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Beauvais B, Mileski M, Ramamonjiarivelo Z, Lee KA, Kruse CS, Betancourt J, Pradhan R, Shanmugam R. The Association Between Facility Affiliations and Revenue Generation in Skilled Nursing Facilities - An Exploratory Study. J Multidiscip Healthc 2023; 16:3099-3114. [PMID: 37901598 PMCID: PMC10612498 DOI: 10.2147/jmdh.s433771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/11/2023] [Indexed: 10/31/2023] Open
Abstract
Background Although hospitals have been the traditional setting for interventional and rehabilitative care, skilled nursing facilities (SNFs) can offer a high-quality and less costly alternative than hospitals. Unfortunately, the financial health of SNFs is often a matter of concern. To partially address these issues, SNF leaders have increased engagement in a number of affiliations to assist in improving quality and reducing operational costs, including Accountable Care Organizations (ACOs), Health Information Exchanges (HIEs), and participation in Bundled Payment for Care Improvement (BPCI) programs. What is not well understood is what impact these affiliations have on the financial viability of the host organizations. Given these factors, this study aims to identify what association, if any, exists between SNF affiliations and revenue generation. Methods Data from calendar year 2022 for n=13,447 SNFs in the US were assessed using multivariate regression analysis. We evaluated two separate dependent measures of revenue generation capacity: net patient revenue per bed and net patient revenue per discharge and considered three unique facility affiliations including (1) ACOs, (2) HIEs, and (3) BPCI participants. Results Six multivariable linear regressions revealed that ACO affiliation is negatively associated with revenue generation on both dependent measures, while HIE affiliation and BPCI participation reflected mixed results. Conclusion A better understanding of the financial impact of SNFs' affiliations may prove insightful. By carefully considering the value of each affiliation, and how each is applicable to any given market, policymakers, funding agencies, and facility leaders may be able to better position SNFs for more sustainable financial performance in a challenging economic environment.
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Affiliation(s)
- Bradley Beauvais
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Michael Mileski
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Zo Ramamonjiarivelo
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Kimberly Ann Lee
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Clemens Scott Kruse
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Jose Betancourt
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Rohit Pradhan
- School of Health Administration, Texas State University, San Marcos, TX, USA
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Simpson SA, Loh R, Elliott L, Everhart R, Bass C, Bol K, Boylls S, Podewils L. A Mortality Surveillance Collaboration Between a Health System and Public Health Department. Am J Public Health 2023; 113:943-946. [PMID: 37410981 PMCID: PMC10413737 DOI: 10.2105/ajph.2023.307335] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 07/08/2023]
Abstract
We describe a collaboration between a health system and public health department to create a mortality surveillance system. The collaboration enabled the health system to identify more than six times the number of deaths identified through local system medical records alone. This powerful epidemiological process, combining the nuanced data captured through clinical care in health systems with subsequent data on mortality, drives quality improvement, scientific research, and epidemiology that can be of particular benefit to underserved communities. (Am J Public Health. 2023;113(9):943-946. https://doi.org/10.2105/AJPH.2023.307335).
