Electronic Health Information Exchange Research Articles

Exploring the impact of primary care utilization and health information exchange upon treatment patterns and clinical outcomes of glioblastoma patients.

There is limited literature describing care coordination for patients with glioblastoma (GBM). We aimed to investigate the impact of primary care and electronic health information exchange (HIE) between neurosurgeons, oncologists, and primary care providers (PCP) on GBM treatment patterns, postoperative outcomes, and survival. We identified adult GBM patients undergoing primary resection at our institution (2007-2020). HIE was defined as shared electronic medical information between PCPs, oncologists, and neurosurgeons. Multivariate logistic regression analyses were used to determine the effect of PCPs and HIE upon initiation and completion of adjuvant therapy. Kaplan-Meier and multivariate Cox regression models were used to evaluate overall survival (OS). Among 374 patients (mean age ± SD: 57.7 ± 13.5, 39.0% female), 81.0% had a PCP and 62.4% had electronic HIE. In multivariate analyses, having a PCP was associated with initiation (OR: 7.9, P < 0.001) and completion (OR: 4.4, P < 0.001) of 6 weeks of concomitant chemoradiation, as well as initiation (OR: 4.0, P < 0.001) and completion (OR: 3.0, P = 0.007) of 6 cycles of maintenance temozolomide thereafter. Having a PCP (median OS [95%CI]: 14.6[13.1-16.1] vs. 10.8[8.2-13.3] months, P = 0.005) and HIE (15.40[12.82-17.98] vs. 13.80[12.51-15.09] months, P = 0.029) were associated with improved OS relative to counterparts in Kaplan-Meier analysis and in multivariate Cox regression analysis (hazard ratio [HR] = 0.7, [95% CI] 0.5-1.0, P = 0.048). In multivariate analyses, chemoradiation (HR = 0.34, [95% CI] 0.2-0.7, P = 0.002) and maintenance temozolomide (HR = 0.5, 95%CI 0.3-0.8, P = 0.002) were associated with improved OS relative to counterparts. Effective care coordination between neurosurgeons, oncologists, and PCPs may offer a modifiable avenue to improve GBM outcomes.

Preventable Emergency Department Visits of Patients with Alzheimer's Disease and Related Dementias During the COVID-19 Pandemic by Hospital-Based Health Information Exchange.

Background: This study examined the relationship between hospital-based electronic health information exchange (HIE) and the likelihood of having a preventable emergency department (ED) visit during the COVID-19 pandemic for US patients with Alzheimer's Disease and Related Dementias (ADRD). Methods: We used multi-level data from six states. The linked data sets included the 2020 State Emergency Department Databases (SEDD), the Area Health Resources File, the American Hospital Association (AHA) Annual Survey, and the AHA Information Technology Supplement to study 85,261 hospital discharges from patients with ADRD. Logistic regression models were produced to determine the odds of having a preventable ED visit among patients with ADRD. Results: Our final sample included 85,261 hospital discharges from patients with ADRD. Patients treated in hospitals that received more types of clinical information for treating patients with COVID-19 from outside providers (OR = 0.961, p < .05) and/or hospitals that received COVID-19 test results from more outside entities were significantly less likely to encounter preventable EDs (OR = 0.964, p < .05), especially among patients who also had multiple chronic conditions (MCC) (OR = 0.89, p = .001; OR = 0.856, p < .001). Conclusion: Our results suggest that electronic HIE may be useful for reducing preventable ED visits during the COVID-19 pandemic for people with ADRD and ADRD alongside MCC.

