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Scheibner J, Sleigh J, Ienca M, Vayena E. Benefits, challenges, and contributors to success for national eHealth systems implementation: a scoping review. J Am Med Inform Assoc 2021; 28:2039-2049. [PMID: 34151990 DOI: 10.1093/jamia/ocab096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/27/2021] [Accepted: 05/21/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Our scoping review aims to assess what legal, ethical, and socio-technical factors contribute to or inhibit the success of national eHealth system implementations. In addition, our review seeks to describe the characteristics and benefits of eHealth systems. MATERIALS AND METHODS We conducted a scoping review of literature published in English between January 2000 and 2020 using a keyword search on 5 databases: PubMed, Scopus, Web of Science, IEEEXplore, and ProQuest. After removal of duplicates, abstract screening, and full-text filtering, 86 articles were included from 8276 search results. RESULTS We identified 17 stakeholder groups, 6 eHealth Systems areas, and 15 types of legal regimes and standards. In-depth textual analysis revealed challenges mainly in implementation, followed by ethico-legal and data-related aspects. Key factors influencing success include promoting trust of the system, ensuring wider acceptance among users, reconciling the system with legal requirements, and ensuring an adaptable technical platform. DISCUSSION Results revealed support for decentralized implementations because they carry less implementation and engagement challenges than centralized ones. Simultaneously, due to decentralized systems' interoperability issues, federated implementations (with a set of national standards) might be preferable. CONCLUSION This study identifies the primary socio-technical, legal, and ethical factors that challenge and contribute to the success of eHealth system implementations. This study also describes the complexities and characteristics of existing eHealth implementation programs, and suggests guidance for resolving the identified challenges.
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Affiliation(s)
- James Scheibner
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zürich, Zürich, Switzerland.,College of Business, Government and Law, Flinders University, Adelaide, Australia
| | - Joanna Sleigh
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zürich, Zürich, Switzerland
| | - Marcello Ienca
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zürich, Zürich, Switzerland
| | - Effy Vayena
- Department of Health Sciences and Technology, Health Ethics and Policy Laboratory, ETH Zürich, Zürich, Switzerland
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Messino PJ, Kharrazi H, Kim JM, Lehmann H. A method for measuring the effect of certified electronic health record technology on childhood immunization status scores among Medicaid managed care network providers. J Biomed Inform 2020; 110:103567. [PMID: 32927058 PMCID: PMC7486207 DOI: 10.1016/j.jbi.2020.103567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 08/05/2020] [Accepted: 09/07/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To provide a methodology for estimating the effect of U.S.-based Certified Electronic Health Records Technology (CEHRT) implemented by primary care physicians (PCPs) on a Healthcare Effectiveness Data and Information Set (HEDIS) measure for childhood immunization delivery. MATERIALS AND METHODS This study integrates multiple health care administrative data sources from 2010 through 2014, analyzed through an interrupted time series design and a hierarchical Bayesian model. We compared managed care physicians using CEHRT to propensity-score matched comparisons from network physicians who did not adopt CEHRT. Inclusion criteria for physicians using CEHRT included attesting to the Childhood Immunization Status clinical quality measure in addition to meeting "Meaningful Use" (MU) during calendar year 2013. We used a first-presence patient attribution approach to develop provider-specific immunization scores. RESULTS We evaluated 147 providers using CEHRT, with 147 propensity-score matched providers selected from a pool of 1253 PCPs practicing in Maryland. The estimate for change in odds of increasing immunization rates due to CEHRT was 1.2 (95% credible set, 0.88-1.73). DISCUSSION We created a method for estimating immunization quality scores using Bayesian modeling. Our approach required linking separate administrative data sets, constructing a propensity-score matched cohort, and using first-presence, claims-based childhood visit information for patient attribution. In the absence of integrated data sets and precise and accurate patient attribution, this is a reusable method for researchers and health system administrators to estimate the impact of health information technology on individual, provider-level, process-based, though outcomes-focused, quality measures. CONCLUSION This research has provided evidence for using Bayesian analysis of propensity-score matched provider populations to estimate the impact of CEHRT on outcomes-based quality measures such as childhood immunization delivery.
