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Asgari E, Kaur J, Nuredini G, Balloch J, Taylor AM, Sebire N, Robinson R, Peters C, Sridharan S, Pimenta D. Impact of Electronic Health Record Use on Cognitive Load and Burnout Among Clinicians: Narrative Review. JMIR Med Inform 2024; 12:e55499. [PMID: 38607672 PMCID: PMC11053390 DOI: 10.2196/55499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/15/2024] [Accepted: 03/11/2024] [Indexed: 04/13/2024] Open
Abstract
The cognitive load theory suggests that completing a task relies on the interplay between sensory input, working memory, and long-term memory. Cognitive overload occurs when the working memory's limited capacity is exceeded due to excessive information processing. In health care, clinicians face increasing cognitive load as the complexity of patient care has risen, leading to potential burnout. Electronic health records (EHRs) have become a common feature in modern health care, offering improved access to data and the ability to provide better patient care. They have been added to the electronic ecosystem alongside emails and other resources, such as guidelines and literature searches. Concerns have arisen in recent years that despite many benefits, the use of EHRs may lead to cognitive overload, which can impact the performance and well-being of clinicians. We aimed to review the impact of EHR use on cognitive load and how it correlates with physician burnout. Additionally, we wanted to identify potential strategies recommended in the literature that could be implemented to decrease the cognitive burden associated with the use of EHRs, with the goal of reducing clinician burnout. Using a comprehensive literature review on the topic, we have explored the link between EHR use, cognitive load, and burnout among health care professionals. We have also noted key factors that can help reduce EHR-related cognitive load, which may help reduce clinician burnout. The research findings suggest that inadequate efforts to present large amounts of clinical data to users in a manner that allows the user to control the cognitive burden in the EHR and the complexity of the user interfaces, thus adding more "work" to tasks, can lead to cognitive overload and burnout; this calls for strategies to mitigate these effects. Several factors, such as the presentation of information in the EHR, the specialty, the health care setting, and the time spent completing documentation and navigating systems, can contribute to this excess cognitive load and result in burnout. Potential strategies to mitigate this might include improving user interfaces, streamlining information, and reducing documentation burden requirements for clinicians. New technologies may facilitate these strategies. The review highlights the importance of addressing cognitive overload as one of the unintended consequences of EHR adoption and potential strategies for mitigation, identifying gaps in the current literature that require further exploration.
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Affiliation(s)
- Elham Asgari
- Guy's and St Thomas' NHS Trust, London, United Kingdom
- Tortus AI, London, United Kingdom
| | - Japsimar Kaur
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | | | | | | | - Neil Sebire
- Great Ormond Street Hospital, London, United Kingdom
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Chen M, Esmaeilzadeh P. Adoption and use of various health information exchange methods for sending inside health information in US hospitals. Int J Med Inform 2023; 177:105156. [PMID: 37487455 DOI: 10.1016/j.ijmedinf.2023.105156] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/08/2023] [Accepted: 07/14/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Hospitals may adopt various information transmission methods to participate in health information exchange (HIE) programs. However, even if they adopt multiple mechanisms, they may not actively use all of them to send inside information. This study analyzes the frequently used methods for sending data and the common barriers blocking sending practices in hospital settings. METHODS Our sample included 3,015 community hospitals that reported their methods of sending patient health information in the 2019 American Hospital Association Information Technology Supplement Survey. The relationship between obstacles hospitals experienced and their use of the information-sending method was analyzed by using robust Poisson regression models. RESULTS Many-to-many exchanges that involve intermediaries such as a health information service provider (HISP), electronic health record (EHR) vendor-based network, and national network, once adopted, were more often used by hospitals than one-to-one exchange methods such as provider portals and direct access to EHR by login credentials. Hospitals that lacked the technical capability to electronically send patient health information were less likely to use any of the methods (p <.01), while hospitals located in a more concentrated market were more likely to send information to outside providers by using provider portal, interface connection and national network (p <.01). DISCUSSION There is still a notable gap between hospitals' adoption and the actual use of different HIE methods to send inside information to outside organizations. Results argue that even if hospitals adopted an HIE method, they might not necessarily participate in the actual sharing of information, and the method may remain unused due to several usage barriers. CONCLUSION Hospital and market-level barriers associated with using one-to-one and many-to-many HIE methods for sharing information may affect progress in interoperability. Examining the barriers to using multiple HIE methods and their impact on interoperability could offer implications for health information technology (IT) policy and inform health system leaders.
