Development Of Health Information Technology Research Articles

What Causes Care Coordination Problems? A Case for Microanalysis.

Introduction:Care coordination (CC) is an important fulcrum for pursuing a range of health care goals. Current research and policy analyses have focused on aggregated data rather than on understanding what happens within individual cases. At the case level, CC emerges as a complex network of communications among providers over time, crossing and recrossing many organizational boundaries. Micro-level analysis is needed to understand where and how CC fails, as well as to identify best practices and root causes of problems.Coordination Process Diagramming:Coordination Process Diagramming (CPD) is a new framework for representing and analyzing CC arcs at the micro level, separating an arc into its participants and roles, communication structure, organizational structures, and transitions of care, all on a common time line.Conclusion:Comparative CPD analysis across a sample of CC arcs identifies common CC problems and potential root causes, showing the potential value of the framework. The analyses also suggest intervention strategies that could be applied to attack the root causes of CC problems, including organizational changes, education and training, and additional health information technology development.

Key global developments in health information technology.

Key global developments in health information technology.

Free-Text Notes as a Marker of Needed Improvements in Electronic Prescribing.

In this issueof JAMAInternalMedicine,Dhavleandcolleagues1 presenttheresultsofastudyindicatingthat,of the14.9%ofelectronic prescriptions with free-text notes, 66.1% contained inappropriate content forwhicha structureddata field (ie, a field intended for certain specific piecesof information, suchas days’ supply or indication for a medication) exists in the mostcommonlyusednationale-prescribingstandard.Mostconcerning, almost 1 in5 (19.0%)of these inappropriatenotes contained conflicting medication directions from the structured fields intended for this purpose. Of the noteswith appropriate content, almost half (47.3%) contained information that could be communicated using structured fields approved in a version of the e-prescribing standard that has yet to be implemented. An additional 9.6% were prescription cancellation requests for which a separate e-prescribing message exists but is not widely supported in most currently available e-prescribing software. The implications of these various types of free-text notes can range from the merely distracting for the community pharmacist to those that could be severely harmful for patients (Table). However, even distractions can lead indirectly to patient harm if they result in lapses of attention that increase the rate of dispensing errors. Several of these categories of notes are time consuming for pharmacists and sometimes for prescribers (eg, if telephone calls are needed to clarify a prescription), therefore wasting valuable health care resources. Moreover, the final category in this Table (ie, conflicting information), as illustrated in the phenytoin sodium (Dilantin) example in the Discussion section by Dhavle and colleagues1 (and included in the present Table) is not infrequent: conflicting informationapparentlyoccurred in 14.6% of all prescriptionswith free-text codes sampled byDhavle et al, or approximately 2.2% of all e-prescriptions. If extrapolated nationally, assuming SureScripts captures two-thirds of all new e-prescriptions in the United States, this wouldmean that more than 34 million such errors occur each year. As with most medication safety issues, the causes of the problemaremultifactorial. Failure of prescribers to use available structured fields likely reflects a combination of poor usabilityof electronichealth records ande-prescribing toolsplus a lack of adequate education, training, and feedback among prescribers. Indeed, in common practice, few such educationalopportunities exist: prescribersoftenhavea single training sessionwhen a new system is implemented or when they join a new practice and have no opportunities for feedback, especially frompharmacists. Failure of approved standards to bewidely implemented reflects deficiencies in regulation and in the health information technology development process. The types of information in these free-text notes also reveals awide communication gulf betweenprescribers andpharmacies, agulf that canonlybepartiallybridgedwithcurrent tools, technologies, and health care structures. Because the causes of this problemaremultifactorial, the solutions must be as well. Vendors of electronic health records and e-prescribing software should view the findings of Dhavle and colleagues1as a guide to improvements thatmust bemade in theusability of their products. For example,many vendorsoftenmake itdifficult toefficientlyandaccuratelyprescribe sliding scales, tapers, or other complicated regimens (eg, “take 1 capsule in themorning and 2 capsules in the evening,” which was likely the intention of the prescriber of the above-mentioned phenytoin example). Updates in currently approvede-prescribing standards shouldbeexpeditedand integrated into thenextgenerationof tools; suchchanges should receive the highest priority by regulators and vendors. Future updates to the standards will also need to be developed and expedited. New structured fields should be considered when there is risk for this type of information to be omitted or incomplete when not prompted. Prescribers need adequate training in theuseof e-prescribing tools.Moreover, onRelated article page 463