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Affiliation(s)
- Scott A Simpson
- Scott Simpson, Ryan Loh, Laura Elliott, Rachel Everhart, and Laura Podewils are with the Denver Health and Hospital Authority, Denver, CO. Conlin Bass, Kirk Bol, and Steve Boylls are with the Colorado Department of Public Health and Environment, Denver
| | - Ryan Loh
- Scott Simpson, Ryan Loh, Laura Elliott, Rachel Everhart, and Laura Podewils are with the Denver Health and Hospital Authority, Denver, CO. Conlin Bass, Kirk Bol, and Steve Boylls are with the Colorado Department of Public Health and Environment, Denver
| | - Laura Elliott
- Scott Simpson, Ryan Loh, Laura Elliott, Rachel Everhart, and Laura Podewils are with the Denver Health and Hospital Authority, Denver, CO. Conlin Bass, Kirk Bol, and Steve Boylls are with the Colorado Department of Public Health and Environment, Denver
| | - Rachel Everhart
- Scott Simpson, Ryan Loh, Laura Elliott, Rachel Everhart, and Laura Podewils are with the Denver Health and Hospital Authority, Denver, CO. Conlin Bass, Kirk Bol, and Steve Boylls are with the Colorado Department of Public Health and Environment, Denver
| | - Conlin Bass
- Scott Simpson, Ryan Loh, Laura Elliott, Rachel Everhart, and Laura Podewils are with the Denver Health and Hospital Authority, Denver, CO. Conlin Bass, Kirk Bol, and Steve Boylls are with the Colorado Department of Public Health and Environment, Denver
| | - Kirk Bol
- Scott Simpson, Ryan Loh, Laura Elliott, Rachel Everhart, and Laura Podewils are with the Denver Health and Hospital Authority, Denver, CO. Conlin Bass, Kirk Bol, and Steve Boylls are with the Colorado Department of Public Health and Environment, Denver
| | - Steve Boylls
- Scott Simpson, Ryan Loh, Laura Elliott, Rachel Everhart, and Laura Podewils are with the Denver Health and Hospital Authority, Denver, CO. Conlin Bass, Kirk Bol, and Steve Boylls are with the Colorado Department of Public Health and Environment, Denver
| | - Laura Podewils
- Scott Simpson, Ryan Loh, Laura Elliott, Rachel Everhart, and Laura Podewils are with the Denver Health and Hospital Authority, Denver, CO. Conlin Bass, Kirk Bol, and Steve Boylls are with the Colorado Department of Public Health and Environment, Denver
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Li E, Lounsbury O, Clarke J, Ashrafian H, Darzi A, Neves AL. Perceptions of chief clinical information officers on the state of electronic health records systems interoperability in NHS England: a qualitative interview study. BMC Med Inform Decis Mak 2023; 23:158. [PMID: 37573388 PMCID: PMC10423420 DOI: 10.1186/s12911-023-02255-8] [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: 12/12/2022] [Accepted: 08/02/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND In the era of electronic health records (EHR), the ability to share clinical data is a key facilitator of healthcare delivery. Since the introduction of EHRs, this aspect has been extensively studied from the perspective of healthcare providers. Less often explored are the day-to-day challenges surrounding the procurement, deployment, maintenance, and use of interoperable EHR systems, from the perspective of healthcare administrators, such as chief clinical information officers (CCIOs). OBJECTIVE Our study aims to capture the perceptions of CCIOs on the current state of EHR interoperability in the NHS, its impact on patient safety, the perceived facilitators and barriers to improving EHR interoperability, and what the future of EHR development in the NHS may entail. METHODS Semi-structured interviews were conducted between November 2020 - October 2021. Convenience sampling was employed to recruit NHS England CCIOs. Interviews were digitally recorded and transcribed verbatim. A thematic analysis was performed by two independent researchers to identify emerging themes. RESULTS Fifteen CCIOs participated in the study. Participants reported that limited EHR interoperability contributed to the inability to easily access and transfer data into a unified source, thus resulting in data fragmentation. The resulting lack of clarity on patients' health status negatively impacts patient safety through suboptimal care coordination, duplication of efforts, and more defensive practice. Facilitators to improving interoperability included the recognition of the need by clinicians, patient expectations, and the inherent centralised nature of the NHS. Barriers included systems usability difficulties, and institutional, data management, and financial-related challenges. Looking ahead, participants acknowledged that realising that vision across the NHS would require a renewed focus on mandating data standards, user-centred design, greater patient involvement, and encouraging inter-organisational collaboration. CONCLUSION Tackling poor interoperability will require solutions both at the technical level and in the wider policy context. This will involve demanding interoperability functionalities from the outset in procurement contracts, fostering greater inter-organisation cooperation on implementation strategies, and encouraging systems vendors to prioritise interoperability in their products. Only by comprehensively addressing these challenges would the full potential promised by the use of fully interoperable EHRs be realised.