Assessing the impact of health information exchange on hospital data breach risk

ObjectiveWidespread electronic health information exchange (HIE) across hospitals remains an important policy goal for reducing costs and improving the quality of care. Meanwhile, cybersecurity incidents are a growing threat to hospitals. The relationship between the electronic sharing of health information and cybersecurity incidents is not well understood. The objective of this study was to empirically examine the impact of hospitals’ HIE engagement on their data breach risk. Materials and MethodsA balanced panel dataset included 4,936 US community hospitals spanning the period 2010–2017, which was assembled by linking the American Hospital Association annual survey database and the Information Technology (IT) supplement, and the Department of Health and Human Services reports of health data breaches. The relationship between HIE engagement and hospital data breaches was modeled using a difference-in-differences specification controlling for time-varying hospital characteristics. ResultsThe percentage of hospitals electronically exchanging information has more than tripled (from 18% to 68%) from 2010 to 2017. Hospital data breaches increased concurrently, largely due to the rise in hacking and unauthorized access. HIE engagement was associated with a 0.672 percentage point increase in the probability of an IT breach three years after the engagement. Hospitals actively engaging in a health information organization and exchanging data with outside providers were associated with a higher risk of IT related breaches in the long run; however, hospitals actively engaging in HIE and exchanging data with inside providers were not associated with any significant risk of IT related breaches. DiscussionOver time, the increasing amount and complexity of patient information being exchanged can create challenges for cybersecurity if data protection is not up to date. Additionally, data security depends on the weakest link of HIE, and providers with fewer resources for data governance and infrastructure are more vulnerable to data breaches. ConclusionMoving toward widespread health information exchange has important cybersecurity implications that can significantly impact both patients and healthcare organizations.

A Privacy-Preserving Scheme for Managing Secure Data in Healthcare System

In the world of modern technology and the huge spread of its use, it has been combined with healthcare systems and the establishment of electronic health records (EHR) to follow up on patients. This merging of technology with healthcare has allowed for more accurate EHRs that follow a patient to different healthcare facilities. Timely exchange of electronic health information (EHR) between providers is critical for aiding medical research and providing fast patient treatment. As a result, security issues and privacy problems are viewed as significant difficulties in the healthcare system. Several remote user authentication methods have been suggested. In this research, we present a feasible patient EHR migration solution for each patient. finally, each patient may securely delegate their current hospital’s information system to a hospital certification authority in order to receive migration proof that can be used to transfer their EHR to a different hospital. In addition, the proposed scheme is based on crypto-hash functions and asymmetric cryptosystems by using homomorphic cryptography. The proposed scheme carried out two exhaustive formal security proofs for the work that was provided. Using Scyther, a formal security tool, we present a secure user authentication technique in the proposed healthcare scheme that ensures security and informal analysis.

Experiences with information blocking in the United States: a national survey of hospitals.

The 21st Century Cures Act Final Rule's information blocking provisions, which prohibited practices likely to interfere with, prevent, or materially discourage access, exchange, or use of electronic health information (EHI), began to apply to a limited set of data elements in April 2021 and expanded to all EHI in October 2022. We sought to describe hospital leaders' perceptions of the prevalence of practices that may constitute information blocking, by actor and hospital characteristics, following the rule's applicability date. Cross-sectional analysis of a national survey of hospitals fielded in 2021. The analytic sample included 2092 nonfederal acute care hospitals in the United States. We present descriptive statistics on the perception of the prevalence of information blocking and results of multivariate regression models examining the association between hospital, health information technology (IT) developer and market characteristics and the perception of information blocking. Overall, 42% of hospitals reported observing some behavior they perceived to be information blocking. Thirty-six percent of responding hospitals perceived that healthcare providers either sometimes or often engaged in practices that may constitute information blocking, while 17% and 19% perceived that health IT developers (such as EHR developers) and State, regional and/or local health information exchanges did the same, respectively. Prevalence varied by health IT developer market share, hospital for-profit status, and health system market share. These results support the value of efforts to further reduce friction in the exchange of EHI and support the need for continued observation to provide a sense of the prevalence of information blocking practices and for education and awareness of information blocking regulations.

Assessing the effect of electronic health information exchange on the completeness and validity of data for measuring viral load testing turnaround time in Nigeria

