1
|
Esmaeilzadeh P, Mirzaei T. Role of Incentives in the Use of Blockchain-Based Platforms for Sharing Sensitive Health Data: Experimental Study. J Med Internet Res 2023; 25:e41805. [PMID: 37594783 PMCID: PMC10474518 DOI: 10.2196/41805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/02/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Blockchain is an emerging technology that enables secure and decentralized approaches to reduce technical risks and governance challenges associated with sharing data. Although blockchain-based solutions have been suggested for sharing health information, it is still unclear whether a suitable incentive mechanism (intrinsic or extrinsic) can be identified to encourage individuals to share their sensitive data for research purposes. OBJECTIVE This study aimed to investigate how important extrinsic incentives are and what type of incentive is the best option in blockchain-based platforms designed for sharing sensitive health information. METHODS In this study, we conducted 3 experiments with 493 individuals to investigate the role of extrinsic incentives (ie, cryptocurrency, money, and recognition) in data sharing with research organizations. RESULTS The findings highlight that offering different incentives is insufficient to encourage individuals to use blockchain technology or to change their perceptions about the technology's premise for sharing sensitive health data. The results demonstrate that individuals still attribute serious risks to blockchain-based platforms. Privacy and security concerns, trust issues, lack of knowledge about the technology, lack of public acceptance, and lack of regulations are reported as top risks. In terms of attracting people to use blockchain-based platforms for data sharing in health care, we show that the effects of extrinsic motivations (cryptoincentives, money, and status) are significantly overshadowed by inhibitors to technology use. CONCLUSIONS We suggest that before emphasizing the use of various types of extrinsic incentives, the users must be educated about the capabilities and benefits offered by this technology. Thus, an essential first step for shifting from an institution-based data exchange to a patient-centric data exchange (using blockchain) is addressing technology inhibitors to promote patient-driven data access control. This study shows that extrinsic incentives alone are inadequate to change users' perceptions, increase their trust, or encourage them to use technology for sharing health data.
Collapse
Affiliation(s)
- Pouyan Esmaeilzadeh
- Department of Information Systems and Business Analytics, Florida International University, Miami, FL, United States
| | - Tala Mirzaei
- Department of Information Systems and Business Analytics, Florida International University, Miami, FL, United States
| |
Collapse
|
2
|
Shade SB, Marseille E, Kirby V, Chakravarty D, Steward WT, Koester KK, Cajina A, Myers JJ. Health information technology interventions and engagement in HIV care and achievement of viral suppression in publicly funded settings in the US: A cost-effectiveness analysis. PLoS Med 2021; 18:e1003389. [PMID: 33826617 PMCID: PMC8059802 DOI: 10.1371/journal.pmed.1003389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 04/21/2021] [Accepted: 03/25/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The US National HIV/AIDS Strategy (NHAS) emphasizes the use of technology to facilitate coordination of comprehensive care for people with HIV. We examined cost-effectiveness from the health system perspective of 6 health information technology (HIT) interventions implemented during 2008 to 2012 in a Ryan White HIV/AIDS Program (RWHAP) Special Projects of National Significance (SPNS) Program demonstration project. METHODS/FINDINGS HIT interventions were implemented at 6 sites: Bronx, New York; Durham, North Carolina; Long Beach, California; New Orleans, Louisiana; New York, New York (2 sites); and Paterson, New Jersey. These interventions included: (1) use of HIV surveillance data to identify out-of-care individuals; (2) extension of access to electronic health records (EHRs) to support service providers; (3) use of electronic laboratory ordering and prescribing; and (4) development of a patient portal. We employed standard microcosting techniques to estimate costs (in 2018 US dollars) associated with intervention implementation. Data from a sample of electronic patient records from each demonstration site were analyzed to compare prescription of antiretroviral therapy (ART), CD4 cell counts, and suppression of viral load, before and after implementation of interventions. Markov models were used to estimate additional healthcare costs and quality-adjusted life-years saved as a result of each intervention. Overall, demonstration site interventions cost $3,913,313 (range = $287,682 to $998,201) among 3,110 individuals (range = 258 to 1,181) over 3 years. Changes in the proportion of patients prescribed ART ranged from a decrease from 87.0% to 72.7% at Site 4 to an increase from 74.6% to 94.2% at Site 6; changes in the proportion of patients with 0 to 200 CD4 cells/mm3 ranged from a decrease from 20.2% to 11.0% in Site 6 to an increase from 16.7% to 30.2% in Site 2; and changes in the proportion of patients with undetectable viral load ranged from a decrease from 84.6% to 46.0% in Site 1 to an increase from 67.0% to 69.9% in Site 5. Four of the 6 interventions-including use of HIV surveillance data to identify out-of-care individuals, use of electronic laboratory ordering and prescribing, and development of a patient portal-were not only cost-effective