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Affiliation(s)
- Min Chen
- Department of Information Systems and Business Analytics, College of Business, Florida International University (FIU), Modesto A. Maidique Campus, 11200 S.W. 8th St, Miami, FL 33199, United States.
| | - Pouyan Esmaeilzadeh
- Department of Information Systems and Business Analytics, College of Business, Florida International University (FIU), Modesto A. Maidique Campus, 11200 S.W. 8th St, Miami, FL 33199, United States.
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3
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Everson J, Patel V. Hospital's adoption of multiple methods of obtaining outside information and use of that information. J Am Med Inform Assoc 2022; 29:1489-1496. [PMID: 35652172 PMCID: PMC9382382 DOI: 10.1093/jamia/ocac079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/19/2022] [Accepted: 05/10/2022] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVE Hospitals have multiple methods available to engage in health information exchange (HIE); however, it is not well understood whether these methods are complements or substitutes. We sought to characterize patterns of adoption of HIE methods and examine the association between these methods and increased availability and use of patient information. MATERIALS AND METHODS Cross-sectional analysis of 3208 nonfederal acute care hospitals in the 2019 American Hospital Association Information Technology Supplement. RESULTS The median hospital obtained outside information through 4 methods. Hospitals that obtained data through a regional HIE organization were 2.2 times more likely to also obtain data via Direct using a health information service provider (HISP) than hospitals that did not (P < .001). Hospitals in a single electronic health record (EHR) vendor network were no more or less likely to participate in a HISP or HIE. Six of 7 methods were associated with greater information availability. Only 4 of 7 methods (portals, interfaces, single vendor networks and multi-vendor networks but not access to outside EHR, regional exchange or Direct using a HISP) were associated with more frequent use of information, and single vendor networks were most strongly associated with more frequent use (odds ratio = 4.7, P < .001). DISCUSSION Adoption of some methods was correlated, indicating complementary use. Few methods were negatively correlated, indicating limited competition. Although information availability was common, low correlation with use indicated that challenges related to integration may be slowing use of information. CONCLUSION Complementarities between methods, and the role of integration in supporting information use, indicate the potential value of efforts aimed at ensuring exchange methods work well together, such as the Trusted Exchange Framework and Common Agreement.
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Affiliation(s)
- Jordan Everson
- Corresponding Author: Jordan Everson, PhD, MPP, Data Analysis Branch, Office of the National Coordinator for Health Information Technology, 330 C St SE, 7th floor, Washington, DC 20024, USA;
| | - Vaishali Patel
- Data Analysis Branch, Office of the National Coordinator for Health Information Technology, Washington, District of Columbia, USA
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Tutty MA, Carlasare LE, Lloyd S, Sinsky CA. The complex case of EHRs: examining the factors impacting the EHR user experience. J Am Med Inform Assoc 2020; 26:673-677. [PMID: 30938754 PMCID: PMC6562154 DOI: 10.1093/jamia/ocz021] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/05/2019] [Accepted: 02/08/2019] [Indexed: 12/24/2022] Open
Abstract
Physicians can spend more time completing administrative tasks in their electronic health record (EHR) than engaging in direct face time with patients. Increasing rates of burnout associated with EHR use necessitate improvements in how EHRs are developed and used. Although EHR design often bears the brunt of the blame for frustrations expressed by physicians, the EHR user experience is influenced by a variety of factors, including decisions made by entities other than the developers and end users, such as regulators, policymakers, and administrators. Identifying these key influences can help create a deeper understanding of the challenges in developing a better EHR user experience. There are multiple opportunities for regulators, policymakers, EHR developers, payers, health system leadership, and users each to make changes to collectively improve the use and efficacy of EHRs.