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Affiliation(s)
| | - Hadi Kharrazi
- Johns Hopkins School of Public Health, Center for Population Health IT, Baltimore, MD, USA; Johns Hopkins School of Medicine, Division of Health Sciences Informatics, Baltimore, MD, USA
| | - Julia M Kim
- Johns Hopkins School of Medicine, Department of Pediatrics, Baltimore, MD, USA
| | - Harold Lehmann
- Johns Hopkins School of Medicine, Division of Health Sciences Informatics, Baltimore, MD, USA
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Bery AK, Anzaldi LJ, Boyd CM, Leff B, Kharrazi H. Potential value of electronic health records in capturing data on geriatric frailty for population health. Arch Gerontol Geriatr 2020; 91:104224. [PMID: 32829083 DOI: 10.1016/j.archger.2020.104224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 07/19/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Despite the availability of many frailty measures to identify older adults at risk, frailty instruments are not routinely used for risk assessment in population health management. Here, we assessed the potential value of electronic health records (EHRs) and administrative claims in providing the necessary data for variables used across various frailty instruments. SETTING AND PARTICIPANTS The review focused on studies conducted worldwide. Participants included older people aged 50 and older. DESIGN We identified frailty instruments published between 2011 and 2018. Frailty variables used in each of the frailty instruments were extracted, grouped, and categorized across health determinants and various clinical factors. MEASURES The availability of the extracted frailty variables across various data sources (e.g., EHRs, administrative claims, and surveys) was evaluated by experts. RESULTS We identified 135 frailty instruments, which contained 593 unique variables. Clinical determinants of health were the best represented variables across frailty instruments (n = 516; 87 %), unlike social and health services factors (n = 33; ∼5% and n = 32; ∼5%). Most frailty instruments require at least one variable that is not routinely available in EHRs or claims (n = 113; ∼83 %). Only 22 frailty instruments have the potential to completely rely on EHR (structured or free-text data) and/or claims data, and possibly be operationalized on a population-level. CONCLUSIONS AND IMPLICATIONS Frailty instruments continue to be highly survey-based. More research is therefore needed to develop EHR-based frailty instruments for population health management. This will permit organizations and societies to stratify risk and better allocate resources among different older adult populations.
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Affiliation(s)
- Anand K Bery
- Division of Neurology, Department of Medicine, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada; Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, United States.
| | - Laura J Anzaldi
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, United States.
| | - Cynthia M Boyd
- Center for Transformative Geriatric Research, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, 200 Eastern Avenue, Baltimore, MD, 21224, United States.
| | - Bruce Leff
- Center for Transformative Geriatric Research, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, 200 Eastern Avenue, Baltimore, MD, 21224, United States.
| | - Hadi Kharrazi
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, United States; Division of Health Sciences and Informatics, Department of General Internal Medicine, Johns Hopkins University School of Medicine, 2024 East Monument St. S 1-200, Baltimore, MD, 21205, United States.
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Getting the message across: Characterizing a need to bridge public health messaging for tuberculosis across a rural/urban and CHW/traditional healer divide in Madagascar (A review). SCIENTIFIC AFRICAN 2020. [DOI: 10.1016/j.sciaf.2020.e00321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Ma X, Jung C, Chang HY, Richards TM, Kharrazi H. Assessing the Population-Level Correlation of Medication Regimen Complexity and Adherence Indices Using Electronic Health Records and Insurance Claims. J Manag Care Spec Pharm 2020; 26:860-871. [PMID: 32584680 PMCID: PMC10391244 DOI: 10.18553/jmcp.2020.26.7.860] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Nonadherence to medication regimens can lead to adverse health care outcomes and increasing costs. OBJECTIVES To (a) assess the level of medication complexity at an outpatient setting using population-level electronic health record (EHR) data and (b) evaluate its association with medication adherence measures derived from medication-dispensing claims. METHODS We linked EHR data with insurance claims of 70,054 patients who had an encounter with a U.S. midwestern health system between 2012 and 2013. We constructed 3 medication-derived indices: medication regimen complexity index (MRCI) using EHR data; medication possession ratio (MPR) using insurance pharmacy claims; and prescription fill rates (PFR; 7 and 30 days) using both data sources. We estimated the partial correlation between indices using Spearman's coefficient (SC) after adjusting for age and sex. RESULTS The mean age (SD) of 70,054 patients was 37.9 (18.0) years, with an average Charlson Comorbidity Index of 0.308 (0.778). The 2012 data showed mean (SD) MRCI, MPR, and 30-day PFR of 14.6 (17.8), 0.624 (0.310), and 81.0 (27.0), respectively. Patients with previous inpatient stays were likely to have high MRCI scores (36.3 [37.9], P < 0.001) and were less adherent to outpatient prescriptions (MPR = 50.3 [27.6%], P < 0.001; 30-day PFR = 75.7 [23.6%], P < 0.001). However, MRCI did not show a negative correlation with MPR (SC = -0.31, P < 0.001) or with 30-day PFR (SC = -0.17, P < 0.001) at significant levels. CONCLUSIONS Medication complexity and adherence indices can be calculated on a population level using linked EHR and claims data. Regimen complexity affects patient adherence to outpatient medication, and strength of correlations vary modestly across populations. Future studies should assess the added values of MRCI, MPR, and PFR to population health management efforts. DISCLOSURES No outside funding supported this study. The authors have nothing to disclose. The abstract of this work was presented at INFORMS Healthcare Conference, held on July 27-29, 2019, in Cambridge, MA.