but also cost saving ($6.87 to $14.91 saved per dollar invested). In contrast, the 2 interventions that extended access to EHRs to support service providers were not effective and, therefore, not cost-effective. Most interventions remained either cost-saving or not cost-effective under all sensitivity analysis scenarios. The intervention that used HIV surveillance data to identify out-of-care individuals was no longer cost-saving when the effect of HIV on an individual's health status was reduced and when the natural progression of HIV was increased. The results of this study are limited in that we did not have contemporaneous controls for each intervention; thus, we are only able to assess sites against themselves at baseline and not against standard of care during the same time period. CONCLUSIONS These results provide additional support for the use of HIT as a tool to enhance rapid and effective treatment of HIV to achieve sustained viral suppression. HIT has the potential to increase utilization of services, improve health outcomes, and reduce subsequent transmission of HIV.
Collapse
Affiliation(s)
- Starley B. Shade
- Institute for Global Health Sciences, Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- Center for AIDS Prevention Studies, University of California, San Francisco, California, United States of America
- * E-mail:
| | | | - Valerie Kirby
- Center for AIDS Prevention Studies, University of California, San Francisco, California, United States of America
| | - Deepalika Chakravarty
- Center for AIDS Prevention Studies, University of California, San Francisco, California, United States of America
| | - Wayne T. Steward
- Center for AIDS Prevention Studies, University of California, San Francisco, California, United States of America
| | - Kimberly K. Koester
- Center for AIDS Prevention Studies, University of California, San Francisco, California, United States of America
| | - Adan Cajina
- Demonstration and Evaluation Branch, HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, United States of America
| | - Janet J. Myers
- Center for AIDS Prevention Studies, University of California, San Francisco, California, United States of America
| |
Collapse
|
3
|
Patients' Perceptions of Different Information Exchange Mechanisms: An Exploratory Study in the United States. Methods Inf Med 2021; 59:162-178. [PMID: 33618421 DOI: 10.1055/s-0040-1721784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patients may seek health care services from various providers during treatment. These providers could serve in a network (affiliated) or practice separately (unaffiliated). Thus, using secure and reliable health information exchange (HIE) mechanisms would be critical to transfer sensitive personal health information (PHI) across distances. Studying patients' perceptions and opinions about exchange mechanisms could help health care providers build more complete HIEs' databases and develop robust privacy policies, consent processes, and patient education programs. OBJECTIVES Due to the exploratory nature of this study, we aim to shed more light on public perspectives (benefits, concerns, and risks) associated with the four data exchange practices in the health care sector. METHODS In this study, we compared public perceptions and expectations regarding four common types of exchange mechanisms used in the United States (i.e., traditional, direct, query-based, patient-mediated exchange mechanisms). Traditional is an exchange through fax, paper mailing, or phone calls, direct is a provider-to-provider exchange, query-based is sharing patient data with a central repository, and patient-mediated is an exchange mechanism in which patients can access data and monitor sharing. Data were collected from 1,624 subjects using an online survey to examine the benefits, risks, and concerns associated with the four exchange mechanisms from patients' perspectives. RESULTS Findings indicate that several concerns and risks such as privacy concerns, security risks, trust issues, and psychological risks are raised. Besides, multiple benefits such as access to complete information, communication improvement, timely and convenient information sharing, cost-saving, and medical error reduction are highlighted by respondents. Through consideration of all risks and benefits associated with the four exchange mechanisms, the direct HIE mechanism was selected by respondents as the most preferred mechanism of information exchange among providers. More than half of the respondents (56.18%) stated that overall they favored direct exchange over the other mechanisms. 42.70% of respondents expected to be more likely to share their PHI with health care providers who implemented and utilized a direct exchange mechanism. 43.26% of respondents believed that they would support health care providers to leverage a direct HIE mechanism for sharing their PHI with other providers. The results exhibit that individuals expect greater benefits and fewer adverse effects from direct HIE among health care providers. Overall, the general public sentiment is more in favor of direct data transfer. Our results highlight that greater public trust in exchange mechanisms is required, and information privacy and security risks must be addressed before the widespread implementation of such mechanisms. CONCLUSION This exploratory study's findings could be interesting for health care providers and HIE policymakers to analyze how consumers perceive the current exchange mechanisms, what concerns should be addressed, and how the exchange mechanisms could be modified to meet consumers' needs.