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Affiliation(s)
- Michael A Tutty
- Professional Satisfaction and Practice Sustainability, American Medical Association, Chicago, USA
| | - Lindsey E Carlasare
- Professional Satisfaction and Practice Sustainability, American Medical Association, Chicago, USA
| | - Stacy Lloyd
- Professional Satisfaction and Practice Sustainability, American Medical Association, Chicago, USA
| | - Christine A Sinsky
- Professional Satisfaction and Practice Sustainability, American Medical Association, Chicago, USA
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Talal AH, Sofikitou EM, Jaanimägi U, Zeremski M, Tobin JN, Markatou M. A framework for patient-centered telemedicine: Application and lessons learned from vulnerable populations. J Biomed Inform 2020; 112:103622. [PMID: 33186707 DOI: 10.1016/j.jbi.2020.103622] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 11/04/2020] [Accepted: 11/05/2020] [Indexed: 01/03/2023]
Abstract
Virtual technologies can facilitate clinical monitoring, clinician-patient interactions, and enhance patient-centered approaches to healthcare delivery. Telemedicine, two-way communication between a healthcare provider and a patient not in the same physical location, emphasizes patient preference and convenience by substituting the transportation of patients with information transfer. We present a framework for implementation of a comprehensive, dynamic, patient-centered telemedicine network deployed in 12 opioid treatment programs (OTP) located throughout New York State (NYS). The program aims to effectively manage hepatitis C virus (HCV) infection via telemedicine with co-administration of HCV and substance use medications. We have found that the Sociotechnical System model with emphasis on patient-centered factors provides a framework for telemedicine deployment and implementation to a vulnerable population. The issue of interoperability between the telemedicine platform and the electronic health record (EHR) system as well as clinical information retrieval for medical decision-making are challenges with implementation of a comprehensive, dynamic telemedicine system. Targeting telemedicine to a vulnerable population requires additional consideration of trust in the security and confidentiality of the telemedicine system. Our contribution is the valuable lessons learned from implementing a comprehensive, dynamic, patient-centered telemedicine system among an OTP network throughout NYS as applied to a vulnerable population that can be generalized to other difficult-to-reach populations.
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Affiliation(s)
- Andrew H Talal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Elisavet M Sofikitou
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
| | - Urmo Jaanimägi
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States
| | - Marija Zeremski
- Clinical Directors Network, Inc. (CDN), New York, NY, United States
| | - Jonathan N Tobin
- Clinical Directors Network, Inc. (CDN), New York, NY, United States; Center for Clinical and Translational Science, The Rockefeller University, New York, NY, United States
| | - Marianthi Markatou
- Department of Biostatistics, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States.
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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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Mori M, Khera R, Lin Z, Ross JS, Schulz W, Krumholz HM. The Promise of Big Data and Digital Solutions in Building a Cardiovascular Learning System: Opportunities and Barriers. Methodist Debakey Cardiovasc J 2020; 16:212-219. [PMID: 33133357 PMCID: PMC7587314 DOI: 10.14797/mdcj-16-3-212] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The learning health system is a conceptual model for continuous learning and knowledge generation rooted in the daily practice of medicine. While companies such as Google and Amazon use dynamic learning systems that learn iteratively through every customer interaction, this efficiency has not materialized on a comparable scale in health systems. An ideal learning health system would learn from every patient interaction to benefit the care for the next patient. Notable advances include the greater use of data generated in the course of clinical care, Common Data Models, and advanced analytics. However, many remaining barriers limit the most effective use of large and growing health care data assets. In this review, we explore the accomplishments, opportunities, and barriers to realizing the learning health system.