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Affiliation(s)
- Edmond Li
- Institute of Global Health Innovation, National Institute for Health and Care Research (NIHR) Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK.
| | | | - Jonathan Clarke
- Institute of Global Health Innovation, National Institute for Health and Care Research (NIHR) Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
- Centre for Mathematics of Precision Healthcare, Department of Mathematics, Imperial College London, London, UK
| | - Hutan Ashrafian
- Institute of Global Health Innovation, National Institute for Health and Care Research (NIHR) Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
| | - Ara Darzi
- Institute of Global Health Innovation, National Institute for Health and Care Research (NIHR) Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
| | - Ana Luisa Neves
- Institute of Global Health Innovation, National Institute for Health and Care Research (NIHR) Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Department of Community Medicine, Health Information and Decision, Center for Health Technology and Services Research, University of Porto, Porto, Portugal
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Brands MR, Haverman L, Muis JJ, Driessens MH, van der Meer FJ, Goedhart G, Meijer S, de Jong M, van der Bom JG, Cnossen MH, Fijnvandraat K, Gouw SC. Patients' and health care providers' perspectives on quality of hemophilia care in the Netherlands: a questionnaire and interview study. Res Pract Thromb Haemost 2023; 7:100159. [PMID: 37346462 PMCID: PMC10279896 DOI: 10.1016/j.rpth.2023.100159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/27/2023] [Accepted: 04/02/2023] [Indexed: 06/23/2023] Open
Abstract
Background Hemophilia care has improved greatly because of advances in treatment options and comprehensive care. In-depth insight into the perspectives of persons with hemophilia and health care providers on their care may provide targets for further improvements. Objectives To assess satisfaction of the hemophilia population with their care, to explore factors determining care satisfaction, and to identify areas for potential health care improvements, including digital health tools. Methods First, to assess care satisfaction and factors determining satisfaction and health care improvements, data from a nationwide, cross-sectional questionnaire among 867 adult and pediatric Dutch persons with hemophilia A or B were analyzed. This included the Hemophilia Patient Satisfaction Scale questionnaire, Canadian Hemophilia Outcomes Kids' Life Assessment Tool satisfaction questions, a visual analog scale satisfaction score, and open questions. Second, to further explore factors determining satisfaction and health care improvements, semistructured interviews were conducted with 19 persons with hemophilia or their parents and 18 health care providers. Results High care satisfaction was found, with an overall median Hemophilia Patient Satisfaction Scale score of 12 (IQR, 6-21). Participants in the interviews reported that patient-professional interactions, availability of care, and coordination of care were major factors determining satisfaction. Suggested health care improvements included improved information provision and coordination of care, especially shared care with professionals not working within comprehensive care centers. Participants suggested that digital health tools could aid in this. Conclusion Satisfaction with hemophilia care is high among persons with hemophilia in the Netherlands, although several potential improvements have been identified. Accentuating these is especially relevant in the current era of treatment innovations, in which we might focus less on other aspects of care.
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Affiliation(s)
- Martijn R. Brands
- Department of Pediatric Hematology, Emma Children’s Hospital, Amsterdam University Medical Centers location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Reproduction & Development, Public Health, Amsterdam, the Netherlands
| | - Lotte Haverman
- Amsterdam Reproduction & Development, Public Health, Amsterdam, the Netherlands
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Emma Children’s Hospital, Amsterdam University Medical Centers location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jelmer J. Muis
- Amsterdam Reproduction & Development, Public Health, Amsterdam, the Netherlands
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Emma Children’s Hospital, Amsterdam University Medical Centers location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | | | - Felix J.M. van der Meer
- HemoNED Foundation, Leiden, the Netherlands
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Geertje Goedhart
- HemoNED Foundation, Leiden, the Netherlands
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Stephan Meijer
- Netherlands Hemophilia Patient Society, Nijkerk, the Netherlands
| | | | - Johanna G. van der Bom
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marjon H. Cnossen
- Department of Pediatric Hematology, Sophia Children’s Hospital, Erasmus University Medical Center, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Karin Fijnvandraat
- Department of Pediatric Hematology, Emma Children’s Hospital, Amsterdam University Medical Centers location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Reproduction & Development, Public Health, Amsterdam, the Netherlands
- Department of Molecular Cellular Hemostasis, Sanquin Research and Landsteiner Laboratory, Amsterdam, the Netherlands
| | - Samantha C. Gouw
