Indiana University-Purdue University Indianapolis (IUPUI) / Physicians receive multiple CCDs for a single patient encompassing various encounters and medical history recorded in different information systems. It is cumbersome for providers to explore different pages of CCDs to find specific data which can be duplicated or even conflicted. This study describes the steps towards a system that integrates multiple CCDs into one consolidated document for viewing or processing patient-level data. Also, the impact of the system on healthcare providers’ perceived workload is evaluated. A modular system is developed to consolidate and de-duplicate CDA-based documents. The system is engineered to be scalable, extensible and open source. The system’s performance and output has evaluated first based on synthesized data and later based on real-world CCDs obtained from INPC database. The accuracy of the consolidation system along with the gaps in identification of the duplications were assessed. Finally, the impact of the system on healthcare providers’ workload is evaluated using NASA TLX tool. All of the synthesized CCDs were successfully consolidated, and no data were lost. The de-duplication accuracy was 100% based on synthesized data and the processing time for each document was 1.12 seconds. For real-world CCDs, our system de-duplicated 99.1% of the problems, 87.0% of allergies, and 91.7% of medications. Although the accuracy of the system is still very promising, however, there is a minor inaccuracy. Due to system improvements, the processing time for each document is reduced to average 0.38 seconds for each CCD. The result of NASA TLX evaluation shows that the system significantly decreases healthcare providers’ perceived workload. Also, it is observed that information reconciliation reduces the medical errors. The time for review of medical documents review time is significantly reduced after CCD consolidation. Given increasing adoption and use of Health Information Exchange (HIE) to share data and information across the care continuum, duplication of information is inevitable. A novel system designed to support automated consolidation and de-duplication of information across clinical documents as they are exchanged shows promise. Future work is needed to expand the capabilities of the system and further test it using heterogeneous vocabularies across multiple HIE scenarios.

Indiana University-Purdue University Indianapolis (IUPUI) / The United States has invested over $40 billion in digitizing the health care system, yet the anticipated gains in improved care coordination, quality, and cost savings remain largely unrealized. This is due in part to limited interoperability and low rates of health information exchange (HIE) use, which can support care coordination and improve provider decision-making. Primary care providers are central to the US health care delivery system and frequently function as care coordinators, yet capability and HIE use gaps among these providers limit the potential of these digital systems to achieve their intended goals. I study HIE use in the context of primary care to examine 1) factors associated with provider HIE use, 2) the extent and nature of team-based HIE use, and 3) differences in HIE system use patterns across discrete groups of system users. First, I use a national sample of primary care providers to analyze market and practice factors related to HIE use for patient referrals. Overall, I find that only 43% of primary care provider referrals used HIE. Furthermore, I find substantial variation in HIE use rates across electronic health record (EHR) vendors. Second, I use HIE system log data to understand the breadth and depth of HIE use among teams, a care model underpinning primary care delivery reform efforts. I find that although use of HIE systems remains low, in primary care settings it overwhelmingly takes place in a manner consistent with team-based care workflows. Furthermore, team-based use does not differ in breadth from single provider HIE use, but illustrates less depth before and after visits. Third, I apply cluster analysis to 16 HIE use measures representing 7 use attributes, and identify 5 discrete user groups. I then compare two of these user groups and find user-level variation in volume and efficiency of use, both of which have implications for HIE system design and usability improvements. Ultimately, these findings help to inform how HIE use can be increased and improved in primary care, moving the US health care system closer to realizing the coordination, quality, and cost savings made possible by a digitized delivery system.

Yes / Health services in many countries are investing in inter-organisational networks, linking patients’ records held in different organisations across a city or region. The aim of the systematic review was to establish how, why, and in what circumstances these networks improve patient safety, fail to do so, or increase safety risks, for people living at home. Design Realist synthesis, drawing on both quantitative and qualitative evidence, and including consultation with stakeholders in nominal groups and semi-structured interviews. Eligibility criteria The co-ordination of services for older people living at home, and medicine reconciliation for older patients returning home from hospital. Information sources 17 sources including Medline, Embase, CINAHL, Cochrane Library, Web of Science, ACM Digital Library and Applied Social Sciences Index and s (ASSIA). Outcomes Changes in patients’ clinical risks. Results We did not find any detailed accounts of the sequences of events that policy makers and others believe will lead from the deployment of interoperable networks to improved patient safety. We were, though, able to identify a substantial number of theory fragments, and these were used to develop programme theories. There is good evidence that there are problems with the co-ordination of services in general, and the reconciliation of medication lists in particular, and it indicates that most problems are social and organisational in nature. There is also good evidence that doctors and other professionals find interoperable networks difficult to use. There was limited high quality evidence about safety-related outcomes associated with the deployment of interoperable networks. Conclusions Empirical evidence does not currently justify claims about the beneficial effects of interoperable networks on patient safety. There appears to be a mismatch between technology-driven assumptions about the effects of networks and the socio-technical nature of co-ordination problems. Review registration: PROSPERO CRD42017073004 / NIHR Grant 16/53/03