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Affiliation(s)
- Xiaomeng Ma
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Changmi Jung
- Carey Business School, Johns Hopkins University, Baltimore, Maryland
| | - Hsien-Yen Chang
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Thomas M. Richards
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Hadi Kharrazi
- Center for Population Health IT, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, and Division of Health Sciences and Informatics, Johns Hopkins School of Medicine, Baltimore, Maryland
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Dixon BE, Zhang Z, Arno JN, Revere D, Joseph Gibson P, Grannis SJ. Improving Notifiable Disease Case Reporting Through Electronic Information Exchange-Facilitated Decision Support: A Controlled Before-and-After Trial. Public Health Rep 2020; 135:401-410. [PMID: 32250707 DOI: 10.1177/0033354920914318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Outbreak detection and disease control may be improved by simplified, semi-automated reporting of notifiable diseases to public health authorities. The objective of this study was to determine the effect of an electronic, prepopulated notifiable disease report form on case reporting rates by ambulatory care clinics to public health authorities. METHODS We conducted a 2-year (2012-2014) controlled before-and-after trial of a health information exchange (HIE) intervention in Indiana designed to prepopulate notifiable disease reporting forms to providers. We analyzed data collected from electronic prepopulated reports and "usual care" (paper, fax) reports submitted to a local health department for 7 conditions by using a difference-in-differences model. Primary outcomes were changes in reporting rates, completeness, and timeliness between intervention and control clinics. RESULTS Provider reporting rates for chlamydia and gonorrhea in intervention clinics increased significantly from 56.9% and 55.6%, respectively, during the baseline period (2012) to 66.4% and 58.3%, respectively, during the intervention period (2013-2014); they decreased from 28.8% and 27.5%, respectively, to 21.7% and 20.6%, respectively, in control clinics (P < .001). Completeness improved from baseline to intervention for 4 of 15 fields in reports from intervention clinics (P < .001), although mean completeness improved for 11 fields in both intervention and control clinics. Timeliness improved for both intervention and control clinics; however, reports from control clinics were timelier (mean, 7.9 days) than reports from intervention clinics (mean, 9.7 days). CONCLUSIONS Electronic, prepopulated case reporting forms integrated into providers' workflow, enabled by an HIE network, can be effective in increasing notifiable disease reporting rates and completeness of information. However, it was difficult to assess the effect of using the forms for diseases with low prevalence (eg, salmonellosis, histoplasmosis).
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Affiliation(s)
- Brian E Dixon
- 10668 Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA.,50826 Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA.,12250 Center for Health Information and Communication, Health Services Research & Development Service, Department of Veterans Affairs, Indianapolis, IN, USA
| | - Zuoyi Zhang
- 50826 Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
| | - Janet N Arno
- 12250 School of Medicine, Indiana University, Indianapolis, IN, USA.,4059 Marion County Public Health Department, Indianapolis, IN, USA
| | - Debra Revere
- 7284 School of Public Health, University of Washington, Seattle, WA, USA
| | - P Joseph Gibson
- 4059 Marion County Public Health Department, Indianapolis, IN, USA
| | - Shaun J Grannis
- 50826 Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA.,12250 School of Medicine, Indiana University, Indianapolis, IN, USA
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van Schaik P, Peng Y, Ojelabi A, Ling J. Explainable statistical learning in public health for policy development: the case of real-world suicide data. BMC Med Res Methodol 2019; 19:152. [PMID: 31315579 PMCID: PMC6636096 DOI: 10.1186/s12874-019-0796-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 07/04/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In recent years, the availability of publicly available data related to public health has significantly increased. These data have substantial potential to develop public health policy; however, this requires meaningful and insightful analysis. Our aim is to demonstrate how data analysis techniques can be used to address the issues of data reduction, prediction and explanation using online available public health data, in order to provide a sound basis for informing public health policy. METHODS Observational suicide prevention data were analysed from an existing online United Kingdom national public health database. Multi-collinearity analysis and principal-component analysis were used to reduce correlated data, followed by regression analyses for prediction and explanation of suicide. RESULTS Multi-collinearity analysis was effective in reducing the indicator set of predictors by 30% and principal component analysis further reduced the set by 86%. Regression for prediction identified four significant indicator predictors of suicide behaviour (emergency hospital admissions for intentional self-harm, children leaving care, statutory homelessness and self-reported well-being/low happiness) and two main component predictors (relatedness dysfunction, and behavioural problems and mental illness). Regression for explanation identified significant moderation of a well-being predictor (low happiness) of suicide behaviour by a social factor (living alone), thereby supporting existing theory and providing insight beyond the results of regression for prediction. Two independent predictors capturing relatedness needs in social care service delivery were also identified. CONCLUSIONS We demonstrate the effectiveness of regression techniques in the analysis of online public health data. Regression analysis for prediction and explanation can both be appropriate for public health data analysis for a better understanding of public health outcomes. It is therefore essential to clarify the aim of the analysis (prediction accuracy or theory development) as a basis for choosing the most appropriate model. We apply these techniques to the analysis of suicide data; however, we argue that the analysis presented in this study should be applied to datasets across public health in order to improve the quality of health policy recommendations.