Collapse
|
4
|
Esmaeilzadeh P, Mirzaei T, Dharanikota S. The impact of data entry structures on perceptions of individuals with chronic mental disorders and physical diseases towards health information sharing. Int J Med Inform 2020; 141:104157. [DOI: 10.1016/j.ijmedinf.2020.104157] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 12/31/2022]
|
5
|
Feldman SS, Bhavsar GP, Schooley BL. Consumer perceptions of health IT utilization and benefits. JAMIA Open 2020; 2:99-106. [PMID: 31984349 PMCID: PMC6951931 DOI: 10.1093/jamiaopen/ooy049] [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: 04/08/2018] [Revised: 05/25/2018] [Accepted: 11/06/2018] [Indexed: 12/02/2022] Open
Abstract
Objectives The objective of this article is to examine consumer perceptions of health information technology (health IT) utilization and benefits through an integrated conceptual framework. Materials and Methods This article employs an integrated conceptual framework to examine consumer perceptions of health IT. A consumer survey yielded 1125 completed responses. A factor-based scale was developed for each sub-construct. Bivariate analysis using χ2 tests was performed to determine differences in the percentage of respondents who agreed with each sub-construct based on whether their physician used an electronic health record (EHR) system. Multivariable logistic regression that controlled for demographic characteristics of respondents was performed to determine adjusted odds of agreeing with selected opinions of health information exchange (HIE). Results Results indicate that respondents whose physicians used an EHR system were significantly more likely to agree that there was a perceived benefit with HIE and to care provided; that the patient should have control over the record; that they trust the physician and security of the medical information; that they understand the need for HIE, and that HIE must be easy to use. Discussion The results suggest that consumers who have experienced the use of one technology in the healthcare setting can recognize the potential benefit of another technology. Race/ethnicity, gender, and education played some role in respondents’ views of EHRs and HIE, more specifically, non-Hispanic African American participants indicated lower levels of trust in HIE when compared with non-Hispanic Whites. Conclusion This cross-sectional survey indicated that physician use of EHRs significantly increases the odds of consumers’ seeing perceived benefits of HIE and understanding the need for HIE.
Collapse
Affiliation(s)
- Sue S Feldman
- Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Grishma P Bhavsar
- Department of Health Sciences, California State University, Northridge, Northridge, California, USA
| | - Benjamin L Schooley
- Department of Integrated Information Technology, University of South Carolina, Columbia, M. Bert Storey Innovation Center, Columbia, South Carolina, USA
| |
Collapse
|
6
|
Raymond L, Paré G, Maillet É. Enabling Laboratory Medicine in Primary Care Through IT Systems Use. DATA BASE FOR ADVANCES IN INFORMATION SYSTEMS 2020. [DOI: 10.1145/3380799.3380806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Important problems remain regarding the efficiency and quality of laboratory testing in primary care. In view of this, a significant function of electronic medical record (EMR) systems is to enable the practice of laboratory medicine by primary care physicians. The present study aims to deepen our understanding of the nature and extent of physicians' use of EMR and other laboratory information exchange systems for patient management and care within the laboratory testing process. We conducted a survey of 684 Canadian family physicians. Results indicate that physicians use 84 percent of the laboratory functionalities available in their EMR system. The two most important impacts are the ability to gain time in the post-analytical phase and to take faster action in this same phase as they follow-up on their patients' test results. Physicians who perceive to benefit most from their EMR use are those who make the most extensive use of their system. Extended use of an EMR system allows primary care physicians to better ascertain and monitor the health status of their patients, verify their diagnosis assumptions, and, if their system includes a clinical decision support module, apply evidence-based practices in laboratory medicine.