The growth of e-health system has influenced the way health organizations conducttheir business. Communication between these systems is one of the most significantfactors since a more efficient communication system can improve an organizationperformance. Nowadays the health organizations make a lot of investments to deploya suitable information and communication technology to meet their goals.This study investigates the health information exchange within different healthinformation systems. We first carried out a theoretical study to find out the relevantconcepts by reviewing the related literature and analyzing them. As a result of ourtheoretical study we investigate and redesign the basic model of the “Super Clinic” asa new model for health information exchange system. Then we conducted anempirical study to validate the result from the theoretical study which helped us tonarrow down our research area. We revised our proposed theoretical model by thelesson learnt from our empirical study results. Three interviews were conducted withexperts and the outcomes were analyzed using comparative analysis. These interviewsallowed us to outline the most important factors of successful health informationexchange systems (i.e. “Super Clinic”).They also helped us to design a central hub (i.e. “health Hub”) for communicationand information exchange between different information systems. This revised modelof Super Clinic (with the central hub) could be going under more investigation infuture works. / Program: Masterutbildning i Informatik

Medication errors increased 64.4% from 2015 to 2018 in the United States due to the use of computerized physician order entry (CPOE) systems and the inability to exchange information among health care facilities. Healthcare information exchange (HIE) and subsequent discrepancies resulted in significant medical errors due to the lack of exchangeable health care information using technology software. The purpose of this qualitative multiple case study was to explore the strategies health care business managers used to manage computerized physician order entry systems within health care facilities to reduce medication errors and increase profitability. The population of the study was 8 clinical business managers in 2 successful small health care clinics located in the mid-Atlantic region of the United States. Data were collected from semistructured interviews with health care leaders and documents from the health care organization as a resource. Inductive analysis was guided by the Donabedian theory and sociotechnical system theory, and trustworthiness of interpretations was confirmed through member checking. Three themes emerged: standardizing data formats reduced medication errors and increased profits, adopting user-friendly HIE reduced medication errors and increase profits, and efficient communication reduced medication errors and increased profits. The findings of this study contribute to positive change through improved health care delivery to patients resulting in healthier communities.

In a context where technology is increasingly being incorporated into health care practice, many U.S. health care providers and organizations are finding it challenging to connect disparate electronic documentation systems to retrieve patient information when coordinating care across providers and heath care entities. Local and regional health information exchange (HIE) systems were created to facilitate collecting information into one integrated patient record to address information transfer between heath care providers. Yet, adoption and use of HIEs have been low. The purpose of this study was to review the predictive factors accounting for physicians' use of a HIE in the U.S. state of Hawaii. Key factors from the technology acceptance model were evaluated to determine the behavioral intention resulting in actual use of the Hawaii health information exchange (HHIE). Physician characteristics (medical specialty, age, and gender) and location characteristics were also assessed. The total population of the study contained 1034 Hawaii physicians who have signed up to use the HHIE. Linear and logistic regression models were structured to evaluate the predictive nature of (a) use to determine if a physician has ever logged into the HIE and (b) usage to evaluate the extent to which a physician is logging into the HIE. Findings from the study reveal a predictive relationship between the characteristic of medical specialty and HHIE use when comparing primary care and emergency department physicians to physician specialists. Using study results, health care leaders can improve physician outreach and review barriers when using the HIE systems to coordinate care. Policy implications include the possible formulation of future requirements surrounding HIE physician participation.

No description available.

Implementation of electronic health records (EHRs) is a driver for the improvement of health care and the reduction of health care costs. Developing countries face substantial challenges in adopting EHRs. The complex adaptive system conceptual framework was used to guide this single case study to explore strategies that health care leaders used to successfully implement the EHR system. Data were collected from 6 health care leaders from an island in the Caribbean using a semistructured interview technique. Data were analyzed using the Bengtsson's 4-stage data analysis process, which includes decontextualization, recontextualization, categorization, and compilation. The results of the study yielded 5 main themes: training, increased staffing, monitoring, identifying organizational gaps, and time. The implications of the study for positive social change include the potential to improve the standards of care provided to promote improved patient outcomes by using the strategies identified in this study to successfully implement the EHR system.

