DIRECT secure messaging as a common transport layer for reporting structured and unstructured lab results to outpatient providers

Adoption and use of various health information exchange methods for sending inside health information in US hospitals

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.

BeatPain Utah: study protocol for a pragmatic randomised trial examining telehealth strategies to provide non-pharmacologic pain care for persons with chronic low back pain receiving care in federally qualified health centers

INTRODUCTION

Although evidence-based guidelines recommend non-pharmacologic treatments as first-line care for chronic low back pain (LBP), uptake has been limited, particularly in rural, low-income and ethnically diverse communities. The BeatPain study will evaluate the implementation and compare the effectiveness of two strategies to provide non-pharmacologic treatment for chronic LBP. The study will use telehealth to overcome access barriers for persons receiving care in federally qualified health centres (FQHCs) in the state of Utah.

METHODS AND ANALYSIS

BeatPain Utah is a pragmatic randomised clinical trial with a hybrid type I design investigating different strategies to provide non-pharmacologic care for adults with chronic LBP seen in Utah FQHCs. The intervention strategies include a brief pain consult (BPC) and telehealth physical therapy (PT) component provided using either an adaptive or sequenced delivery strategy across two 12-week treatment phases. Interventions are provided via telehealth by centrally located physical therapists. The sequenced delivery strategy provides the BPC, followed by telehealth PT in the first 12 weeks for all patients. The adaptive strategy uses a stepped care approach and provides the BPC in the first 12 weeks and telehealth PT to patients who are non-responders to the BPC component. We will recruit 500 English-speaking or Spanish-speaking participants who will be individually randomised with 1:1 allocation. The primary outcome is the Pain, Enjoyment and General Activity measure of pain impact with secondary outcomes including the additional pain assessment domains specified by the National Institutes (NIH) of Health Helping to End Addiction Long Initiative and implementation measures. Analyses of primary and secondary measures of effectiveness will be performed under longitudinal mixed effect models across assessments at baseline, and at 12, 26 and 52 weeks follow-ups.

ETHICS AND DISSEMINATION

Ethics approval for the study was obtained from the University of Utah Institutional Review Board. On completion, study data will be made available in compliance with NIH data sharing policies.

TRIAL REGISTRATION NUMBER

NCT04923334.

A pathology order interface based on the transmission of texts obtained from pathology requisitions and just-in-time construction of HL7 messages

Background

A pathology order interface using Health Level 7 standards (HL7) generally has an HL7 client program that gathers information from the clinical electronic medical record system, packages the information in the form of HL7 message, and sends the message using secure communication protocols to an HL7 interface engine located on the pathology side. We describe an alternative approach that transmits the texts obtained from requisitions, with subsequent just-in-time construction of HL7 messages.

Materials and methods

The order interface is between a dermatology clinic EMR and pathology information system. A text acquisition and processing program runs in the background in desktop computers in dermatology clinic so that a copy of pathology requisition text is obtained each time when the clinic prints a pathology requisition. Discrete elements of the data are extracted from this text, prepended to the text and saved on a shared drive within the dermatology office intranet. This text file is then transferred to pathology intranet using secure File Transfer Protocol (sFTP). Once received, an HL7 message construction program extracts the discrete data elements to construct an HL7 message. The HL7 message is then forwarded to an HL7 interface engine and entered into the pathology information system as an order.

Results

Using an actual case as an example, the content and format of the information flowing through different steps of the interface are demonstrated.

Conclusions

The construction of such an interface does not involve the clinic EMR vendor, thus avoiding its associated cost and potential delay. This interface has advantages over our other order interfaces constructed using the conventional approach in that it does not require a change of order process and it avoids duplicate orders.

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.

Construction of an exchange interface for the transmission of laboratory results: a case of the National Tuberculosis Center

Introduction The transmission of test results by laboratories and their receipt by health facilities are common tasks in the processing of medical information. Managing the flow of information generated by these tasks remains a challenge for these centers. We describe a new system that will allow for electronic management of the transmission of results. Materials and methods The information system implemented is a client-server system consisting three main components: the server installed in the laboratory, the client distributed in the Anti-Tuberculosis Center and the communication channel represented by a Virtual Network. The exchange protocol is based on the HL7 standard that used messages of type ORU_R01. Results During the two months of implementation of this electronic result transmission system between the National Tuberculosis Reference Center in Abidjan and the Anti-Tuberculosis Center in Adzopé, which is about 110 kilometers away, twenty laboratory results were transmitted as soon as they left the laboratory, an improvement from the previous long turn-around-time of about 1 month. The minimalist interface and ease of use of the system have allowed it to be adopted by users. Discussion The use of the HL7 protocol for electronic notifications has proven its effectiveness in making transmissions of results instantaneous. Our system specifically addresses the problems related to efficient transmission of results; reduction of transmission time, information loss attributed to the use of paper, and transport costs incurred when transmitting results from remote sites. This system representing the 1rst version use a local codification that limits it to an interoperability with other environment that use a different code system. The use of a code system such as LOINC would allow full interoperability between different information systems.

Consensus Statement: Feature and Function Recommendations to Optimize Clinician Usability of Direct Interoperability to Enhance Patient Care

Background  Secure clinical messaging and document exchange utilizing the Direct Protocol (Direct interoperability) has been widely implemented in health information technology (HIT) applications including electronic health records (EHRs) and by health care providers and organizations in the United States. While Direct interoperability has allowed clinicians and institutions to satisfy regulatory requirements and has facilitated communication and electronic data exchange as patients transition across care environments, feature and function enhancements to HIT implementations of the Direct Protocol are required to optimize the use of this technology.

Objective  To describe and address this gap, we developed a prioritized list of recommended features and functions desired by clinicians to utilize Direct interoperability for improved quality, safety, and efficiency of patient care. This consensus statement is intended to inform policy makers and HIT vendors to encourage further development and implementation of system capabilities to improve clinical care.

Methods  An ad hoc group of interested clinicians came together under the auspices of DirectTrust to address challenges of usability and create a consensus recommendation. This group drafted a list of desired features and functions that was published online. Comments were solicited from interested parties including clinicians, EHR and other HIT vendors, and trade organizations. Resultant comments were collected, reviewed by the authors, and incorporated into the final recommendations.

Results  This consensus statement contains a list of 57 clinically desirable features and functions categorized and prioritized for support by policy makers, development by HIT vendors, and implementation and use by clinicians.

Conclusion  Fully featured, standardized implementation of Direct interoperability will allow clinicians to utilize Direct messaging more effectively as a component of HIT and EHR interoperability to improve care transitions and coordination.

Web Applications for Patient Communication

Communication between imaging professionals and patients can help achieve many goals, including improved patient understanding of imaging-related diagnostic and treatment options, better compliance with appropriate imaging screening procedures, and improved efficiency of service. The explosive growth of out-of-pocket consumer spending on health care has heightened health care shopping, thus making patient communication an important goal of any imaging practice or health care organization. Furthermore, the Merit-Based Incentive Payment System introduced by CMS will publicly disclose physicians' quality ratings, which are in part dependent on patient engagement. The authors summarize the rationale for web communication with patients, the range of content that should be considered, and the technology options. The aim is to help imaging providers develop organized patient communication strategic and implementation plans.