Collapse
Affiliation(s)
- Louis Raymond
- Université du Québec à Trois-Rivières, Trois-Rivières, PQ, Canada
| | - Guy Paré
- HEC Montréal, Montréal, PQ, Canada
| | | |
Collapse
|
7
|
Shanbehzadeh M, Ahmadi M. Identification of the necessary data elements to report AIDS: a systematic review. Electron Physician 2017; 9:5920-5931. [PMID: 29560143 PMCID: PMC5843417 DOI: 10.19082/5920] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 07/23/2017] [Indexed: 11/21/2022] Open
Abstract
Background The main focus of the surveillance system of AIDS in Iran is on direct clinical care for HIV, and other supportive facilities and secondary programmes have been somewhat neglected. Creating templates for reporting AIDS in Iran that can fulfil the needs of all information stakeholders, is a necessity for the Public Health Information Exchange (PHIE) system. Objective The aim of this study was to develop a comprehensive reporting template of the PHIE system for HIV/AIDS in Iran. Methods This study was performed in 2017. Through a systematic review of the Web of Science, Science Direct, Scopus, PubMed databases and Google Scholar search engine from 2000 to 2016, the necessary data elements are identified by the main keywords of the “Minimum Data Set” and HIV / AIDS collection. Results As many as 28 studies were enrolled in the research. The MDS was designed for the following categories: 1) administrative, managerial, and policy-makers (with 10 data classes and 90 data elements), 2) Clinical and medical (six data classes and 83 data elements), and 3) support services, counselling and subsidiary (three data classes and 32 data elements). Conclusion Iran stands in a fortunate position in terms of clinical and care programmes for AIDS treatment. A fundamental challenge is the insufficient attention to support and consulting programmes as well as the lack of information for accurate and efficient policy and decision-making. A reporting format has been designed to meet the needs of all information requirements of beneficiaries related to HIV/AIDS care and management.
Collapse
Affiliation(s)
- Mostafa Shanbehzadeh
- Ph.D. Student of Health Information Management, Department of Health Information Management, School of Health Management and Information Science, Iran University of Medical Science, Tehran, Iran
| | - Maryam Ahmadi
- Ph.D. of Health Information Management, Professor, Department of Health Information Management, School of Health Management and Information Science, Iran University of Medical Science, Tehran, Iran
| |
Collapse
|
8
|
Moseholm E, Fetters MD. Conceptual models to guide integration during analysis in convergent mixed methods studies. METHODOLOGICAL INNOVATIONS 2017. [DOI: 10.1177/2059799117703118] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Methodologists have offered general strategies for integration in mixed-methods studies through merging of quantitative and qualitative data. While these strategies provide researchers in the field general guidance on how to integrate data during mixed-methods analysis, a methodological typology detailing specific analytic frameworks has been lacking. The purpose of this article is to introduce a typology of analytical approaches for mixed-methods data integration in mixed-methods convergent studies. We distinguish three dimensions of data merging analytics: (1) the relational dimension, (2) the methodological dimension, and (3) the directional dimension. Five different frameworks for data merging relative to the methodological and directional dimension in convergent mixed-methods studies are described: (1) the explanatory unidirectional approach, (2) the exploratory unidirectional approach, (3) the simultaneous bidirectional approach, (4) the explanatory bidirectional approach, and (5) the exploratory bidirectional approach. Examples from empirical studies are used to illustrate each type. Researchers can use this typology to inform and articulate their analytical approach during the design, implementation, and reporting phases to convey clearly how an integrated approach to data merging occurred.