- Department of Pediatric Hematology, Emma Children’s Hospital, Amsterdam University Medical Centers location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Reproduction & Development, Public Health, Amsterdam, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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Susha I, Rukanova B, Zuiderwijk A, Gil-Garcia JR, Gasco Hernandez M. Achieving voluntary data sharing in cross sector partnerships: Three partnership models. INFORMATION AND ORGANIZATION 2023. [DOI: 10.1016/j.infoandorg.2023.100448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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A State Health Department and Health Information Exchange Partnership: an Effective Collaboration for a Data-Driven Response for COVID-19 Contact Tracing in Maryland. Sex Transm Dis 2022:00007435-990000000-00081. [PMID: 36098564 PMCID: PMC9992453 DOI: 10.1097/olq.0000000000001702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Accurate, complete, timely data were essential to effective contact tracing for COVID-19. Maryland Department of Health partnered with Maryland's designated health information exchange, Chesapeake Regional Information System for Our Patients (CRISP), to establish data enhancement processes that provided the foundation for Maryland's successful contact tracing program. METHODS Hourly, electronic positive COVID-19 test results were routed through CRISP to the contact tracing data platform. CRISP matched reports against its master patient index to enhance the record with demographic, locating, fatality, vaccination, and hospitalization data. Records were de-duplicated and flagged if associated with a congregate setting, select state universities, or recent international travel. Chi-square tests were used to assess if CRISP-added phone numbers resulted in better contact tracing outcomes. RESULTS During June 15, 2020-September 1, 2021, CRISP pushed 531,094 records to the state's contact tracing data platform within an hour of receipt; of those eligible for investigation, 99% had a phone number. CRISP matched 521,731 (98%) records to their master patient index, allowing for deduplication and enrichment. CRISP flagged 15,615 cases in congregate settings and 3,304 cases as university students; these records were immediately routed for outbreak investigation. Records with an added phone number were significantly more likely to be successfully reached compared to cases with no added phone number (p = 0.01). CONCLUSIONS CRISP enhanced COVID-19 electronic laboratory reports with a near-instant impact on public health actions. The partnership and data processing workflows can serve as a blueprint for data modernization in public health agencies across the United States.
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Cifra CL, Sittig DF, Singh H. Bridging the feedback gap: a sociotechnical approach to informing clinicians of patients' subsequent clinical course and outcomes. BMJ Qual Saf 2021; 30:591-597. [PMID: 33958442 PMCID: PMC8237185 DOI: 10.1136/bmjqs-2020-012464] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/27/2021] [Accepted: 04/28/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Christina L Cifra
- Department of Pediatrics, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| | - Dean F Sittig
- School of Biomedical Informatics, Center for Healthcare Quality and Safety, University of Texas Health Science Center, Houston, Texas, USA
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA
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Vest JR, Unruh MA, Casalino LP, Shapiro JS. The complementary nature of query-based and directed health information exchange in primary care practice. J Am Med Inform Assoc 2021; 27:73-80. [PMID: 31592529 DOI: 10.1093/jamia/ocz134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/27/2019] [Accepted: 07/07/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Many policymakers and advocates assume that directed and query-based health information exchange (HIE) work together to meet organizations' interoperability needs, but this is not grounded in a substantial evidence base. This study sought to clarify the relationship between the usage of these 2 approaches to HIE. MATERIALS AND METHODS System user log files from a regional HIE organization and electronic health record system were combined to model the usage of HIE associated with a patient visit at 3 federally qualified health centers in New York. Regression models tested the hypothesis that directed HIE usage was associated with query-based usage and adjusted for factors reflective of the FITT (Fit between Individuals, Task & Technology) framework. Follow-up interviews with 8 key informants helped interpret findings. RESULTS Usage of query-based HIE occurred in 3.1% of encounters and directed HIE in 23.5%. Query-based usage was 0.6 percentage points higher when directed HIE provided imaging information, and 4.8 percentage points higher when directed HIE provided clinical documents. The probability of query-based HIE was lower for specialist visits, higher for postdischarge visits, and higher for encounters with nurse practitioners. Informants used query-based HIE after directed HIE to obtain additional information, support transitions of care, or in cases of abnormal results. DISCUSSION The complementary nature of directed and query-based HIE indicates that both HIE functionalities should be incorporated into EHR Certification Criteria. CONCLUSIONS Quantitative and qualitative findings suggest that directed and query-based HIE exist in a complementary manner in ambulatory care settings.