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Affiliation(s)
- Paul van Schaik
- School of Social Sciences, Humanities and Law, Teesside University, Borough Road, Middlesbrough, TS1 3BA UK
| | - Yonghong Peng
- The University of Sunderland, St Peters Campus, St Peters Way, Sunderland, SR6 0DD UK
| | - Adedokun Ojelabi
- The University of Sunderland, St Peters Campus, St Peters Way, Sunderland, SR6 0DD UK
| | - Jonathan Ling
- The University of Sunderland, St Peters Campus, St Peters Way, Sunderland, SR6 0DD UK
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Comparing the Trends of Electronic Health Record Adoption Among Hospitals of the United States and Japan. J Med Syst 2019; 43:224. [PMID: 31187293 DOI: 10.1007/s10916-019-1361-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 05/30/2019] [Indexed: 10/26/2022]
Abstract
The goal of this study is to examine the trends of Electronic Health Record (EHR) adoption among hospitals in Japan compared to those in the United States. Japan's nationwide survey of hospitals was utilized to extract the EHR adoption rates among Japanese hospitals. Comparable datasets from the Healthcare Information and Management System Society (HIMSS) and the American Hospital Association (AHA) were utilized to extract EHR adoption rates among U.S. hospitals. The trends of EHR adoption were stratified and analyzed by hospital size and hospital ownership status. As of 2014, the U.S. hospitals had a wider adoption of 'basic with clinical notes' EHRs compared to Japan (45.6% vs. 27.3%), but large hospitals (400+ beds) in Japan have shown a similar adoption rate of EHR systems than those of U.S. (65.6% vs. 68.5%). Governmental hospitals tend to be more advanced in EHR adoption than non-profit hospitals in Japan (53.0% vs. 21.5%). Non-profit hospitals show the highest adoption rate of 'basic' EHR systems in the U.S. as of 2014 (63.3%). Using the 'certified' definition of EHRs, the EHR adoption rate was close to 96% among U.S. hospitals as of 2016; however, updated EHR adoption data from Japanese hospitals has yet to be collected and published. U.S. and Japan have considerably increased EHR adoption among hospitals; however, this analysis indicates different trends of EHR adoption among hospitals by size and ownership status in both countries. Learnings from government programs supporting EHR adoption in the U.S. and Japan can be helpful in planning useful strategies for future hospital-oriented health IT policies in other developed nations.