Collapse
Affiliation(s)
- Ellen Moseholm
- Department of Pulmonary and Infectious Diseases, University Hospital of Copenhagen, Hillerød, Denmark
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
9
|
Raymond L, Paré G, Maillet É. IT-based clinical knowledge management in primary health care: A conceptual framework. KNOWLEDGE AND PROCESS MANAGEMENT 2017. [DOI: 10.1002/kpm.1545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Louis Raymond
- Institut de recherche sur les PME; Université du Québec à Trois-Rivières; Trois-Rivières Québec Canada
| | - Guy Paré
- Institut de recherche sur les PME; Université du Québec à Trois-Rivières; Trois-Rivières Québec Canada
| | - Éric Maillet
- Institut de recherche sur les PME; Université du Québec à Trois-Rivières; Trois-Rivières Québec Canada
| |
Collapse
|
10
|
Lambooij MS, Drewes HW, Koster F. Use of electronic medical records and quality of patient data: different reaction patterns of doctors and nurses to the hospital organization. BMC Med Inform Decis Mak 2017; 17:17. [PMID: 28187729 PMCID: PMC5303309 DOI: 10.1186/s12911-017-0412-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 02/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As the implementation of Electronic Medical Records (EMRs) in hospitals may be challenged by different responses of different user groups, this paper examines the differences between doctors and nurses in their response to the implementation and use of EMRs in their hospital and how this affects the perceived quality of the data in EMRs. METHODS Questionnaire data of 402 doctors and 512 nurses who had experience with the implementation and the use of EMRs in hospitals was analysed with Multi group Structural equation modelling (SEM). The models included measures of organisational factors, results of the implementation (ease of use and alignment of EMR with daily routine), perceived added value, timeliness of use and perceived quality of patient data. RESULTS Doctors and nurses differ in their response to the organisational factors (support of IT, HR and administrative departments) considering the success of the implementation. Nurses respond to culture while doctors do not. Doctors and nurses agree that an EMR that is easier to work with and better aligned with their work has more added value, but for the doctors this is more pronounced. The doctors and nurses perceive that the quality of the patient data is better when EMRs are easier to use and better aligned with their daily routine. CONCLUSIONS The result of the implementation, in terms of ease of use and alignment with work, seems to affect the perceived quality of patient data more strongly than timeliness of entering patient data. Doctors and nurses value bottom-up communication and support of the IT department for the result of the implementation, and nurses respond to an open and innovative organisational culture.
Collapse
Affiliation(s)
- Mattijs S Lambooij
- Department Quality of care and health Economics, National Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA, Bilthoven, The Netherlands.
| | - Hanneke W Drewes
- Department Quality of Care and Health Economics, National Institute for Public Health and the Environment (RIVM), Center for Nutrition, Prevention and Health Services, PO Box 1, 3720 BA, Bilthoven, The Netherlands
| | - Ferry Koster
- Department of Sociology, Erasmus University Rotterdam, Rotterdam and TIAS School for Business and Society, Tilburg, The Netherlands
| |
Collapse
|
11
|
Eden KB, Totten AM, Kassakian SZ, Gorman PN, McDonagh MS, Devine B, Pappas M, Daeges M, Woods S, Hersh WR. Barriers and facilitators to exchanging health information: a systematic review. Int J Med Inform 2016; 88:44-51. [PMID: 26878761 DOI: 10.1016/j.ijmedinf.2016.01.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 01/12/2016] [Accepted: 01/12/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We conducted a systematic review of studies assessing facilitators and barriers to use of health information exchange (HIE). METHODS We searched MEDLINE, PsycINFO, CINAHL, and the Cochrane Library databases between January 1990 and February 2015 using terms related to HIE. English-language studies that identified barriers and facilitators of actual HIE were included. Data on study design, risk of bias, setting, geographic location, characteristics of the HIE, perceived barriers and facilitators to use were extracted and confirmed. RESULTS Ten cross-sectional, seven multiple-site case studies, and two before-after studies that included data from several sources (surveys, interviews, focus groups, and observations of users) evaluated perceived barriers and facilitators to HIE use. The most commonly cited barriers to HIE use were incomplete information, inefficient workflow, and reports that the exchanged information that did not meet the needs of users. The review identified several facilitators to use. DISCUSSION Incomplete patient information was consistently mentioned in the studies conducted in the US but not mentioned in the few studies conducted outside of the US that take a collective approach toward healthcare. Individual patients and practices in the US may exercise the right to participate (or not) in HIE which effects the completeness of patient information available to be exchanged. Workflow structure and user roles are key but understudied. CONCLUSIONS We identified several facilitators in the studies that showed promise in promoting electronic health data exchange: obtaining more complete patient information; thoughtful workflow that folds in HIE; and inclusion of users early in implementation.