IntroductionImplementation of health information exchange has been shown to result in several benefits which includes the improvement in the completeness and timeliness of data for public health program monitoring and surveillance. ObjectiveThe objective of this study was to assess the effect of implementing an electronic health information exchange (HIE) on the quality of data available to measure HIV viral load testing turnaround time (TAT) in Nigeria. MethodsWe measured viral load data validity and completeness before the implementation of electronic health information exchange, and 6 months after implementation. Records of specimens collected at 30 healthcare facilities and tested in 3 Polymerase Chain Reaction (PCR) labs were analyzed. We define data completeness as the percentage of non-missing values and measured this value by specimens and by data elements in the dataset for calculating TAT. To examine data validity, we classified TAT segments with negative values and date fields that were not in International Organization for Standardization(ISO) standard date format as invalid. Validity was measured by specimens and by each TAT segment. Pearson’s chi square was used to assess for improvements in validity and completeness post implementation of HIE. Results15,226 records of specimens were analyzed at baseline and 18,022 records of specimens analyzed at endline. Data completeness for all specimens recorded increased significantly from 47% before HIE implementation to 67% six months after implementation (p < 0.01). Data validity also increased from 90% before implementation to 91% after implementation (p < 0.01) ConclusionOur study demonstrated evidence of significant improvement in the quality of data available to measure viral load turnaround time with the implementation of HIE.

A novel architecture of a secure medical data storage management system based on tangle

Electronic health information exchange allows providers to healthcare providers and patients to securely access vital medical information of the patient and share it in electronically with other healthcare providers. However, existing health systems for the exchange of medical data faced with a number of problems, in particular: security, confidentiality and fragmentation of medical data. Data information systems are isolated because each medical institution, laboratory, doctor use their own system. The patient cannot access their medical information in the right time, since patients still do not have access to these systems. And the exchange of medical information between doctors occurs through mail or patients carry their own medical records with them admission to reception. In healthcare, there is no single system that allows both doctors and patients to have permanent access to the history the patient's illness and prescribed treatment. The paper considers the electronic health system eHealth. In this system, all medical data is stored on central component, and physicians using information systems gets access to them. However, this system has its limitations: single point of failure, lack of a unified medical information systems and patients still do not have access to their medical data. Therefore, one of the solutions to these problems is to create systems for exchanging medical information using directed acyclic graph (DAG). DAG will allow freely exchange data with a guarantee of their integrity. The patient's medical records will be stored in a distributed ledger, and not on the server of the medical institution. So no one can change patient data or deny him access to his own data. The use of DAG is considered on the example of the transfer of medical patient data to the doctor. The process of creating and sending medical data to DAG is illustrated with a specific example.

A novel architecture of a secure medical system using dag

Electronic health information exchange allows providers to healthcare providers and patients to securely access vital medical information of the patient and share it in electronically with other healthcare providers. The paper considers the electronic health system eHealth. The patient's medical records will be stored in a distributed ledger, and not on the server of the medical institution. So no one can change patient data or deny him access to his own data. The use of DAG is considered on the example of the transfer of medical patient data to the doctor. The process of creating and sending medical data to DAG is illustrated with a specific example.

Electronic Connectivity Among US Hospitals Treating Shared Patients.

Increasing electronic health information exchange (HIE) between provider organizations is a top policy priority that has been pursued by establishing varied types of networks. To measure electronic connectivity enabled by these networks, including community, electronic health record vendor, and national HIE networks, across US hospitals weighted by the volume of shared patients and identify characteristics that predict connectivity. Cross-sectional analysis of 1721 hospitals comprising 16,344 hospital pairs and 6,492,232 shared patients from 2018 CareSet Labs HOP data and national hospital surveys. Pairs of US acute care hospitals that delivered care to 11 or more of the same fee-for-service Medicare beneficiaries in 2018. Whether a patient was treated by a pair of hospitals connected through participation in the same HIE network ("connected hospitals") or not connected because the hospitals participated in different networks, only 1 participated, or both did not participate. Sixty-four percent of shared patients were treated by connected hospitals. Of the remaining shared patients, 14% were treated by hospital pairs that participated in different HIE networks, 21% by pairs in which only 1 hospital participated in an HIE network, and 2% by pairs in which neither participated. Patients treated by pairs with at least 1 for-profit hospital, and by pairs located in competitive markets, were less likely to be treated by connected hospitals. While the majority of shared patients received care from connected hospitals, remaining gaps could be filled by connecting HIE networks to each other and by incentivizing certain types of hospitals that may not participate because of competitive concerns.

Retrospective Study of the Reasons and Time Involved for Dental Providers' Medical Consults.