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Chen T, Dredze M, Weiner JP, Hernandez L, Kimura J, Kharrazi H. Extraction of Geriatric Syndromes From Electronic Health Record Clinical Notes: Assessment of Statistical Natural Language Processing Methods. JMIR Med Inform 2019; 7:e13039. [PMID: 30862607 PMCID: PMC6454337 DOI: 10.2196/13039] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/18/2019] [Accepted: 03/07/2019] [Indexed: 01/08/2023] Open
Abstract
Background Geriatric syndromes in older adults are associated with adverse outcomes. However, despite being reported in clinical notes, these syndromes are often poorly captured by diagnostic codes in the structured fields of electronic health records (EHRs) or administrative records. Objective We aim to automatically determine if a patient has any geriatric syndromes by mining the free text of associated EHR clinical notes. We assessed which statistical natural language processing (NLP) techniques are most effective. Methods We applied conditional random fields (CRFs), a widely used machine learning algorithm, to identify each of 10 geriatric syndrome constructs in a clinical note. We assessed three sets of features and attributes for CRF operations: a base set, enhanced token, and contextual features. We trained the CRF on 3901 manually annotated notes from 85 patients, tuned the CRF on a validation set of 50 patients, and evaluated it on 50 held-out test patients. These notes were from a group of US Medicare patients over 65 years of age enrolled in a Medicare Advantage Health Maintenance Organization and cared for by a large group practice in Massachusetts. Results A final feature set was formed through comprehensive feature ablation experiments. The final CRF model performed well at patient-level determination (macroaverage F1=0.834, microaverage F1=0.851); however, performance varied by construct. For example, at phrase-partial evaluation, the CRF model worked well on constructs such as absence of fecal control (F1=0.857) and vision impairment (F1=0.798) but poorly on malnutrition (F1=0.155), weight loss (F1=0.394), and severe urinary control issues (F1=0.532). Errors were primarily due to previously unobserved words (ie, out-of-vocabulary) and a lack of context. Conclusions This study shows that statistical NLP can be used to identify geriatric syndromes from EHR-extracted clinical notes. This creates new opportunities to identify patients with geriatric syndromes and study their health outcomes.
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Affiliation(s)
- Tao Chen
- Center for Language and Speech Processing, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Mark Dredze
- Department of Computer Science, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, United States
| | - Jonathan P Weiner
- Center for Population Health IT, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | | | - Joe Kimura
- Academic Institute, Atrius Health, Boston, MA, United States
| | - Hadi Kharrazi
- Center for Population Health IT, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.,Division of Health Sciences Informatics, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
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Bhattarai AK, Zarrin A, Lee J. Applications of information and communications technologies to public health: A scoping review using the MeSH term: "public health informatics". Online J Public Health Inform 2017; 9:e192. [PMID: 29026457 PMCID: PMC5630279 DOI: 10.5210/ojphi.v9i2.7985] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To investigate the public health domains, key informatics concepts, and information and communications technologies (ICTs) applied in articles that are tagged with the MeSH term "public health informatics" and primarily focus on applying ICTs to public health. MATERIALS AND METHODS The MeSH term "public health informatics" was searched on MEDLINE-PubMed. The results of the search were then screened in two steps in order to only include articles about applying ICTs to public health problems. First, articles were screened based on their titles and abstracts. Second, a full-text review was conducted to ensure the relevance of the included articles. All articles were charted based on public health domain, information technology, article type, and informatics concept. RESULTS 515 articles were included. Communicable disease monitoring (N=235), public health policy and research (N=201), and public health awareness (N=85) constituted the majority of the articles. Inconsistent results were found regarding the validity of syndromic surveillance and the effectiveness of PHI integration within the healthcare systems. DISCUSSION PHI articles with an ICT focus cover a wide range of themes. Collectively, the included articles emphasized the need for further research in interoperability, data quality, appropriate data sources, accessible health information, and communication. The limitations of the study include:1) only one database was searched; 2) by using MeSH tags as a selection criterion, PHI articles without the "public health informatics" MeSH term were excluded. CONCLUSION Due to the multi-disciplinary nature of PHI, MeSH identifiers were not assigned consistently. Current MeSH-tagged articles indicate that a comprehensive approach is required to integrate PHI into the healthcare system.
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Affiliation(s)
- Arjun Kumar Bhattarai
- Health Data Science Lab, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Aein Zarrin
- Health Data Science Lab, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Joon Lee
- Health Data Science Lab, School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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Hussein R. The Promise of Enterprise Architecture for Global Health Informatics. J Med Syst 2017; 41:108. [DOI: 10.1007/s10916-017-0756-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 05/25/2017] [Indexed: 10/19/2022]
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Dixon BE, Zhang Z, Lai PTS, Kirbiyik U, Williams J, Hills R, Revere D, Gibson PJ, Grannis SJ. Completeness and timeliness of notifiable disease reporting: a comparison of laboratory and provider reports submitted to a large county health department. BMC Med Inform Decis Mak 2017. [PMID: 28645285 PMCID: PMC5481902 DOI: 10.1186/s12911-017-0491-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background Most public health agencies expect reporting of diseases to be initiated by hospital, laboratory or clinic staff even though so-called passive approaches are known to be burdensome for reporters and produce incomplete as well as delayed reports, which can hinder assessment of disease and delay recognition of outbreaks. In this study, we analyze patterns of reporting as well as data completeness and timeliness for traditional, passive reporting of notifiable disease by two distinct sources of information: hospital and clinic staff versus clinical laboratory staff. Reports were submitted via fax machine as well as electronic health information exchange interfaces. Methods Data were extracted from all submitted notifiable disease reports for seven representative diseases. Reporting rates are the proportion of known cases having a corresponding case report from a provider, a faxed laboratory report or an electronic laboratory report. Reporting rates were stratified by disease and compared using McNemar’s test. For key data fields on the reports, completeness was calculated as the proportion of non-blank fields. Timeliness was measured as the difference between date of laboratory confirmed diagnosis and the date the report was received by the health department. Differences in completeness and timeliness by data source were evaluated using a generalized linear model with Pearson’s goodness of fit statistic. Results We assessed 13,269 reports representing 9034 unique cases. Reporting rates varied by disease with overall rates of 19.1% for providers and 84.4% for laboratories (p < 0.001). All but three of 15 data fields in provider reports were more often complete than those fields within laboratory reports (p <0.001). Laboratory reports, whether faxed or electronically sent, were received, on average, 2.2 days after diagnosis versus a week for provider reports (p <0.001). Conclusions Despite growth in the use of electronic methods to enhance notifiable disease reporting, there still exists much room for improvement.