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Affiliation(s)
- Joshua R Vest
- Indiana University Richard M Fairbanks School of Public Health at IUPUI, Department of Health Policy & Management; Center for Biomedical Informatics, the Regenstrief Institute, Inc, Indianapolis, IN
| | - Mark A Unruh
- Department of Healthcare Policy and Research, Weill Medical College, New York, NY, USA
| | - Lawrence P Casalino
- Department of Healthcare Policy and Research, Weill Medical College, New York, NY, USA
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Park YT, Kim YS, Heo YJ, Lee JH, Chang H. Association of the Magnitude of Nurses With the Use of Health Information Exchanges: Analyzing the National Health Insurance Claim Data of Hospitals and Clinics in Korea. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211060788. [PMID: 34865552 PMCID: PMC8649911 DOI: 10.1177/00469580211060788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Many features of health care organizations (HCOs) have been identified to be associated with health information exchange (HIE), but subcategories of organizational factors focusing on nurse workforces still need to be identified. The objective of this study is to investigate the association of number of nurses with HIE use in Korea. METHODS This study had a retrospective study design and used health insurance claim data from June 1, 2016 to June 30, 2018. The unit of analysis was the HCO, and any health insurance claims having HIE were counted by HCO. There were a total of 1490 HCOs having any HIE and 24 026 HCOs not having HIE. For statistical analysis, two-part model was used: logistic regression for HIE participation and the generalized linear model for the volume of HIE use. RESULTS HIE was used by 44.6% of general hospitals, and 8.6% and 5.3% of small hospitals and clinics, respectively. Both HIE use and its volume were significantly positively associated with nurse variables. The use of HIE was significantly positively associated with nurse-to-bed ratio in general hospitals (OR 1.028; 1.016 to 1.041) and in small hospitals (OR 1.021; 1.016 to 1.027), and with the number of nurses (OR 1.041; 1.028 to 1.054) in clinics (P<.001). The volume of HIE use was also positively associated with nurse-to-bed ratio in general hospitals (OR 1.010; 1.004 to 1.017) and in small hospitals (OR 1.014; 1.006 to 1.022), and with the number of nurses (OR 1.055; 1.037 to 1.073) in clinics (P<.01). CONCLUSION This study found that there was a low rate of HIE use in small hospitals and clinics. The number of nurses was critically associated with the use of HIE and the volume of HIE claims. HIE policy makers need to be aware of this factor in seeking to accelerate HIE.
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Affiliation(s)
- Young-Taek Park
- HIRA Research Institute, Health Insurance Review and Assessment Service (HIRA), Wonju, Korea
- Department of Medical Humanities & Social Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Yeon Sook Kim
- Department of Nursing, California State University, San Bernardino, CA, USA
| | - Yun-Jung Heo
- Department of Medical Humanities & Social Medicine, Ajou University School of Medicine, Suwon, Korea
| | - Jae-Ho Lee
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyejung Chang
- School of Management, Kyung Hee University, Seoul, Korea
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Keen J, Abdulwahid MA, King N, Wright JM, Randell R, Gardner P, Waring J, Longo R, Nikolova S, Sloan C, Greenhalgh J. Effects of interorganisational information technology networks on patient safety: a realist synthesis. BMJ Open 2020; 10:e036608. [PMID: 33039991 PMCID: PMC7552839 DOI: 10.1136/bmjopen-2019-036608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Health services in many countries are investing in interorganisational networks, linking patients' records held in different organisations across a city or region. The aim of the systematic review was to establish how, why and in what circumstances these networks improve patient safety, fail to do so, or increase safety risks, for people living at home. DESIGN Realist synthesis, drawing on both quantitative and qualitative evidence, and including consultation with stakeholders in nominal groups and semistructured interviews. ELIGIBILITY CRITERIA The coordination of services for older people living at home, and medicine reconciliation for older patients returning home from hospital. INFORMATION SOURCES 17 sources including Medline, Embase, CINAHL, Cochrane Library, Web of Science, ACM Digital Library, and Applied Social Sciences Index and Abstracts. OUTCOMES Changes in patients' clinical risks. RESULTS We did not find any detailed accounts of the sequences of events that policymakers and others believe will lead from the deployment of interoperable networks to improved patient safety. We were, though, able to identify a substantial number of theory fragments, and these were used to develop programme theories.There is good evidence that there are problems with the coordination of services in general, and the reconciliation of medication lists in particular, and it indicates that most problems are social and organisational in nature. There is also good evidence that doctors and other professionals find interoperable networks difficult to use. There was limited high-quality evidence about safety-related outcomes associated with the deployment of interoperable networks. CONCLUSIONS Empirical evidence does not currently justify claims about the beneficial effects of interoperable networks on patient safety. There appears to be a mismatch between technology-driven assumptions about the effects of networks and the sociotechnical nature of coordination problems. PROSPERO REGISTRATION NUMBER CRD42017073004.