A Theory-Integrated Model of Medical Diagnosis

Recent research investigating diagnosis has generally relied upon one of two approaches to categorize and assess the antecedents of diagnostic error: (a) describing diagnostic error as a result of flaws in human cognition or (b) explaining diagnostic error as a result of working with complex health information systems. Each approach has uncovered important features that promote diagnostic error. However, each approach has inherent limitations, and integrating results from one approach to the other has proved difficult. In the current study, a cognitive engineering technique known as work domain analysis was implemented to provide a framework for uncovering the relationship between diagnosis, complex health systems, and theories of cognition and reasoning. The resulting model of diagnosis provides a comprehensive, novel perspective of the diagnostic process that offers a new foundation to formulate empirical inquiries about diagnosis and provides new avenues for the design and development of health information technologies, assessment strategies, and diagnosis-centered simulation paradigms.

Drug Information Services Today: Current Role and Future Perspectives in Rational Drug Therapy

Polypharmacy and complex drug treatment regimens are becoming increasingly common, which may lead to adverse drug reactions, drug interactions, medication nonadherence, and increasing costs and thus challenge the rational use of drugs. At the same time, the accessibility of drug information increases, and health care professionals may have limited opportunities and capabilities to search and critically evaluate drug information. Clinicians have reported difficulties in searching the best evidence and translating study findings into clinically meaningful information applicable to specific patients. Consequently, it remains a challenge to ensure the rational use of drugs in the years to come. Drug information centers (DICs) have been established to promote the rational use of drugs. One of the most important tasks of DICs is the question and answer services for health care professionals posing drug-related questions. DICs staffed by pharmacists and clinical pharmacologists hold expertise in searching for drug information and critical evaluation of the literature. The uniqueness in this service lies not only in the identification and interpretation of the scientific literature but also in the adaptation of the findings into specific clinical situations and the discussion of possible solutions with the enquirer. Thus, DICs could provide valuable decision support to the clinic. Taking into account the increasing number of possible drug-related questions that will arise today and in the future, the DICs will remain highly relevant in the years to come. However, the DICs must follow the developments in health information technology to disseminate relevant, unbiased drug information to old and new users of the service. Moreover, the DICs are important tools to counterbalance the drug information published by the pharmaceutical industry.

Understanding information synthesis in oral surgery for the design of systems for clinical information technology

An understanding of the processes of clinical decision-making is essential for the development of health information technology. In this study we have analysed the acquisition of information during decision-making in oral surgery, and analysed cognitive tasks using a “think-aloud” protocol. We studied the techniques of processing information that were used by novices and experts as they completed 4 oral surgical cases modelled from data obtained from electronic hospital records. We studied 2 phases of an oral surgeon's preoperative practice including the “diagnosis and planning of treatment” and “preparing for a procedure”. A framework analysis approach was used to analyse the qualitative data, and a descriptive statistical analysis was made of the quantitative data. The results showed that novice surgeons used hypotheticodeductive reasoning, whereas experts recognised patterns to diagnose and manage patients. Novices provided less detail when they prepared for a procedure. Concepts regarding “signs”, “importance”, “decisions”, and “process” occurred most often during acquisition of information by both novices and experts. Based on these results, we formulated recommendations for the design of clinical information technology that would help to improve the acquisition of clinical information required by oral surgeons at all levels of expertise in their clinical decision-making.

A needs assessment of health information technology for improving care coordination in three leading patient-centered medical homes.

We investigated ways that patient-centered medical homes (PCMHs) are currently using health information technology (IT) for care coordination and what types of health IT are needed to improve care coordination. A multi-disciplinary team of researchers conducted semi-structured telephone interviews with 28 participants from 3 PCMHs in the United States. Participants included administrators and clinicians from PCMHs, electronic health record (EHR) and health information exchange (HIE) representatives, and policy makers. Participants identified multiple barriers to care coordination using current health IT tools. We identified five areas in which health IT can improve care coordination in PCMHs: 1) monitoring patient populations, 2) notifying clinicians and other staff when specific patients move across care settings, 3) collaborating around patients, 4) reporting activities, and 5) interoperability. To accomplish these tasks, many participants described using homegrown care coordination systems separate from EHRs. The participants in this study have resources, experience, and expertise with using health IT for care coordination, yet they still identified multiple areas for improvement. We hypothesize that focusing health IT development in the five areas we identified can enable more effective care coordination. Key findings from this work are that homegrown systems apart from EHRs are currently used to support care coordination and, also, that reporting tools are key components of care coordination. New health IT that enables monitoring, notifying, collaborating, reporting, and interoperability would enhance care coordination within PCMHs beyond what current health IT enables.