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Affiliation(s)
- Brian E Dixon
- Indiana University, Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, RG 5000, Indianapolis, IN, 46202, USA. .,Regenstrief Institute, Center for Biomedical Informatics, 1101 W 10th St, Indianapolis, IN, USA. .,Department of Veterans Affairs, Health Services Research & Development Service, Center for Health Information and Communication, 1481 W. 10th St, 11H, Indianapolis, IN, USA. .,Department of BioHealth Informatics, School of Informatics and Computing, Indiana University, 535 W Michigan St, Indianapolis, IN, 46202, USA.
| | - Zuoyi Zhang
- Regenstrief Institute, Center for Biomedical Informatics, 1101 W 10th St, Indianapolis, IN, USA
| | - Patrick T S Lai
- Regenstrief Institute, Center for Biomedical Informatics, 1101 W 10th St, Indianapolis, IN, USA.,Department of BioHealth Informatics, School of Informatics and Computing, Indiana University, 535 W Michigan St, Indianapolis, IN, 46202, USA
| | - Uzay Kirbiyik
- Indiana University, Richard M. Fairbanks School of Public Health, 1050 Wishard Blvd, RG 5000, Indianapolis, IN, 46202, USA.,Regenstrief Institute, Center for Biomedical Informatics, 1101 W 10th St, Indianapolis, IN, USA
| | - Jennifer Williams
- Regenstrief Institute, Center for Biomedical Informatics, 1101 W 10th St, Indianapolis, IN, USA
| | - Rebecca Hills
- University of Washington, School of Public Health, 1107 NE 45th St, Suite 400, Box 354809, Seattle, WA, 98195-4809, USA
| | - Debra Revere
- University of Washington, School of Public Health, 1107 NE 45th St, Suite 400, Box 354809, Seattle, WA, 98195-4809, USA
| | - P Joseph Gibson
- Marion County Public Health Department, 3838 N Rural St, Indianapolis, IN, 46205, USA
| | - Shaun J Grannis
- Regenstrief Institute, Center for Biomedical Informatics, 1101 W 10th St, Indianapolis, IN, USA.,Indiana University, School of Medicine, 3410 10th St, #6200, Indianapolis, IN, USA
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Lovelace K, Shah GH. Using Information Systems to Improve a Mid-Sized Local Health Department's Effectiveness in a Time of Rapid Change. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 22 Suppl 6, Public Health Informatics:S89-S94. [PMID: 27684626 PMCID: PMC5049941 DOI: 10.1097/phh.0000000000000455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Informatics capacity building is resource and personnel intensive. Many local health departments (LHDs) face tradeoffs between using their resources to carry out existing mandates and using resources to build their capacity, for example, through informatics, to deliver essential services in a more effective and efficient manner. OBJECTIVE The purpose of this case study is to describe how a mid-sized LHD built and used information systems to support its strategic objectives, clinical services, and surveillance. METHODS The mid-sized LHD described here was chosen for its "best practices" in informatics capacity building and use by NACCHO's study advisory committee. To conduct the case study, authors reviewed departmental documents and conducted semistructured interviews with key informants in the agency. Interviews were recorded, transcribed, thematically coded, and analyzed. RESULTS AND CONCLUSIONS Findings from the case study suggest that including capacity building in informatics as a strategic priority is one of the most effective ways to ensure that informatics are assessed, updated, and included in resource decisions. Leadership at all levels is critical to the successful implementation of informatics as is proactive partnership with community partners who have overlapping goals. The efficiency and effectiveness of LHDs rely on informatics capacity, especially when resources are challenged.