Collapse
Affiliation(s)
- Karen B Eden
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
| | - Annette M Totten
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Steven Z Kassakian
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Paul N Gorman
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Marian S McDonagh
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Beth Devine
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; University of Washington, Pharmaceutical Outcomes Research and Policy Program, Box 357630, Seattle, WA 98195-7630, USA
| | - Miranda Pappas
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Monica Daeges
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| | - Susan Woods
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Veterans Affairs Maine Healthcare System, 1 VA Center, Augusta, ME 04330, USA
| | - William R Hersh
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA
| |
Collapse
|
12
|
Raymond L, Paré G, Ortiz de Guinea A, Poba-Nzaou P, Trudel MC, Marsan J, Micheneau T. Improving performance in medical practices through the extended use of electronic medical record systems: a survey of Canadian family physicians. BMC Med Inform Decis Mak 2015; 15:27. [PMID: 25888991 PMCID: PMC4397686 DOI: 10.1186/s12911-015-0152-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 03/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Numerous calls have been made for greater assimilation of information technology in healthcare organizations in general, and in primary care settings in particular. Considering the levels of IT investment and adoption in primary care medical practices, a deeper understanding is needed of the factors leading to greater performance outcomes from EMR systems in primary care. To address this issue, we developed and tested a research model centered on the concept of Extended EMR Use. METHODS An online survey was conducted of 331 family physicians in Canadian private medical practices to empirically test seven research hypotheses using a component-based structural equation modeling approach. RESULTS Five hypotheses were partially or fully supported by our data. Family physicians in our sample used 67% of the clinical and 41% of the communicational functionalities available in their EMR systems, compared to 90% of the administrative features. As expected, extended use was associated with significant improvements in perceived performance benefits. Interestingly, the benefits derived from system use were mainly tied to the clinical support provided by an EMR system. The extent to which physicians were using their EMR systems was influenced by two system design characteristics: functional coverage and ease of use. The more functionalities that are available in an EMR system and the easier they are to use, the greater the potential for exploration, assimilation and appropriation by family physicians. CONCLUSIONS Our study has contributed to the extant literature by proposing a new concept: Extended EMR Use. In terms of its practical implications, our study reveals that family physicians must use as many of the capabilities supported by their EMR system as possible, especially those which support clinical tasks, if they are to maximize its performance benefits. To ensure extended use of their software, vendors must develop EMR systems that satisfy two important design characteristics: functional coverage and system ease of use.
Collapse
Affiliation(s)
- Louis Raymond
- Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Guy Paré
- Chair in Information Technology in Health Care, HEC Montréal, 3000, Chemin de la Côte-Sainte-Catherine, Montréal, Québec, H3T 2A7, Canada.
| | - Ana Ortiz de Guinea
- Chair in Information Technology in Health Care, HEC Montréal, 3000, Chemin de la Côte-Sainte-Catherine, Montréal, Québec, H3T 2A7, Canada
| | | | - Marie-Claude Trudel
- Chair in Information Technology in Health Care, HEC Montréal, 3000, Chemin de la Côte-Sainte-Catherine, Montréal, Québec, H3T 2A7, Canada
| | | | - Thomas Micheneau
- Chair in Information Technology in Health Care, HEC Montréal, 3000, Chemin de la Côte-Sainte-Catherine, Montréal, Québec, H3T 2A7, Canada
| |
Collapse
|
13
|
Hsieh PJ. Physicians’ acceptance of electronic medical records exchange: An extension of the decomposed TPB model with institutional trust and perceived risk. Int J Med Inform 2015; 84:1-14. [DOI: 10.1016/j.ijmedinf.2014.08.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 08/22/2014] [Accepted: 08/23/2014] [Indexed: 10/24/2022]
|
14
|