Tech Trends We Are Watching in 2015: Health Information Technology Developments

Tech Trends We Are Watching in 2015: Health Information Technology Developments

Tech trends we are watching in 2015: health information technology developments.

As a new year begins, we look ahead to several important topics that we will closely follow over the next 12 months. The list is certainly not exhaustive, but we believe these topics should be on all hospital pharmacy staff members' radar screens.

Enabling patient-centered communication and care through health information technology

Advances in communication science and developments in health information technology coupled with recent health reform initiatives have created unique opportunities for progressing toward a patient-centered healthcare system in the US. We propose a conceptual framework to describe ways in which patient-centered communication may serve as a critical link in translating health information technology functionality into delivery of patient-centered care. In this context, health information technology may provide the infrastructure for patient-centered communication to enable delivery of patient-centered care. Key aspects of patient-centered communication and health information technology are reviewed and patient-centered care is described as emerging through health information technology-enabled patient-centered communication.

SABER and MyDispense: Building better pharmacy education through innovation and sharing

Information technology (IT) is increasingly a part of everyday life for health professionals. Technology such as decision support systems (DSS) and electronic health records (EHR) have great potential in improving practice efficiency and standard, and improve patient outcomes; however, like most health IT, available programs are often lacking in usability and efficiency. To improve the quality of IT available, health professionals need to be actively involved in the developmental process, from early planning stages to final testing and feedback. Aims: To gain insight into the role of IT in the health sector and pharmacy. To explore what the general requirements are of complex DSS used by health professionals. To discuss if and how these requirements change depending on practice setting. To gain insight into what skills are needed to be involved in different stages of health IT development. Learning objectives: By the end of the session participants should be able to: Describe the different types of IT used in the health sector and pharmacy. Describe the role of EHR, computer physician order entry systems dispensing systems, DSS and how these systems are related. Involved in the development of a usable health IT. Description of Workshop Activities: This workshop is aimed at health practitioners, researchers, policy makers, and other parties interested in health IT. During this workshop participants will be shown a short presentation describing a) different types of health IT, and b) the development process of a prototype DSS to illustrate how health professionals can be involved in health IT development. This will be followed by small group discussions on the requirements for DSS in clinical practice and various environments, a demonstration of a DSS developed by the authors, and feedback. Additional information (if required): N/A

Health Professional Involvement in Health Information Technology Development: What Can Your Do to Improve Them?

Information technology (IT) is increasingly a part of everyday life for health professionals. Technology such as decision support systems (DSS) and electronic health records (EHR) have great potential in improving practice efficiency and standard, and improve patient outcomes; however, like most health IT, available programs are often lacking in usability and efficiency. To improve the quality of IT available, health professionals need to be actively involved in the developmental process, from early planning stages to final testing and feedback. Aims: To gain insight into the role of IT in the health sector and pharmacy. To explore what the general requirements are of complex DSS used by health professionals. To discuss if and how these requirements change depending on practice setting. To gain insight into what skills are needed to be involved in different stages of health IT development. Learning objectives: By the end of the session participants should be able to: Describe the different types of IT used in the health sector and pharmacy. Describe the role of EHR, computer physician order entry systems dispensing systems, DSS and how these systems are related. Involved in the development of a usable health IT. Description of Workshop Activities: This workshop is aimed at health practitioners, researchers, policy makers, and other parties interested in health IT. During this workshop participants will be shown a short presentation describing a) different types of health IT, and b) the development process of a prototype DSS to illustrate how health professionals can be involved in health IT development. This will be followed by small group discussions on the requirements for DSS in clinical practice and various environments, a demonstration of a DSS developed by the authors, and feedback. Additional information (if required): N/A

Issues in mHealth: Findings From Key Informant Interviews

BackgroundmHealth is enjoying considerable interest and private investment in the United States. A small but growing body of evidence indicates some promise in supporting healthy behavior change and self-management of long-term conditions. The unique benefits mobile phones bring to health initiatives, such as direct access to health information regardless of time or location, may create specific issues for the implementation of such initiatives. Other issues may be shared with general health information technology developments.ObjectiveTo determine the important issues facing the implementation of mHealth from the perspective of those within the US health system and those working in mHealth in the United States.MethodsSemistructured interviews were conducted with 27 key informants from across the health and mHealth sectors in the United States. Interviewees were approached directly following an environmental scan of mHealth in the United States or recommendation by those working in mHealth.ResultsThe most common issues were privacy and data security, funding, a lack of good examples of the efficacy and cost effectiveness of mHealth in practice, and the need for more high-quality research. The issues are outlined and categorized according to the environment within which they predominantly occur: policy and regulatory environments; the wireless industry; the health system; existing mHealth practice; and research.ConclusionsMany of these issues could be addressed by making the most of the current US health reform environment, developing a strategic and coordinated approach, and seeking to improve mHealth practice.