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Affiliation(s)
- Makoto Mori
- YALE SCHOOL OF MEDICINE, NEW HAVEN, CONNECTICUT
- YALE-NEW HAVEN HOSPITAL, NEW HAVEN, CONNECTICUT
| | - Rohan Khera
- UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER, DALLAS, TEXAS
| | - Zhenqiu Lin
- YALE SCHOOL OF MEDICINE, NEW HAVEN, CONNECTICUT
- YALE-NEW HAVEN HOSPITAL, NEW HAVEN, CONNECTICUT
| | - Joseph S Ross
- YALE SCHOOL OF MEDICINE, NEW HAVEN, CONNECTICUT
- YALE-NEW HAVEN HOSPITAL, NEW HAVEN, CONNECTICUT
- YALE SCHOOL OF PUBLIC HEALTH, NEW HAVEN, CONNECTICUT
| | - Wade Schulz
- YALE SCHOOL OF MEDICINE, NEW HAVEN, CONNECTICUT
- YALE-NEW HAVEN HOSPITAL, NEW HAVEN, CONNECTICUT
| | - Harlan M Krumholz
- YALE SCHOOL OF MEDICINE, NEW HAVEN, CONNECTICUT
- YALE-NEW HAVEN HOSPITAL, NEW HAVEN, CONNECTICUT
- YALE SCHOOL OF PUBLIC HEALTH, NEW HAVEN, CONNECTICUT
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8
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Keen J, Greenhalgh J, Randell R, Gardner P, Waring J, Longo R, Fistein J, Abdulwahid M, King N, Wright J. Networked information technologies and patient safety: a protocol for a realist synthesis. Syst Rev 2019; 8:307. [PMID: 31806015 PMCID: PMC6896666 DOI: 10.1186/s13643-019-1223-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 11/06/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND There is a widespread belief that information technologies will improve diagnosis, treatment and care. Evidence about their effectiveness in health care is, however, mixed. It is not clear why this is the case, given the remarkable advances in hardware and software over the last 20 years. This review focuses on interoperable information technologies, which governments are currently advocating and funding. These link organisations across a health economy, with a view to enabling health and care professionals to coordinate their work with one another and to access patient data wherever it is stored. Given the mixed evidence about information technologies in general, and current policies and funding, there is a need to establish the value of investments in this class of system. The aim of this review is to establish how, why and in what circumstances interoperable systems affect patient safety. METHODS A realist synthesis will be undertaken, to understand how and why inter-organisational systems reduce patients' clinical risks, or fail to do so. The review will follow the steps in most published realist syntheses, including (1) clarifying the scope of the review and identifying candidate programme and mid-range theories to evaluate, (2) searching for evidence, (3) appraising primary studies in terms of their rigour and relevance and extracting evidence, (4) synthesising evidence, (5) identifying recommendations, based on assessment of the extent to which findings can be generalised to other settings. DISCUSSION The findings of this realist synthesis will shed light on how and why an important class of systems, that span organisations in a health economy, will contribute to changes in patients' clinical risks. We anticipate that the findings will be generalizable, in two ways. First, a refined mid-range theory will contribute to our understanding of the underlying mechanisms that, for a range of information technologies, lead to changes in clinical practices and hence patients' risks (or not). Second, many governments are funding and implementing cross-organisational IT networks. The findings can inform policies on their design and implementation. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017073004.
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Affiliation(s)
- Justin Keen
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9NL, England.
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, England
| | | | - Peter Gardner
- School of Psychology, University of Leeds, Leeds, England
| | - Justin Waring
- Health Services Management Centre, University of Birmingham, Birmingham, England
| | - Roberta Longo
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9NL, England
| | - Jon Fistein
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9NL, England
| | - Maysam Abdulwahid
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9NL, England
| | - Natalie King
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9NL, England
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9NL, England
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9
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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 DOI: 10.1111/1475-6773.13169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [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 Policy, Indianapolis, Indiana.,Health Policy and Management, Indiana University Richard M Fairbanks School of Public Health at IUPUI, Indianapolis, Indiana.,Regenstrief Institute, Inc., Indianapolis, Indiana
| | - Mark Aaron Unruh
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
| | - Jason S Shapiro
- Department of Emergency Medicine, Icahn School of Medicine at Mout Sinai, New York, New York
| | - Lawrence P Casalino
- Division of Health Policy and Economics, The Livingston Farrand Professor of Public Health, New York, New York.,Weill Cornell Graduate School of Medical Sciences, Weill Cornell Medical College, New York, New York
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10
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Everson J, Cross DA. Mind the gap: the potential of alternative health information exchange. THE AMERICAN JOURNAL OF MANAGED CARE 2019; 25:32-38. [PMID: 30667609 PMCID: PMC7336522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To determine the proportion of patient transitions that could be connected through 3 proprietary alternatives to open, community-based health information exchange (HIE): HIE between physicians who are part of the same integrated system, use the same electronic health record (EHR), or use an EHR that participates in an EHR vendor alliance. STUDY DESIGN Cross-sectional analysis of Medicare patient transitions and physician EHR adoption and organizational affiliation from SK&A. METHODS We characterized the percentage of transitions that could be covered by each HIE approach and the degree of redundancy. We then assessed whether coverage opportunities differed by provider type and used multivariate linear regression to estimate the association between physician characteristics and proportion of transitions uncovered by any proprietary approach (ie, requiring an open HIE approach). RESULTS Given current EHR adoption and organizational affiliations, 33% of transitions could be covered by proprietary HIE. For the average physician, open methods of HIE would still be needed for 45% of patients treated by other physicians. Physicians who did not use a market-leading EHR, were not members of a large integrated system, and shared patients with a broader network of physicians have the greatest need for open HIE. CONCLUSIONS Proprietary approaches to HIE do not eliminate the need for open HIE and may further disadvantage providers in small healthcare organizations using less common EHRs. Ongoing support and innovative value creation within open HIE will likely remain necessary to support HIE by independent physicians. Public efforts to promote interoperability should seek to integrate proprietary models with open HIE.