Kruse CS, Regier V, Rheinboldt KT. Barriers over time to full implementation of health information exchange in the United States. JMIR Med Inform 2014; 2:e26. [PMID: 25600635 PMCID: PMC4288063 DOI: 10.2196/medinform.3625] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 08/15/2014] [Accepted: 09/01/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although health information exchanges (HIE) have existed since their introduction by President Bush in his 2004 State of the Union Address, and despite monetary incentives earmarked in 2009 by the health information technology for economic and clinical health (HITECH) Act, adoption of HIE has been sparse in the United States. Research has been conducted to explore the concept of HIE and its benefit to patients, but viable business plans for their existence are rare, and so far, no research has been conducted on the dynamic nature of barriers over time. OBJECTIVE The aim of this study is to map the barriers mentioned in the literature to illustrate the effect, if any, of barriers discussed with respect to the HITECH Act from 2009 to the early months of 2014. METHODS We conducted a systematic literature review from CINAHL, PubMed, and Google Scholar. The search criteria primarily focused on studies. Each article was read by at least two of the authors, and a final set was established for evaluation (n=28). RESULTS The 28 articles identified 16 barriers. Cost and efficiency/workflow were identified 15% and 13% of all instances of barriers mentioned in literature, respectively. The years 2010 and 2011 were the most plentiful years when barriers were discussed, with 75% and 69% of all barriers listed, respectively. CONCLUSIONS The frequency of barriers mentioned in literature demonstrates the mindfulness of users, developers, and both local and national government. The broad conclusion is that public policy masks the effects of some barriers, while revealing others. However, a deleterious effect can be inferred when the public funds are exhausted. Public policy will need to lever incentives to overcome many of the barriers such as cost and impediments to competition. Process improvement managers need to optimize the efficiency of current practices at the point of care. Developers will need to work with users to ensure tools that use HIE resources work into existing workflows.
Collapse
Affiliation(s)
- Clemens Scott Kruse
- School of Health Administration, College of Allied Health Professions, Texas State University, San Marcos, TX, United States.
| | | | | |
Collapse
|
15
|
Shade SB, Steward WT, Koester KA, Chakravarty D, Myers JJ. Health information technology interventions enhance care completion, engagement in HIV care and treatment, and viral suppression among HIV-infected patients in publicly funded settings. J Am Med Inform Assoc 2014; 22:e104-11. [PMID: 25030033 DOI: 10.1136/amiajnl-2013-002623] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 06/30/2014] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The National HIV/AIDS Strategy (NHAS) emphasizes the use of technology to facilitate coordination of comprehensive care for people with HIV. We examined the effect of six health information technology (HIT) interventions in a Ryan White-funded Special Projects of National Significance (SPNS) on care completion services, engagement in HIV care, and viral suppression. METHODS Interventions included use of surveillance data to identify out-of-care individuals, extending access to electronic health records to support service providers, use of electronic laboratory ordering and prescribing, and development of a patient portal. Data from a sample of electronic patient records from each site were analyzed to assess changes in utilization of comprehensive care (prevention screening, support service utilization), engagement in primary HIV medical care (receipt of services and use of antiretroviral therapy), and viral suppression. We used weighted generalized estimating equations to estimate outcomes while accounting for the unequal contribution of data and differences in the distribution of patient characteristics across sites and over time. RESULTS We observed statistically significant changes in the desired direction in comprehensive care utilization and engagement in primary care outcomes targeted by each site. Five of six sites experienced statistically significant increases in viral suppression. DISCUSSION These results provide additional support for the use of HIT as a valuable tool for achieving the NHAS goal of providing comprehensive care for all people living with HIV. HIT has the potential to increase utilization of services, improve health outcomes for people with HIV, and reduce community viral load and subsequent transmission of HIV.
Collapse
Affiliation(s)
- Starley B Shade
- Center for AIDS Prevention Studies, University of California at San Francisco, San Francisco, California, USA
| | - Wayne T Steward
- Center for AIDS Prevention Studies, University of California at San Francisco, San Francisco, California, USA
| | - Kimberly A Koester
- Center for AIDS Prevention Studies, University of California at San Francisco, San Francisco, California, USA
| | - Deepalika Chakravarty
- Center for AIDS Prevention Studies, University of California at San Francisco, San Francisco, California, USA
| | - Janet J Myers
- Center for AIDS Prevention Studies, University of California at San Francisco, San Francisco, California, USA
| |
Collapse
|