusions, and key words. We then reviewed the citations of all MIM papers from 2014 to determine if there were references to ACI articles from any year. Lessons learned in the context of bridging informatics practice and theory and opinions on ACI editorial policies were developed by consensus among the two authors. RESULTS A total of 70 articles were published in ACI in 2014. Clinical decision support, clinical documentation, usability, Meaningful Use, health information exchange, patient portals, and clinical research informatics emerged as major themes. Only one MIM article from 2014 cited an ACI article. There are several lessons learned including the possibility that there may not be direct links between MIM theory and ACI practice articles. ACI editorial policies will continue to evolve to reflect the breadth and depth of the practice of clinical informatics and articles received for publication. Efforts to encourage bridging of informatics practice and theory may be considered by the ACI editors. CONCLUSIONS The lack of direct links from informatics theory-based papers published in MIM in 2014 to papers published in ACI continues as was described for papers published during 2012 to 2013 in the two companion journals. Thus, there is little evidence that theory in MIM has been informed by practice in ACI.
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Affiliation(s)
| | - A V Gundlapalli
- Adi V. Gundlapalli, MD, PhD, MS, Chief Health Informatics Officer, VA Salt Lake City Health Care System, Salt Lake City, UT 84148, USA, E-mail:
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Vest JR, Abramson E. Organizational Uses of Health Information Exchange to Change Cost and Utilization Outcomes: A Typology from a Multi-Site Qualitative Analysis. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2015; 2015:1260-1268. [PMID: 26958266 PMCID: PMC4765592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Health information exchange (HIE) systems facilitate access to patient information for a variety of health care organizations, end users, and clinical and organizational goals. While a complex intervention, organizations' usage of HIE is often conceptualized and measured narrowly. We sought to provide greater specificity to the concept of HIE as an intervention by formulating a typology of organizational HIE usage. We interviewed representatives of a regional health information organization and health care organizations actively using HIE information to change patient utilization and costs. The resultant typology includes three dimensions: user role, usage initiation, and patient set. This approach to categorizing how health care organizations are actually applying HIE information to clinical and business tasks provides greater clarity about HIE as an intervention and helps elucidate the conceptual linkage between HIE an organizational and patient outcomes.
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Affiliation(s)
- Joshua R Vest
- Division of Health Policy and Economics, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York NY
| | - Erika Abramson
- Division of Health Policy and Economics, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York NY; Department of Pediatrics, Weill Cornell Medical College, New York, NY
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Feazel L, Schlichting AB, Bell GR, Shane DM, Ahmed A, Faine B, Nugent A, Mohr NM. Achieving regionalization through rural interhospital transfer. Am J Emerg Med 2015; 33:1288-96. [PMID: 26087707 DOI: 10.1016/j.ajem.2015.05.032] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 05/19/2015] [Indexed: 01/19/2023] Open
Abstract
Regionalization of emergency medical care aims to provide consistent and efficient high-quality care leading to optimal clinical outcomes by matching patient needs with appropriate resources at a network of hospitals. Regionalized care has been shown to improve outcomes in trauma, myocardial infarction, stroke, cardiac arrest, and acute respiratory distress syndrome. In rural areas, effective regionalization often requires interhospital transfer. The decision to transfer is complex and includes such factors as capabilities of the presenting hospital; capacity at the receiving hospital; and financial, geographic, and patient-preference considerations. Although transfer to a comprehensive center has proven benefits for some conditions, the transfer process is not without risk. These risks include clinical deterioration, limited resource availability during transport, vehicular crashes, time delays for time-sensitive care, poor communication between providers, and neglect of patient preferences. This article reviews the transfer decision, financial implications, risks, and considerations for patients undergoing rural interhospital transfer. We identify several strategies that should be considered for development of the regionalized emergency health care system of the future and identify areas where further research is necessary.