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Affiliation(s)
- Jordan Everson
- Department of Health Policy and Department of Biomedical Informatics, Vanderbilt University, 2525 West End Ave, Ste 1275, Nashville, TN 37203.
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11
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Vendor of choice and the effectiveness of policies to promote health information exchange. BMC Health Serv Res 2018; 18:405. [PMID: 29866179 PMCID: PMC5987601 DOI: 10.1186/s12913-018-3230-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As more hospitals adopt Electronic Health Records (EHR), focus has shifted to how these records can be used to improve patient care. One barrier to this improvement is limited information exchange between providers. In this work we examine the role of EHR vendors, hypothesizing that vendors strategically control the exchange of clinical care summaries. Their strategy may involve the creation of networks that easily exchange information between providers with the same vendor but frustrate exchange between providers with different vendors, even as both Federal and State policies attempt to incentivize exchange through a common format. METHODS Using data from the 2013 American Hospital Association's Information Technology Supplement, we examine the relationship between a hospital's decision to share clinical care summaries outside of their network and EHR vendor market share, measured by the percentage of hospitals that have the same vendor in a Hospital Referral Region. RESULTS Our findings show that the likelihood of a hospital exchanging clinical summaries with hospitals outside its health system increases as the percentage of hospitals with the same EHR vendor in the region increases. The estimated odds of a hospital sharing clinical care summaries outside their system is 5.4 (95% CI, 3.29-8.80) times greater if all hospitals in the Hospital Referral Region use the same EHR Vendor than the corresponding odds for a hospital in an area with no hospitals using the same EHR Vendor. When reviewing the relationship of vendor market concentration at the state level we find a positive significant relationship with the percentage of hospitals that share clinical care summaries within a state. We find no significant impact from state policies designed to incentivize information exchange through the State Health Information Exchange Cooperative Program. CONCLUSION There are benefits to exchanging using proprietary methods that are strengthened when the vendors are more concentrated. In order to avoid closed networks that foreclose some hospitals, it is important that future regulation attempt to be more inclusive of hospitals that do not use large vendors and are therefore unable to use proprietary methods for exchange.
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Klapman S, Sher E, Adler-Milstein J. A snapshot of health information exchange across five nations: an investigation of frontline clinician experiences in emergency care. J Am Med Inform Assoc 2018; 25:686-693. [PMID: 29409028 DOI: 10.1093/jamia/ocx153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 12/17/2017] [Indexed: 11/14/2022] Open
Abstract
Objective Ensuring the ability to exchange patient information among disparate electronic health records systems is a top priority and a domain of substantial public investment across countries. However, we know little about the extent to which current capabilities meet the needs of frontline clinicians. Materials and Methods We conducted in-person, semistructured interviews with emergency care physicians and nurses in select hospitals in Canada, Denmark, Finland, Germany, and the USA. We characterized the state of health information exchange (HIE) by country and used thematic analysis to identify the perceived benefits of access to complete past medical history (PMH), the conditions under which PMH is sought, and the challenges to accessing and using HIE capabilities. Results HIE approaches, and the information electronically accessible to clinicians, differed by country. Benefits of access to PMH included safer care, reduced patient length of stay, and fewer lab and imaging orders. Conditions under which PMH was sought included moderate-acuity patients, patients with chronic conditions, and instances where accessing PMH was convenient. Challenges to HIE access and use included difficulty knowing where information is located, delay in receiving information, and difficulty finding information within documents. Discussion Even with different HIE approaches across countries, all clinicians reported shortcomings in their country's approach. Notably, challenges were similar and shaped the conditions under which PMH was sought. Conclusion As countries continue to pursue broad-based HIE, they appear to be facing similar challenges in realizing HIE value and therefore have an opportunity to learn from one another.