Indiana University-Purdue University Indianapolis (IUPUI) / Public health agencies protect the health and safety of populations. A key function of public health agencies is surveillance or the ongoing, systematic collection, analysis, interpretation, and dissemination of data about health-related events. Recent public health events, such as the H1N1 outbreak, have triggered increased funding for and attention towards the improvement and sustainability of public health agencies’ capacity for surveillance activities. For example, provisions in the final U.S. Centers for Medicare and Medicaid Services (CMS) “meaningful use” criteria ask that physicians and hospitals report surveillance data to public health agencies using electronic laboratory reporting (ELR) and syndromic surveillance functionalities within electronic health record (EHR) systems. Health information exchange (HIE), organized exchange of clinical and financial health data among a network of trusted entities, may be a path towards achieving meaningful use and enhancing the nation’s public health surveillance infrastructure. Yet the evidence on the value of HIE, especially in the context of public health surveillance, is sparse. In this research, the value of HIE to the process of public health surveillance is explored. Specifically, the study describes the real and perceived completeness and usefulness of HIE in public health surveillance activities. To explore the real value of HIE, the study examined ELR data from two states, comparing raw, unedited data sent from hospitals and laboratories to data enhanced by an HIE. To explore the perceived value of HIE, the study examined public health, infection control, and HIE professionals’ perceptions of public health surveillance data and information flows, comparing traditional flows to HIE-enabled ones. Together these methods, along with the existing literature, triangulate the value that HIE does and can provide public health surveillance processes. The study further describes remaining gaps that future research and development projects should explore. The data collected in the study show that public health surveillance activities vary dramatically, encompassing a wide range of paper and electronic methods for receiving and analyzing population health trends. Few public health agencies currently utilize HIE-enabled processes for performing surveillance activities, relying instead on direct reporting of information from hospitals, physicians, and laboratories. Generally HIE is perceived well among public health and infection control professionals, and many of these professionals feel that HIE can improve surveillance methods and population health. Human and financial resource constraints prevent additional public health agencies from participating in burgeoning HIE initiatives. For those agencies that do participate, real value is being added by HIEs. Specifically, HIEs are improving the completeness and semantic interoperability of ELR messages sent from clinical information systems. New investments, policies, and approaches will be necessary to increase public health utilization of HIEs while improving HIEs’ capacity to deliver greater value to public health surveillance processes.

<p>  </p> <p>Although community pharmacists have further reduced medication errors and improved care with access to patient data through unidirectional health information exchange (HIE), access to routine patient data has not been sustained. Several barriers to sustaining use and access of HIE in community pharmacies have been noted, such as lack of implementation supports and technological restrictions. Further, pharmacists and pharmacy technicians have not been involved in the development of HIE systems for their use previously. My research aims to optimize HIE access for community pharmacists through our co-developed HIE interface prototype specifically for use by community pharmacy teams in collaboration with PioneerRx, a pharmacy dispensing software system and our state HIE, the Indiana Health Information Exchange (IHIE), and provide supports for the sustainability of community pharmacist access to HIE.</p> <p>Therefore, the objectives of my research are to 1) conduct a formative usability evaluation of the HIE interface prototype with community pharmacists and pharmacy technicians to inform strategies to improve the HIE interface design for future implementation in community pharmacies (“<em>Study One”</em>) and 2) identify the potential barriers, facilitators, and recommendations for HIE implementation in community pharmacies through semi-structured interviews to create a curated list of resources to address identified implementation needs to assist with the future implementation of HIE (“<em>Study Two”</em>).</p> <p>The findings from Study One demonstrate the HIE interface prototype was viewed favorably by pharmacists and pharmacy technicians, with the average System Usability Scale (SUS) score 69 (scale 0 – 100, where 100 is the best). Pharmacists reported higher satisfaction than technicians on average (74 vs. 65, respectively). Key problems identified included accessibility of HIE links and placement in the existing workflow and application label name clarifications. The same eight pharmacists and eight pharmacy technicians, with the addition of seven patients, completed interviews in Study Two. Five barriers, four facilitators, and two recommendations were identified. These were further characterized into four key implementation needs: instruction on how to use HIE, guidance on workflow and team roles, and provider and patient facing resources for discussing HIE. Curated draft implementation resource items that are responsive to all four key implementation needs are in development. The combination of findings from Study One and Study Two create the blueprint for pharmacy-team informed implementation of HIE in community pharmacies.</p>