Quality evaluation of the available Internet information regarding pain during orthodontic treatment

To investigate the quality of the data disseminated via the Internet regarding pain experienced by orthodontic patients. A systematic online search was performed for 'orthodontic pain' and 'braces pain' separately using five search engines. The first 25 results from each search term-engine combination were pooled for analysis. After excluding advertising sites, discussion groups, video feeds, and links to scientific articles, 25 Web pages were evaluated in terms of accuracy, readability, accessibility, usability, and reliability using recommended research methodology; reference textbook material, the Flesch Reading Ease Score; and the LIDA instrument. Author and information details were also recorded. Overall, the results indicated a variable quality of the available informational material. Although the readability of the Web sites was generally acceptable, the individual LIDA categories were rated of medium or low quality, with average scores ranging from 16.9% to 86.2%. The orthodontic relevance of the Web sites was not accompanied by the highest assessment results, and vice versa. The quality of the orthodontic pain information cited by Web sources appears to be highly variable. Further structural development of health information technology along with public referral to reliable sources by specialists are recommended.

Implementing the Learning Health System: From Concept to Action

Clinicians and health systems are facing widespread challenges, including changes in care delivery, escalating health care costs, and the need to keep up with rapid scientific discovery. Reorganizing U.S. health care and changing its practices to render better, more affordable care requires transformation in how health systems generate and apply knowledge. The "rapid-learning health system"-posited as a conceptual strategy to spur such transformation-leverages recent developments in health information technology and a growing health data infrastructure to access and apply evidence in real time, while simultaneously drawing knowledge from real-world care-delivery processes to promote innovation and health system change on the basis of rigorous research. This article describes an evolving learning health system at Group Health Cooperative, the 6 phases characterizing its approach, and examples of organization-wide applications. This practical model promotes bidirectional discovery and an open mind at the system level, resulting in willingness to make changes on the basis of evidence that is both scientifically sound and practice-based. Rapid learning must be valued as a health system property to realize its full potential for knowledge generation and application.

The Dynamics of Information Collaboration: A Case Study of Blended IT Value Propositions for Health Information Exchange in Disability Determination

Special Issue Recent developments in health information technology (health IT) for health information exchange suggest that successful public-private collaborations should devote more attention to understanding the dynamics of collaboration. In the context of health information sharing for disability determination, this case study examines early instances of public-private interorganizational sharing of health information. The theoretical focus of the paper is on the construction of blended value propositions and their role in collaboration for health information exchange. For this purpose, we performed a case analysis of a prototype health IT application to be shared between the United States Social Security Administration and Beth Israel Deaconess Medical Center. The case analysis found that business, socio-organizational, and technical dynamics were operative during the planning and execution of the prototype. From a theoretical perspective, the case study provides insight into blended value propositions in terms of understanding and potentially predicting the success of newly established Health Information Exchanges (HIEs). The findings have implications for further development of collaboration value propositions and their evolution over the course of IT deployments for health information exchange.