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Affiliation(s)
- Leah Feazel
- University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Adam B Schlichting
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Division of Pulmonary, Critical Care, and Occupational Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Gregory R Bell
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Dan M Shane
- Department of Health Management and Policy, College of Public Health, Iowa City, IA, USA
| | - Azeemuddin Ahmed
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Brett Faine
- Department of Pharmacy, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Andrew Nugent
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA; Division of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
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Kierkegaard P, Kaushal R, Vest JR. Applications of health information exchange information to public health practice. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2014; 2014:795-804. [PMID: 25954386 PMCID: PMC4419901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Increased information availability, timeliness, and comprehensiveness through health information exchange (HIE) can support public health practice. The potential benefits to disease monitoring, disaster response, and other public health activities served as an important justification for the US' investments in HIE. After several years of HIE implementation and funding, we sought to determine if any of the anticipated benefits of exchange participation were accruing to state and local public health practitioners participating in five different exchanges. Using qualitative interviews and template analyses, we identified public health efforts and activities that were improved by participation in HIE. HIE supported public health activities consistent with expectations in the literature. However, no single department realized all the potential benefits of HIE identified. These findings suggest ways to improve HIE usage in public health.
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Affiliation(s)
| | - Rainu Kaushal
- Center for Healthcare Informatics & Policy, Weill Cornell Medical College, New York NY ; Department of Healthcare Policy and Research, Weill Cornell Medical College, New York NY ; Department of Medicine, Weill Cornell Medical College, New York, NY ; Department of Pediatrics, Weill Cornell Medical College, New York, NY ; NewYork-Presbyterian Hospital, New York, NY
| | - Joshua R Vest
- Center for Healthcare Informatics & Policy, Weill Cornell Medical College, New York NY ; Department of Healthcare Policy and Research, Weill Cornell Medical College, New York NY
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Vest JR, Kern LM, Silver MD, Kaushal R. The potential for community-based health information exchange systems to reduce hospital readmissions. J Am Med Inform Assoc 2014; 22:435-42. [DOI: 10.1136/amiajnl-2014-002760] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Abstract
Background Hospital readmissions are common, costly, and offer opportunities for utilization reduction. Electronic health information exchange (HIE) systems may help prevent readmissions by improving access to clinical data by ambulatory providers after discharge from the hospital.
Objective We sought to determine the association between HIE system usage and 30-day same-cause hospital readmissions among patients who consented and participated in an operational community-wide HIE during a 6-month period in 2009–2010.
Methods We identified a retrospective cohort of hospital readmissions among adult patients in the Rochester, New York area. We analyzed claims files from two health plans that insure more than 60% of the area population. To be included in the dataset, patients needed to be continuously enrolled in the health plan with at least one encounter with a participating provider in the 6 months following consent to be included in the HIE system. Each patient appeared in the dataset only once and each discharge could be followed for at least 30 days.
Results We found that accessing patient information in the HIE system in the 30 days after discharge was associated with a 57% lower adjusted odds of readmission (OR 0.43; 95% CI 0.27 to 0.70). The estimated annual savings in the sample from averted readmissions associated with HIE usage was $605 000.
Conclusions These findings indicate that usage of an electronic HIE system in the ambulatory setting within 30 days after hospital discharge may effectively prevent hospital readmissions, thereby supporting the need for ongoing HIE efforts.
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Affiliation(s)
- Joshua R Vest
- Center for Healthcare Informatics & Policy, Weill Cornell Medical College, New York, New York, USA
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
- Health Information Technology Evaluation Collaborative, New York, New York, USA
| | - Lisa M Kern
- Center for Healthcare Informatics & Policy, Weill Cornell Medical College, New York, New York, USA
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
- Health Information Technology Evaluation Collaborative, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Michael D Silver
- Center for Healthcare Informatics & Policy, Weill Cornell Medical College, New York, New York, USA
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
- Health Information Technology Evaluation Collaborative, New York, New York, USA
| | - Rainu Kaushal
- Center for Healthcare Informatics & Policy, Weill Cornell Medical College, New York, New York, USA
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, USA
- Health Information Technology Evaluation Collaborative, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Pediatrics, Weill Cornell Medical College, New York, New York, USA
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