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Affiliation(s)
- Justin Keen
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Natalie King
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Judy M Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Rebecca Randell
- Faculty of Health Studies, University of Bradford, Bradford, West Yorkshire, UK
| | - Peter Gardner
- School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - Justin Waring
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Roberta Longo
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Silviya Nikolova
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Claire Sloan
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Keen J, Abdulwahid M, King N, Wright J, Randell R, Gardner P, Waring J, Longo R, Nikolova S, Sloan C, Greenhalgh J. The effects of interoperable information technology networks on patient safety: a realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Interoperable networks connect information technology systems of different organisations, allowing professionals in one organisation to access patient data held in another one. Health policy-makers in many countries believe that they will improve the co-ordination of services and, hence, the quality of services and patient safety. To the best of our knowledge, there have not been any previous systematic reviews of the effects of these networks on patient safety.
Objectives
The aim of the study was to establish how, why and in what circumstances interoperable information technology networks improved patient safety, failed to do so or increased safety risks. The objectives of the study were to (1) identify programme theories and prioritise theories to review; (2) search systematically for evidence to test the theories; (3) undertake quality appraisal, and use included texts to support, refine or reject programme theories; (4) synthesise the findings; and (5) disseminate the findings to a range of audiences.
Design
Realist synthesis, including consultation with stakeholders in nominal groups and semistructured interviews.
Settings and participants
Following a stakeholder prioritisation process, several domains were reviewed: older people living at home requiring co-ordinated care, at-risk children living at home and medicines reconciliation services for any patients living at home. The effects of networks on services in health economies were also investigated.
Intervention
An interoperable network that linked at least two organisations, including a maximum of one hospital, in a city or region.
Outcomes
Increase, reduction or no change in patients’ risks, such as a change in the risk of taking an inappropriate medication.
Results
We did not find any detailed accounts of the ways in which interoperable networks are intended to work and improve patient safety. Theory fragments were identified and used to develop programme and mid-range theories. There is good evidence that there are problems with the co-ordination of services in each of the domains studied. The implicit hypothesis about interoperable networks is that they help to solve co-ordination problems, but evidence across the domains showed that professionals found interoperable networks difficult to use. There is insufficient evidence about the effectiveness of interoperable networks to allow us to establish how and why they affect patient safety.
Limitations
The lack of evidence about patient-specific measures of effectiveness meant that we were not able to determine ‘what works’, nor any variations in what works, when interoperable networks are deployed and used by health and social care professionals.
Conclusions
There is a dearth of evidence about the effects of interoperable networks on patient safety. It is not clear if the networks are associated with safer treatment and care, have no effects or increase clinical risks.
Future work
Possible future research includes primary studies of the effectiveness of interoperable networks, of economies of scope and scale and, more generally, on the value of information infrastructures.