FAQs About HIPAA and HITECH: What Physicians Need to Know

Back to table of contents Previous article Next article Professional NewsFull AccessFAQs About HIPAA and HITECH: What Physicians Need to KnowDonna Vanderpool, M.B.A., J.D.Donna VanderpoolSearch for more papers by this author, M.B.A., J.D.Published Online:1 Jan 2010https://doi.org/10.1176/pn.45.1.psychnews_45_1_017AbstractThe HITECH (Health Information Technology for Economic and Clinical Health) Act is Title 13 of the American Recovery and Reinvestment Act of 2009 (ARRA). While the various subtitles of HITECH cover many topics relevant to physicians (for example, financial incentives for health information technology), this article will address only Subtitle D of HITECH amending the privacy and security rules under HIPAA (Health Insurance Portability and Accountability Act of 1996).HIPAA's privacy and security rules established floors of confidentiality and security protections for patients' demographic and health information in all forms—paper, oral, and electronic. The development of health information technology (for example, electronic health records, personal health records, health information exchanges) has resulted in additional risks; HITECH builds on the privacy and security rules to address these new risks.•. Who must comply with the HITECH amendments to HIPAA?Covered entities and business associates under HIPAA must comply with HIPAA, as amended by HITECH.•. Isn't every physician a covered entity under HIPAA?No. Only providers who electronically submit specific transactions electronically are covered by (required to comply with) HIPAA. The most common transaction that makes a provider covered is the electronic submission of claims to health plans. The Department of Health and Human Services (HHS) has useful resources to determine the applicability of the federal HIPAA regulations posted at <www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/index.html>.•. What is a business associate?Under the privacy rule, a business associate is a person who provides a function on behalf of a covered entity (other than as part of the covered entity's workforce) that involves the use of protected health information (PHI). Examples of this type of business associate include billing services, transcription services, and answering services. A business associate is also a person who provides specified services involving the use of PHI to a covered entity. The specified services are legal, actuarial, accounting, consulting, data aggregation, management, administrative, accreditation, and financial services. The HHS Web site at <www.hhs.gov/ocr/privacy> has much more information on entities that are, and are not, business associates.Business associates may use and disclose PHI, but only in compliance with the business associate agreement evidencing the business associate's promise to maintain the confidentiality and security of PHI. Under existing law, business associates only have contractual liability with the covered entity via the business associate agreement. As of February 2010, business associates must comply with the security rule and will be subject to government enforcement.•. What does HITECH say about HIPAA?There are many changes to HIPAA under HITECH, but not all of the provisions have the same effective date. See Summary Timeline for HITECH Requirements for Providers Covered Under HIPAA for a summary timeline showing the implications of the major HITECH provisions on HIPAA-covered entities.The most significant provisions of HITECH include the following: •. Increasing enforcement of existing HIPAA regulations (privacy and security rules). •. Increasing penalties for violations of existing HIPAA regulations. •. Adding a new federal breach notification law. •. Subjecting business associates to government enforcement.Part 2 of this article will include FAQs on enforcement and compliance with HIPAA, as well as breach notification. Please note that nothing in this article should be construed as legal advice.Donna Vanderpool, M.B.A., J.D., is assistant vice president, risk management, at Professional Risk Management Services Inc. (PRMS Inc.). ISSUES NewArchived

Where's the Revolution? Digital Technology and Health Care in the Internet Age

Despite the growing use of online resources, it is unclear how many Americans are using the World Wide Web for different health-related purposes and whether factors promoting use of the Internet in health care correspond with those affecting more traditional in-person and telemedicine encounters. This research uses a national public opinion survey to examine the degree to which health care consumers communicate through conventional, face-to-face consultation, telemedicine, or digital technology, and the relationship between these means of communication and respondent characteristics. Results indicate that few people are using digital technology to get information, communicate with health personnel, or make online medical purchases. Furthermore, less well educated, lower-income individuals living in rural areas tend to use the health care Internet less than others. Several policy measures need to be undertaken in order to accelerate the appropriate use of digital technology by health care consumers of all kinds. These include improving education and technological literacy and providing access to low-cost digital technology. Without a consumer complement to prevailing efforts to spur health information technology development and implementation on the part of providers, the promise of the digital revolution will continue to be limited to certain better-connected segments of the population.

The Public Role in Promoting Child Health Information Technology

The public sector plays an important role in promoting child health information technology. Public sector support is essential in 5 main aspects of child health information technology, namely, data standards, pediatric functions in health information systems, privacy policies, research and implementation funding, and incentives for technology adoption. Some innovations in health information technology for adult populations can be transferred to or adapted for children, but there also are unique needs in the pediatric population. Development of health information technology that addresses children's needs and effective adoption of that technology are critical for US children to receive care of the highest possible quality in the future.

Identifying Organizational Capacities and Incentives for Clinical Data-sharing: The Case of a Regional Perinatal Information System

The development of regional data-sharing among healthcare organizations is viewed as an important step in the development of health information technology (HIT), but little is known about this complex task. This is a case study of a regional perinatal data system that involved four hospitals, together responsible for over 10,000 births annually. Using standard qualitative methods, we chronicled project milestones, and identified 31 “critical incidents” that delayed or prevented their achievement. We then used these critical incidents to articulate six organizational capacity domains associated with the achievement of project milestones, and a seventh domain consisting of organizational incentives. Finally, we analyzed the relationship of milestone achievement to the presence of these capacities and incentives. This data center case suggests four requirements for sharing data across organizations: 1) a readiness assessment; 2) a perceived mandate; 3) a formal governance structure; and 4) a third party IT component.