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Affiliation(s)
- Kay Lovelace
- Department of Public Health Education, The University of North Carolina at Greensboro (Dr Lovelace); and Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro (Dr Shah)
| | - Gulzar H. Shah
- Department of Public Health Education, The University of North Carolina at Greensboro (Dr Lovelace); and Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro (Dr Shah)
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Shah GH, Vest JR, Lovelace K, McCullough JM. Local Health Departments' Partners and Challenges in Electronic Exchange of Health Information. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 22 Suppl 6, Public Health Informatics:S44-S50. [PMID: 27684617 PMCID: PMC5049940 DOI: 10.1097/phh.0000000000000442] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Unprecedented amounts of data are produced by the health care and other sectors, presenting opportunities for local health departments (LHDs) to access these data. LHDs will need to participate in health information exchange (HIE) with a number of partners in order to benefit from these data resources. LHDs' participation in HIEs with specific partners has not been studied. OBJECTIVES To describe the level of and challenges in LHD participation in HIE with other partners, and variation by LHD population size and governance type. DATA AND METHODS This research uses data from the 2015 Informatics Capacity and Needs Assessment Survey, with a target population of all LHDs in the United States. A representative sample of 650 LHDs was drawn using a stratified random sampling design. A total of 324 completed responses were received with a 50% response rate. Survey data were cleaned, and bivariate comparisons were conducted using χ and Somer's D. RESULTS Substantial variation existed in LHDs' participation in HIE by type of exchange partner. Although 71% participated in HIE with the state departments of health, only 12% with jail/correctional health, 14% with health or county-based purchasing plans, and 15% with home health agencies. Compared with large LHDs (jurisdiction populations of ≥500 000), smaller LHDs were more likely to participate in HIE with state departments of health, but less likely with other exchange partners. The challenges to HIE participation were technological, and organizational/interorganizational in nature and variation existed by LHDs' population size and governance structure with respect to state authority. CONCLUSIONS Local public health agencies more commonly participate in HIE with some partners, but may need to improve HIE with many others. National strategies targeting an increase in HIE of LHDs may use our findings to focus those initiatives.
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Affiliation(s)
- Gulzar H. Shah
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Dr Shah); Indiana University Richard M. Fairbanks School of Public Health at IUPUI, and Regenstrief Institute, Indianapolis, Indiana (Dr Vest); Department of Public Health Education, UNCG, Greensboro, North Carolina (Dr Lovelace); and School for the Science of Health Care Delivery, Arizona State University, Tempe, Arizona (Dr McCullough)
| | - Joshua R. Vest
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Dr Shah); Indiana University Richard M. Fairbanks School of Public Health at IUPUI, and Regenstrief Institute, Indianapolis, Indiana (Dr Vest); Department of Public Health Education, UNCG, Greensboro, North Carolina (Dr Lovelace); and School for the Science of Health Care Delivery, Arizona State University, Tempe, Arizona (Dr McCullough)
| | - Kay Lovelace
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Dr Shah); Indiana University Richard M. Fairbanks School of Public Health at IUPUI, and Regenstrief Institute, Indianapolis, Indiana (Dr Vest); Department of Public Health Education, UNCG, Greensboro, North Carolina (Dr Lovelace); and School for the Science of Health Care Delivery, Arizona State University, Tempe, Arizona (Dr McCullough)
| | - J. Mac McCullough
- Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Dr Shah); Indiana University Richard M. Fairbanks School of Public Health at IUPUI, and Regenstrief Institute, Indianapolis, Indiana (Dr Vest); Department of Public Health Education, UNCG, Greensboro, North Carolina (Dr Lovelace); and School for the Science of Health Care Delivery, Arizona State University, Tempe, Arizona (Dr McCullough)
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McCullough JM, Goodin K. Clinical Data Systems to Support Public Health Practice: A National Survey of Software and Storage Systems Among Local Health Departments. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 22 Suppl 6, Public Health Informatics:S18-S26. [PMID: 27684613 PMCID: PMC5049960 DOI: 10.1097/phh.0000000000000443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
CONTEXT Numerous software and data storage systems are employed by local health departments (LHDs) to manage clinical and nonclinical data needs. Leveraging electronic systems may yield improvements in public health practice. However, information is lacking regarding current usage patterns among LHDs. OBJECTIVE To analyze clinical and nonclinical data storage and software types by LHDs. DESIGN Data came from the 2015 Informatics Capacity and Needs Assessment Survey, conducted by Georgia Southern University in collaboration with the National Association of County and City Health Officials. PARTICIPANTS A total of 324 LHDs from all 50 states completed the survey (response rate: 50%). MAIN OUTCOME MEASURES Outcome measures included LHD's primary clinical service data system, nonclinical data system(s) used, and plans to adopt electronic clinical data system (if not already in use). Predictors of interest included jurisdiction size and governance type, and other informatics capacities within the LHD. Bivariate analyses were performed using χ and t tests. RESULTS Up to 38.4% of LHDs reported using an electronic health record (EHR). Usage was common especially among LHDs that provide primary care and/or dental services. LHDs serving smaller populations and those with state-level governance were both less likely to use an EHR. Paper records were a common data storage approach for both clinical data (28.9%) and nonclinical data (59.4%). Among LHDs without an EHR, 84.7% reported implementation plans. CONCLUSIONS Our findings suggest that LHDs are increasingly using EHRs as a clinical data storage solution and that more LHDs are likely to adopt EHRs in the foreseeable future. Yet use of paper records remains common. Correlates of electronic system usage emerged across a range of factors. Program- or system-specific needs may be barriers or facilitators to EHR adoption. Policy makers can tailor resources to address barriers specific to LHD size, governance, service portfolio, existing informatics capabilities, and other pertinent characteristics.
