Uncovering differences in interoperability across hospital size

The substance-exposed birthing person-infant/child dyad and health information exchange in the United States

OBJECTIVE

Timely access to data is needed to improve care for substance-exposed birthing persons and their infants, a significant public health problem in the United States. We examined the current state of birthing person and infant/child (dyad) data-sharing capabilities supported by health information exchange (HIE) standards and HIE network capabilities for data exchange to inform point-of-care needs assessment for the substance-exposed dyad.

MATERIAL AND METHODS

A cross-map analysis was performed using a set of dyadic data elements focused on pediatric development and longitudinal supportive care for substance-exposed dyads (70 birthing person and 110 infant/child elements). Cross-mapping was conducted to identify definitional alignment to standardized data fields within national healthcare data exchange standards, the United States Core Data for Interoperability (USCDI) version 4 (v4) and Fast Healthcare Interoperability Resources (FHIR) release 4 (R4), and applicable structured vocabulary standards or terminology associated with USCDI. Subsequent survey analysis examined representative HIE network sharing capabilities, focusing on USCDI and FHIR usage.

RESULTS

91.11% of dyadic data elements cross-mapped to at least 1 USCDI v4 standardized data field (87.80% of those structured) and 88.89% to FHIR R4. 75% of the surveyed HIE networks reported supporting USCDI versions 1 or 2 and the capability to use FHIR, though demand is limited.

DISCUSSION

HIE of clinical and supportive care data for substance-exposed dyads is supported by current national standards, though limitations exist.

CONCLUSION

These findings offer a dyadic-focused framework for electronic health record-centered data exchange to inform bedside care longitudinally across clinical touchpoints and population-level health.

Impact of Electronic Health Records Interoperability on Telehealth Service Outcomes

This paper aims to develop a telehealth success model and discusses three critical components: (1) health information quality, (2) electronic health record system quality, and (3) telehealth service quality to ensure effective telehealth service delivery, reduce professional burnout, and enhance access to care. The paper applied a policy analysis method and discussed telehealth applications in rural health, mental health, and veterans health services. The results pointed out the fact that, although telehealth paired with semantic/organizational interoperability facilitates value-based and team-based care, challenges remain to enhance user (both patients and clinicians) experience and satisfaction. The conclusion indicates that approaches at systemic and physician levels are needed to reduce disparities in health technology adoption and improve access to telehealth care.

Impact of the 2015 Health Information Technology Certification Edition on Interoperability among Hospitals

OBJECTIVE

Most nonfederal acute care hospitals use electronic health records (EHRs) certified by the Office of the National Coordinator for Health Information Technology. In 2015, the Office of the National Coordinator for Health Information Technology finalized the 2015 Health IT Certification Edition and adoption by hospitals began in 2016. We examine the impact of the 2015 Edition on rates of interoperable exchange among nonfederal acute hospitals.

MATERIALS AND METHODS

The study applies a standard difference-in-differences design and a recently developed fixed effects estimator that relaxes the assumption of treatment effects being constant across groups and time. In the analysis, we identify separate effects of the 2015 Edition for hospitals that switched EHR developers and forecast hospitals' interoperability over 2015 Edition adoption rates.

RESULTS

The adoption of the 2015 Edition increased hospitals' rates of interoperable exchange and especially benefited hospitals that switched EHR developers in the post-implementation period. Forecasting results indicate that if all hospitals adopted the 2015 Edition, 53% to 61% of hospitals would engage in interoperable health information exchange compared with the current rate of 46%.

DISCUSSION

Hospitals' levels of interoperability have been rising over the last few years. Adoption of newer technology improved hospitals' interoperability and accounts for up to 12% of the rise in interoperability.

CONCLUSIONS

Certified technology is one mechanism to ensure providers use recent and safe technologies for interoperable exchange. Adoption of certified EHRs improves the nation's interoperable exchange; however, it has a clear limited effect. Other mechanisms are necessary for achieving comprehensive interoperable exchange.

Measuring time clinicians spend using EHRs in the inpatient setting: a national, mixed-methods study

OBJECTIVE

To understand hospitals' use of EHR audit-log-based measures to address burden associated with inpatient EHR use.

MATERIALS AND METHODS

Using mixed methods, we analyzed 2018 American Hospital Association Information Technology Supplement Survey data (n = 2864 hospitals; 64% response rate) to characterize measures used and provided by EHR vendors to track clinician time spent documenting. We interviewed staff from the top 3 EHR vendors that provided these measures. Multivariable analyses identified variation in use of the measures among hospitals with these 3 vendors.

RESULTS

53% of hospitals reported using EHR data to track clinician time documenting, compared to 68% of the hospitals using the EHR from the top 3 vendors. Among hospitals with EHRs from these vendors, usage was significantly lower among rural hospitals and independent hospitals (P < .05). Two of these vendors provided measures of time spent doing specific tasks while the third measured an aggregate of auditable activities. Vendors varied in the underlying data used to create measures, measure specification, and data displays.

DISCUSSION

Tools to track clinicians' documentation time are becoming more available. The measures provided differ across vendors and disparities in use exist across hospitals. Increasing the specificity of standards underlying the data would support a common set of core measures making these measures more widely available.

CONCLUSION

Although half of US hospitals use measures of time spent in the EHR derived from EHR generated data, work remains to make such measures and analyses more broadly available to all hospitals and to increase its utility for national burden measurement.

Potential Savings in DHW Facilities through the Use of Solar Thermal Energy in the Hospitals of Extremadura (Spain)

Hospitals need to prepare large amounts of domestic hot water (DHW) to develop their healthcare activity. The aim of this work was to analyse potential savings that can be achieved by installing solar thermal energy for production of domestic hot water in the hospitals of Extremadura (Spain). For this purpose, 25 hospitals between 533 and 87,118 m² and between 15 and 529 beds were studied, three solar factor scenarios were simulated (0.70, 0.75 and 0.80) and the necessary investment and corresponding economic and environmental savings were calculated. Better economic results and energy ratios for 70% of solar contribution were obtained. These results show an average payback of 4.74 years (SD = 0.26) reaching 4.29 kWh/€ per year (SD = 0.20). Undertaking an investment of 674,423 €, 2,895,416 kWh/year of thermal energy could be generated with which to save both 145,933 € and 638 tons of CO₂ per year. It was statistically demonstrated the priority of carrying out an installation with a solar factor of 70%, investing preferably in hospitals in Cáceres over those in Badajoz, especially in the public sector with more than 300 beds. These findings will provide hospital managers with useful information to make decisions on future investments.