BackgroundPatient-reported medical histories and medical consults are primary approaches to obtaining patients' medical histories in dental settings. While patient-reported medical histories are reported to have inconsistencies, sparse information exists regarding the completeness of medical providers' responses to dental providers' medical consults. This study examined records from a predoctoral dental student clinic to determine the reasons for medical consults; the medical information requested, the completeness of returned responses, and the time taken to receive answers for medical consult requests.MethodsA random sample of 240 medical consult requests for 179 distinct patients were selected from patient encounters between 1 January 2015 and 31 December 2017. Descriptive statistics and summaries were calculated to determine the reasons for the consult, the type of information requested and returned, and the time interval for each consult.ResultsThe top two reasons for medical consults were to obtain more information (46.1%) and seek medical approval to proceed with treatment (30.3%). Laboratory and diagnostic reports (56.3%), recommendations/medical clearances (39.6%), medication information (38.3%), and current medical conditions (19.2%) were the frequent requests. However, medical providers responded fewer times to dental providers' laboratory and diagnostic report requests (41.3%), recommendations/medical clearances (19.2%), and current medical conditions (13.3%). While 86% of consults were returned in 30 days and 14% were completed after 30 days.ConclusionsThe primary reasons for dental providers' medical consults are to obtain patient information and seek recommendations for dental care. Laboratory/diagnostic reports, current medical conditions, medication history, or modifications constituted the frequently requested information. Precautions for dental procedures, antibiotic prophylaxis, and contraindications included reasons to seek medical providers' recommendations. The results also highlight the challenges they experience, such as requiring multiple attempts to contact medical providers, the incompleteness of information shared, and the delays experienced in completing at least 25% of the consults.Practical ImplicationsThe study results call attention to the importance of interdisciplinary care to provide optimum dental care and the necessity to establish systems such as integrated electronic dental record-electronic health record systems and health information exchanges to improve information sharing and communication between dental and medical providers.

Patient portal access for caregivers of adult and geriatric patients: reframing the ethics of digital patient communication

Patient portals are poised to transform health communication by empowering patients with rapid access to their own health data. The 21st Century Cures Act is a US federal law that,...

Progress Toward Digital Transformation in an Evolving Post-Acute Landscape

Digitization has been a central pillar of structural investments to promote organizational capacity for transformation, and yet skilled nursing facilities (SNFs) and other post-acute providers have been excluded and/or delayed in benefitting from the past decade of substantial public and private-sector investment in information technology (IT). These settings have limited internal capacity and resources to invest in digital capabilities on their own, propagating a limited infrastructure that may only further sideline SNFs and their role in an ever-evolving health care landscape that needs to be focused on age-friendly, high-value care. Meaningful progress will require continuous refinement of supportive policy, financial investment, and scalable organizational best practices specific to the SNF context. In this essay, we lay out an action agenda to move from age-agnostic to age-friendly digital transformation. Key to the value proposition of these efforts is a focus on interoperability—the seamless exchange of electronic health information across settings that is critical for care coordination and for providers to have the information they need to make safe and appropriate care decisions. Interoperability is not synonymous with digital transformation, but a foundational building block for its potential. We characterize the current state of digitization in SNFs in the context of key health IT policy advancements over the past decade, identifying ongoing and emergent policy work where the digitization needs of SNFs and other post-acute settings can be better addressed. We also discuss accompanying implementation considerations and strategies for optimally translating policy efforts into impactful practice change across an ever-evolving post-acute landscape. Acting on these insights at the policy and practice level provides cautious optimism that nursing home care—and care for older adults across the care continuum—may benefit more equitably from the promise of future digitization.

The IMPACT Act of 2014: Standardizing patient assessment data to support care coordination, quality outcomes, and interoperability.

The Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act) addressed the need for uniform, clinical, and demographic data in post-acute care (PAC) settings. Structured, uniform data enables potential interoperable data exchange, quality comparisons across PAC provider types, and the capacity to explore a Medicare unified PAC payment system. Standardized patient assessment data elements were developed for clinical domains such as cognitive function and mental status, special services, treatments, and interventions, and medical conditions and comorbidities to create a common language that can be used to bolster a patient's needs and goals to improve clinical outcomes. Clinical care, decision making, and care planning were at the center of all decisions made to standardize specific data elements. In addition, all standardized data were mapped to nationally accepted vocabulary standards to support electronic health information exchange. The standardized patient assessment data elements present the foundation for uniform language across the PAC continuum to promote a greater quality of care for every patient.