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Affiliation(s)
- Seth Klapman
- Office of Medical Student Education, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Emily Sher
- Office of Medical Education, A.T. Still University of Osteopathic Medicine, Mesa, AZ, USA
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Khurshid A. A tale of two cities: Developing health information platforms for a learning health system in Austin and in New Orleans. Learn Health Syst 2016. [DOI: 10.1002/lrh2.10017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Zheng L, Wang Y, Hao S, Shin AY, Jin B, Ngo AD, Jackson-Browne MS, Feller DJ, Fu T, Zhang K, Zhou X, Zhu C, Dai D, Yu Y, Zheng G, Li YM, McElhinney DB, Culver DS, Alfreds ST, Stearns F, Sylvester KG, Widen E, Ling XB. Web-based Real-Time Case Finding for the Population Health Management of Patients With Diabetes Mellitus: A Prospective Validation of the Natural Language Processing-Based Algorithm With Statewide Electronic Medical Records. JMIR Med Inform 2016; 4:e37. [PMID: 27836816 PMCID: PMC5124114 DOI: 10.2196/medinform.6328] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/01/2016] [Accepted: 10/12/2016] [Indexed: 02/06/2023] Open
Abstract
Background Diabetes case finding based on structured medical records does not fully identify diabetic patients whose medical histories related to diabetes are available in the form of free text. Manual chart reviews have been used but involve high labor costs and long latency. Objective This study developed and tested a Web-based diabetes case finding algorithm using both structured and unstructured electronic medical records (EMRs). Methods This study was based on the health information exchange (HIE) EMR database that covers almost all health facilities in the state of Maine, United States. Using narrative clinical notes, a Web-based natural language processing (NLP) case finding algorithm was retrospectively (July 1, 2012, to June 30, 2013) developed with a random subset of HIE-associated facilities, which was then blind tested with the remaining facilities. The NLP-based algorithm was subsequently integrated into the HIE database and validated prospectively (July 1, 2013, to June 30, 2014). Results Of the 935,891 patients in the prospective cohort, 64,168 diabetes cases were identified using diagnosis codes alone. Our NLP-based case finding algorithm prospectively found an additional 5756 uncodified cases (5756/64,168, 8.97% increase) with a positive predictive value of .90. Of the 21,720 diabetic patients identified by both methods, 6616 patients (6616/21,720, 30.46%) were identified by the NLP-based algorithm before a diabetes diagnosis was noted in the structured EMR (mean time difference = 48 days). Conclusions The online NLP algorithm was effective in identifying uncodified diabetes cases in real time, leading to a significant improvement in diabetes case finding. The successful integration of the NLP-based case finding algorithm into the Maine HIE database indicates a strong potential for application of this novel method to achieve a more complete ascertainment of diagnoses of diabetes mellitus.
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Affiliation(s)
- Le Zheng
- Tsinghua University, Beijing, China.,Stanford University, Stanford, CA, United States
| | - Yue Wang
- Stanford University, Stanford, CA, United States.,Zhejiang University, Hangzhou, China
| | - Shiying Hao
- Stanford University, Stanford, CA, United States
| | | | - Bo Jin
- HBI Solutions Inc, Palo Alto, CA, United States
| | - Anh D Ngo
- HBI Solutions Inc, Palo Alto, CA, United States
| | | | | | - Tianyun Fu
- HBI Solutions Inc, Palo Alto, CA, United States
| | - Karena Zhang
- Stanford University, Stanford, CA, United States
| | - Xin Zhou
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Tianjin, China
| | | | - Dorothy Dai
- HBI Solutions Inc, Palo Alto, CA, United States
| | - Yunxian Yu
- School of Medicine, Zhejiang University, Hangzhou, China
| | | | - Yu-Ming Li
- Tianjin Key Laboratory of Cardiovascular Remodeling and Target Organ Injury, Pingjin Hospital Heart Center, Tianjin, China
| | | | | | | | | | | | - Eric Widen
- HBI Solutions Inc, Palo Alto, CA, United States
| | - Xuefeng Bruce Ling
- Stanford University, Stanford, CA, United States.,School of Medicine, Zhejiang University, Hangzhou, China
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What Data Are Really Needed to Evaluate the Population Impact of Chlamydia Screening Programs? Sex Transm Dis 2016; 43:9-11. [PMID: 26650989 DOI: 10.1097/olq.0000000000000397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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