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Affiliation(s)
- J. Mac McCullough
- School for the Science of Health Care Delivery, College of Health Solutions, Arizona State University, Phoenix (Dr McCullough); and Maricopa County Department of Public Health, Phoenix, Arizona (Dr McCullough and Ms Goodin)
| | - Kate Goodin
- School for the Science of Health Care Delivery, College of Health Solutions, Arizona State University, Phoenix (Dr McCullough); and Maricopa County Department of Public Health, Phoenix, Arizona (Dr McCullough and Ms Goodin)
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Shah GH, Leider JP, Luo H, Kaur R. Interoperability of Information Systems Managed and Used by the Local Health Departments. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 22 Suppl 6, Public Health Informatics:S34-S43. [PMID: 27684616 PMCID: PMC5049946 DOI: 10.1097/phh.0000000000000436] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND In the post-Affordable Care Act era marked by interorganizational collaborations and availability of large amounts of electronic data from other community partners, it is imperative to assess the interoperability of information systems used by the local health departments (LHDs). OBJECTIVES To describe the level of interoperability of LHD information systems and identify factors associated with lack of interoperability. DATA AND METHODS This mixed-methods research uses data from the 2015 Informatics Capacity and Needs Assessment Survey, with a target population of all LHDs in the United States. A representative sample of 650 LHDs was drawn using a stratified random sampling design. A total of 324 completed responses were received (50% response rate). Qualitative data were used from a key informant interview study of LHD informatics staff from across the United States. Qualitative data were independently coded by 2 researchers and analyzed thematically. Survey data were cleaned, bivariate comparisons were conducted, and a multivariable logistic regression was run to characterize factors associated with interoperability. RESULTS For 30% of LHDs, no systems were interoperable, and 38% of LHD respondents indicated some of the systems were interoperable. Significant determinants of interoperability included LHDs having leadership support (adjusted odds ratio [AOR] = 3.54), control of information technology budget allocation (AOR = 2.48), control of data systems (AOR = 2.31), having a strategic plan for information systems (AOR = 1.92), and existence of business process analysis and redesign (AOR = 1.49). CONCLUSION Interoperability of all systems may be an informatics goal, but only a small proportion of LHDs reported having interoperable systems, pointing to a substantial need among LHDs nationwide.
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Affiliation(s)
- Gulzar H. Shah
- Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Drs Shah and Kaur); de Beaumont Foundation, Bethesda, Maryland (Dr Leider); and Department of Public Health, Brody School of Medicine, East Carolina University, North Carolina (Dr Luo)
| | - Jonathon P. Leider
- Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Drs Shah and Kaur); de Beaumont Foundation, Bethesda, Maryland (Dr Leider); and Department of Public Health, Brody School of Medicine, East Carolina University, North Carolina (Dr Luo)
| | - Huabin Luo
- Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Drs Shah and Kaur); de Beaumont Foundation, Bethesda, Maryland (Dr Leider); and Department of Public Health, Brody School of Medicine, East Carolina University, North Carolina (Dr Luo)
| | - Ravneet Kaur
- Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia (Drs Shah and Kaur); de Beaumont Foundation, Bethesda, Maryland (Dr Leider); and Department of Public Health, Brody School of Medicine, East Carolina University, North Carolina (Dr Luo)
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