Rapid adoption of electronic health record and health information exchange among assisted living communities, 2010-2018.

Adoption of electronic health records (EHRs) and health information exchange (HIE) is a key tool to improving the quality of care in assisted living communities (ALC). We examined whether EHRs were being used in ALC to support HIE in 2010 and 2018. We found that adoption of EHR and HIE functions increased substantially over the study period. However, adoption of HIE functions lagged significantly behind EHR functions in both 2010 and 2018 and was accompanied by growing disparities in the adoption of EHR functions among smaller, nonchain, and for-profit communities. To improve the quality of care for this important and growing population, targeted policies are needed to support the adoption of both EHR and HIE functions in ALC.

Acceptability of Health Information Exchange and Patient Portal Use in Depression Care Among Underrepresented Patients.

BackgroundDepression is often untreated or undertreated, particularly among underrepresented groups, such as racial and ethnic minorities, and individuals of lower socioeconomic status. Electronic health information exchange (HIE) is a recommended practice to improve care coordination and encourage patient engagement in services, but it remains underutilized in depression care. Understanding factors affecting acceptance and adoption of this technology among underrepresented patient populations is needed to increase dissemination of HIE within mental health treatment.ObjectiveThe present study aims to identify patient barriers and facilitators towards the acceptance of HIE within the context of depression treatment and to examine how HIE impacts depression-related care coordination and patient activation.DesignSemi-structured qualitative interviews were conducted with 27 patients.ParticipantsRespondents were English-speaking adults (> 18) receiving depression treatment within a large, safety-net primary care clinic.ApproachA grounded theory approach was used to code and analyze data for emergent themes. Thematic analysis was guided by the Unified Theory of Acceptance and Use of Technology, a leading informatics theory used to predict end-user adoption of technology.Key ResultsRespondents reported that HIE made depression care more convenient, transparent, and trustworthy. Though respondents desired greater access to their health records, stigma surrounding depression inhibited acceptance of electronic communication and information sharing. Confusing electronic interface also diminished perceived benefits of HIE.Conclusion(s)Respondents desire greater transparency in their depression care. While HIE was perceived to improve the overall quality of depression care, stigma associated with mental illness undermined more robust adoption of this technology among underserved populations.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11606-022-07427-2.

Assessment of structured data elements for social risk factors.

Computable social risk factor phenotypes derived from routinely collected structured electronic health record (EHR) or health information exchange (HIE) data may represent a feasible and robust approach to measuring social factors. This study convened an expert panel to identify and assess the quality of individual EHR and HIE structured data elements that could be used as components in future computable social risk factor phenotypes. Technical expert panel. A 2-round Delphi technique included 17experts with an in-depth knowledge of available EHR and/or HIE data. The first-round identification sessions followed a nominal group approach to generate candidate data elements that may relate to socioeconomics, cultural context, social relationships, and community context. In the second-round survey, panelists rated each data element according to overall data quality and likelihood of systematic differences in quality across populations (ie, bias). Panelists identified a total of 89 structured data elements. About half of the data elements (n = 45) were related to socioeconomic characteristics. The panelists identified a diverse set of data elements. Elements used in reimbursement-related processes were generally rated as higher quality. Panelists noted that several data elements may be subject to implicit bias or reflect biased systems of care, which may limit their utility in measuring social factors. Routinely collected structured data within EHR and HIE systems may reflect patient social risk factors. Identifying and assessing available data elements serves as a foundational step toward developing future computable social factor phenotypes.