Study registration
This study is registered as PROSPERO CRD42017073004.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 40. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Justin Keen
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Natalie King
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Peter Gardner
- School of Psychology, University of Leeds, Leeds, UK
| | - Justin Waring
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Roberta Longo
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Claire Sloan
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
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Payne TH, Lovis C, Gutteridge C, Pagliari C, Natarajan S, Yong C, Zhao LP. Status of health information exchange: a comparison of six countries. J Glob Health 2020; 9:0204279. [PMID: 31673351 PMCID: PMC6815656 DOI: 10.7189/jogh.09.020427] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Health information exchange (HIE) is frequently cited as an important objective of health information technology investment because of its potential to improve quality, reduce cost, and increase patient satisfaction. In this paper we examine the status and practices of HIE in six countries, drawn from a range of higher and lower income regions. Methods For each of the countries represented – China, England, India, Scotland, Switzerland, and the United States – we describe the state of current practice of HIE with reference to two scenarios: transfer of care and referral. For each country we discuss national objectives, barriers and plans for further advancing clinical information exchange. Results The countries vary widely in levels of adoption of EHRs, availability of health information in electronic form suitable for HIE, and in the information technology infrastructure to be used for transmission. Common themes emerged, however, including an expectation that information will be exchanged rather than gathered anew, the need for incentives to promote information exchange, and concerns about data security and patient confidentiality. Conclusions Although the ability to transfer health information to where it is most needed is nearly always mentioned as an advantage of HIE adoption, there are wide differences in the degree to which this has been achieved to support the scenarios used in this study. Nevertheless, these differences indicate varying stages of progress along a comparable pathway, with similar barriers being identified in the countries described. In some cases, these have been partially surmounted while elsewhere work is needed. We reflect on contextual factors influencing the status and direction of HIE efforts in different global regions and their implications for progress.
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Affiliation(s)
| | - Christian Lovis
- University of Geneva and University hospitals of Geneva, Switzerland
| | | | | | | | - Cui Yong
- Peking University Medical Informatics Center, Beijing, Peoples' Republic of China
| | - Lue-Ping Zhao
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
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13
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Vest JR, Hilts KE, Ancker JS, Unruh MA, Jung HY. Usage of query-based health information exchange after event notifications. JAMIA Open 2020; 2:291-295. [PMID: 31984363 PMCID: PMC6951916 DOI: 10.1093/jamiaopen/ooz028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/17/2019] [Accepted: 07/03/2019] [Indexed: 11/13/2022] Open
Abstract
Objectives This study sought to quantify the association between event notifications and subsequent query-based health information exchange (HIE) use among end users of three different community health information organizations. Materials and Methods Using system-log data merged with user characteristics, regression-adjusted estimates were used to describe the association between event notifications and subsequent query-based HIE usage. Results Approximately 5% of event notifications were associated with query-based HIE usage within 30 days. In adjusted models, odds of query-based HIE usage following an event notification were higher for older patients and for alerts triggered by a discharge event. Query-based HIE usage was more common among specialty clinics and Federally Qualified Health Centers than primary care organizations. Discussion and Conclusion In this novel combination of data, 1 in 20 event notifications resulted in subsequent query-based HIE usage. Results from this study suggest that event notifications and query-based HIE can be applied together to address clinical and population health use cases.
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Affiliation(s)
- Joshua R Vest
- Indiana University Richard M. Fairbanks School of Public Health, Department of Health Policy & Management, Indiana, USA.,Regenstrief Institute Inc., Center for Biomedical Informatics, Indianapolis, Indiana, USA
| | - Katy Ellis Hilts
- Indiana University Richard M. Fairbanks School of Public Health, Department of Health Policy & Management, Indiana, USA
| | - Jessica S Ancker
- Weill Cornell Medical College, Department of Healthcare Policy & Research, New York City, New York, USA
| | - Mark Aaron Unruh
- Weill Cornell Medical College, Department of Healthcare Policy & Research, New York City, New York, USA
| | - Hye-Young Jung
- Weill Cornell Medical College, Department of Healthcare Policy & Research, New York City, New York, USA
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14
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Esmaeilzadeh P. The Impacts of the Perceived Transparency of Privacy Policies and Trust in Providers for Building Trust in Health Information Exchange: Empirical Study. JMIR Med Inform 2019; 7:e14050. [PMID: 31769757 PMCID: PMC6913631 DOI: 10.2196/14050] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 09/11/2019] [Accepted: 09/28/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND In the context of exchange technologies, such as health information exchange (HIE), existing technology acceptance theories should be expanded to consider not only the cognitive beliefs resulting in adoption behavior but also the affect provoked by the sharing nature of the technology. OBJECTIVE We aimed to study HIE adoption using a trust-centered model. Based on the Theory of Reasoned Action, the technology adoption literature, and the trust transfer mechanism, we theoretically explained and empirically tested the impacts of the perceived transparency of privacy policy and trust in health care providers on cognitive and emotional trust in an HIE. Moreover, we analyzed the effects of cognitive and emotional trust on the intention to opt in to the HIE and willingness to disclose health information. METHODS A Web-based survey was conducted using data from a sample of 493 individuals who were aware of the HIE through experiences with a (or multiple) provider(s) participating in an HIE network. RESULTS Structural Equation Modeling analysis results provided empirical support for the proposed model. Our findings indicated that when patients trust in health care providers, and they are aware of HIE security measures, HIE sharing procedures, and privacy terms, they feel more in control, more assured, and less at risk. Moreover, trust in providers has a significant moderating effect on building trust in HIE efforts (P<.05). Results also showed that patient trust in HIE may take the forms of opt-in intentions to HIE and patients' willingness to disclose health information that are exchanged through the HIE (P<.001). CONCLUSIONS The results of this research should be of interest to both academics and practitioners. The findings provide an in-depth dimension of the HIE privacy policy that should be addressed by the health care organizations to exchange personal health information in a secure and private manner. This study can contribute to trust transfer theory and enrich the literature on HIE efforts. Primary and secondary care providers can also identify how to leverage the benefit of patients' trust and trust transfer process to promote HIE initiatives nationwide.