A study of the adoption behaviour of an Electronic Health Information Exchange System for a Green economy

ABSTRACT Sustainable Development Goals (SDGs), 17 of which all nations of the world are targeting to achieve by 2030, are essential for a sustainable future. Two key aspects pertaining to good health and well-being, responsible production and consumption are integral to SDGs. Adoption of technologies like artificial intelligence and big data, presented by the fourth industrial revolution, can facilitate achieving these goals and also help establish a circular economy. In this paper, we study the concerns related to the security, privacy and confidentiality of personal information of patients in an Electronic Health Information Exchange (EHIE) System. This system helps achieve the two SDGs mentioned above and is linked to the adoption of green recovery efforts. The Antecedent, Privacy-Concern and Outcomes Micro Model (APCO) and the Theory of Planned Behaviour (TPB) are used in this study to develop testable hypotheses which have been corroborated through a survey. Aadhar Card based Medical Records EHIE, which the Government of India is planning to implement by 2030, has been taken as the case study. Adoption behaviour of the EHIE System is validated through this study. Three hundred fifty-seven responses across a wide range of demographic participants were received. The structural equation modelling technique (PL-SEM) was used to validate the hypotheses. This study has found that the EHIE System has a positive impact on the intention of citizens to use EHIE for exchange of health information.

Institutional factors affecting the electronic health information exchange by ambulatory providers

ObjectiveElectronic exchange of health information by health entities along the care continuum can vastly improve patient health outcomes as well as reduce costs. To realize the national goal of a health information highway, it is important for a large pool of ambulatory providers to engage in health information exchange (HIE) to share clinical information with affiliated and unaffiliated providers. Applying institutional theory, this research seeks to examine the key institutional factors that influence the HIE use by ambulatory practices. Material and MethodsData was gathered through a web-based survey of 320 ambulatory providers in the US state of Illinois. Partial least squares approach to structural equation modeling was used to examine the influence of five institutional factors viz. government, patients, peers, affiliates and technology vendors on the use of HIE by ambulatory providers to share clinical information with (i) affiliated providers, and (ii) external, unaffiliated providers. FindingsWe found positive and significant influence of government initiatives, patients, peers and affiliates on ambulatory providers’ HIE with affiliated providers (R2 = 0.347) and unaffiliated providers (R2 = 0.328). Peer influence was positive and significant for HIE with unaffiliated providers only. No significant influence of technology vendors on HIE use by ambulatory practices was found. ConclusionAddressing a critical gap in our knowledge of how ambulatory providers engage in HIE, we provide compelling evidence for the influence of institutional factors on ambulatory providers’ electronic HIE with both affiliated and unaffiliated providers. Policy makers and healthcare leaders need to pay attention to the institutional factors and frame appropriate programs to augment and promote the use of HIE by ambulatory providers.

The effect of a mobile integrated health program on health care cost and utilization.

To measure the effect of a mobile integrated health community paramedicine (MIH-CP) transitional care program on hospital utilization, emergency department visits, and charges. Retrospective secondary data from the electronic health record and regional health information exchange were used to analyze patients discharged from a large academic medical center and an affiliated community hospital in Baltimore, Maryland, May 2018-October 2019. We performed an observational study comparing patients enrolled in an MIH-CP program to propensity-matched controls. Propensity scores were calculated using measures of demographics, clinical characteristics, social determinants of health, and prior health care utilization. The primary outcome is inpatient readmission within 30 days of discharge. Secondary outcomes include excess days in acute care 30 days after discharge and emergency department visits, observation hospitalizations, and total health care charges within 30 and 60 days of discharge. Included patients were over 18 years old, discharged to home from internal/family medicine services, and live in eligible ZIP codes. The intervention group was enrolled in the MIH-CP program; controls met inclusion criteria but were not enrolled during the study period. The adjusted model showed no difference in 30-day inpatient readmission between 464 enrolled patients and propensity-matched controls (adjusted incidence rate ratio=1.19, 95% confidence interval [CI] [0.89, 1.60]). There was a higher rate of observation hospitalizations within 30 days of index discharge for MIH-CP patients (adjusted incidence rate ratio=1.78, 95% CI=[1.01, 3.14]). This difference did not persist at 60 days, and there were no differences in other secondary outcomes. We found no significant difference in short-term health care utilization or charges between patients enrolled in an MIH-CP transitional care program and propensity-matched controls. This highlights the importance of well-controlled, robust evaluations of effectiveness in novel care-delivery systems.

Hospital SUD Programs, Psychiatric Hospitals Lag in Electronic Health Record Use

Hospital SUD Programs, Psychiatric Hospitals Lag in Electronic Health Record Use