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Affiliation(s)
- Pouyan Esmaeilzadeh
- Department of Information Systems and Business Analytics, College of Business, Florida International University, Miami, FL, United States
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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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Miyoshi NSB, Azevedo-Marques JMD, Alves D, Azevedo-Marques PMD. An eHealth Platform for the Support of a Brazilian Regional Network of Mental Health Care (eHealth-Interop): Development of an Interoperability Platform for Mental Care Integration. JMIR Ment Health 2018; 5:e10129. [PMID: 30530455 PMCID: PMC6303678 DOI: 10.2196/10129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 07/20/2018] [Accepted: 09/03/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The electronic exchange of health-related data can support different professionals and services to act in a more coordinated and transparent manner and make the management of health service networks more efficient. Although mental health care is one of the areas that can benefit from a secure health information exchange (HIE), as it usually involves long-term and multiprofessional care, there are few published studies on this topic, particularly in low- and middle-income countries. OBJECTIVE The aim of this study was to design, implement, and evaluate an electronic health (eHealth) platform that allows the technical and informational support of a Brazilian regional network of mental health care. This solution was to enable HIE, improve data quality, and identify and monitor patients over time and in different services. METHODS The proposed platform is based on client-server architecture to be deployed on the Web following a Web services communication model. The interoperability information model was based on international and Brazilian health standards. To test platform usage, we have utilized the case of the mental health care network of the XIII Regional Health Department of the São Paulo state, Brazil. Data were extracted from 5 different sources, involving 26 municipalities, and included national demographic data, data from primary health care, data from requests for psychiatric hospitalizations performed by community services, and data obtained from 2 psychiatric hospitals about hospitalizations. Data quality metrics such as accuracy and completeness were evaluated to test the proposed solution. RESULTS The eHealth-Interop integration platform was designed, developed, and tested. It contains a built-in terminology server and a record linkage module to support patients' identification and deduplication. The proposed interoperability environment was able to integrate information in the mental health care network case with the support of 5 international and national terminologies. In total, 27,353 records containing demographic and clinical data were integrated into eHealth-Interop. Of these records, 34.91% (9548/27,353) were identified as patients who were present in more than 1 data source with different levels of accuracy and completeness. The data quality analysis was performed on 26 demographic attributes for each integrable patient record, totaling 248,248 comparisons. In general, it was possible to achieve an improvement of 18.40% (45,678/248,248) in completeness and 1.10% (2731/248,248) in syntactic accuracy over the test dataset after integration and deduplication. CONCLUSIONS The proposed platform established an eHealth solution to fill the gap in the availability and quality of information within a network of health services to improve the continuity of care and the health services management. It has been successfully applied in the context of mental health care and is flexible to be tested in other areas of care.
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Affiliation(s)
| | | | - Domingos Alves
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
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McElroy JA, Proulx CM, Johnson L, Heiden-Rootes KM, Albright EL, Smith J, Brown MT. Breaking bad news of a breast cancer diagnosis over the telephone: an emerging trend. Support Care Cancer 2018; 27:943-950. [DOI: 10.1007/s00520-018-4383-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/26/2018] [Indexed: 10/28/2022]
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