Health Information Exchange Systems Research Articles

Searchable Blockchain-Based Healthcare Information Exchange System to Enhance Privacy Preserving and Data Usability.

Ensuring the security and usability of electronic health records (EHRs) is important in health information exchange (HIE) systems that handle healthcare records. This study addressed the need to balance privacy preserving and data usability in blockchain-based HIE systems. We propose a searchable blockchain-based HIE system that enhances privacy preserving while improving data usability. The proposed methodology includes users collecting healthcare information (HI) from various Internet of Medical Things (IoMT) devices and compiling this information into EHR blocks for sharing on a blockchain network. This approach allows participants to search and utilize specific health data within the blockchain effectively. The results demonstrate that the proposed system mitigates the issues of traditional HIE systems by providing secure and user-friendly access to EHRs. The proposed searchable blockchain-based HIE system resolves the trade-off dilemma in HIE by achieving a balance between security and the data usability of EHRs.

Monitoring and reporting the US COVID-19 vaccination effort

Immunizations are an important tool to reduce the burden of vaccine preventable diseases and improve population health.1 High-quality immunization data is essential to inform clinical and public health interventions and respond to outbreaks of vaccine-preventable diseases. To track COVID-19 vaccines and vaccinations, CDC established an integrated network that included vaccination provider systems, health information exchange systems, immunization information systems, pharmacy and dialysis systems, vaccine ordering systems, electronic health records, and tools to support mass vaccination clinics. All these systems reported data to CDC’s COVID-19 response system (either directly or indirectly) where it was processed, analyzed, and disseminated. This unprecedented vaccine tracking effort provided essential information for public health officials that was used to monitor the COVID-19 response and guide decisions. This paper will describe systems, processes, and policies that enabled monitoring and reporting of COVID-19 vaccination efforts and share challenges and lessons learned for future public health emergency responses.

Multi-Agent Systems Requirements Analysis for Patient-centered Healthcare Consultancy Service

Agents are currently being discussed in nearly every domain of science and engineering. Through the utilization of IoT and agent-based systems, remote consultations and virtual doctors can provide essential healthcare services by analyzing patient data and medical history. The purpose of this paper is provide an analysis the requirements for multi-agent systems in patient-centered health consultancy services in Kenya. It focuses on various agent types, including hardware, hospital, human, software, database/storage, and technological/framework agents. For hardware, computers, laptops, and mobile devices need specific processing power, memory, network connectivity, storage, and security. Medical equipment must prioritize accuracy, reliability, integration with records, and regulatory compliance. Networking requires high-speed internet, security, and redundancy. Hospital agents offer comprehensive inpatient and outpatient care, categorized into general, mental health, and specialized hospitals. Human agents, like medical specialists, IT professionals, and administrators, play essential roles in healthcare consultancy. Software agents encompass Electronic Health Records (EHRs), Clinical Decision Support Systems (CDSS), Telemedicine platforms, and more. Database/storage agents include EHRs, Health Information Exchange (HIE) systems, and data encryption. Technological/framework agents involve health information systems, telemedicine platforms, decision support systems, and health data analytics frameworks. These agents enable efficient data management, remote care, evidence-based decisions, and secure data exchange.

SMART HEALTHCARE EMPOWERMENT: INTEGRATING IOT, CLOUD, AND HEALTHCARE STANDARDS WITH RASPBERRY PI FOR ENHANCED PATIENTDATA COLLECTION

The research paper introduces an innovative framework that harnesses the capabilities of In- ternet of Things (IoT) and cloud computing technologies to revolutionize patient data collection within smart healthcare systems. This framework bears similarities to the Electronic Health Records System (EHRS) in the USA and aligns with the development of a health stack in India. In this context, the Raspberry Pi functions as a central gateway device, facilitating seamless connections between various sensors and medical devices for data acquisition. The collected data is then transmitted to a cloud-based platform for secure storage, comprehensive analysis, and seam- less accessibility by healthcare providers. This system, in line with the development of the health stack in India, aims to create a robust and standardized digital infrastructure for healthcare data management. By doing so, it paves the way for a nationwide health information exchange system, similar to the EHRS [Rahman et al.2019]in the USA. The framework also empowers remote mon- itoring, real-time data analysis, and the provision of personalized healthcare services to patients, thus significantly enhancing the efficiency and effectiveness of healthcare systems in India, while promoting interoperability and data exchange, akin to the EHRS model in the USA.

Successes and Barriers of Health Information Exchange Participation Across Hospitals in South Carolina From 2014 to 2020: Longitudinal Observational Study.

The 2009 Health Information Technology for Economic and Clinical Health Act sets three stages of Meaningful Use requirements for the electronic health records incentive program. Health information exchange (HIE) technologies are critical in the meaningful use of electronic health records to support patient care coordination. However, HIE use trends and barriers remain unclear across hospitals in South Carolina (SC), a state with the earliest HIE implementation. This study aims to explore changes in the proportion of HIE participation and factors associated with HIE participation, and barriers to exchange and interoperability across SC hospitals. This study derived data from a longitudinal data set of the 2014-2020 American Hospital Association Information Technology Supplement for 69 SC hospitals. The primary outcome was whether a hospital participated in HIE in a year. A cross-sectional multivariable logistic regression model, clustered at the hospital level and weighted by bed size, was used to identify factors associated with HIE participation. The second outcome was barriers to sending, receiving, or finding patient health information to or from other organizations or hospital systems. The frequency of hospitals reporting each barrier related to exchange and interoperability were then calculated. Hospitals in SC have been increasingly participating in HIE, improving from 43% (24/56) in 2014 to 82% (54/66) in 2020. After controlling for other hospital factors, teaching hospitals (adjusted odds ratio [AOR] 3.7, 95% CI 1.0-13.3), system-affiliated hospitals (AOR 6.6, 95% CI 3.2-13.7), and rural referral hospitals (AOR 8.0, 95% CI 1.2-53.4) had higher odds to participate in HIE than their counterparts, whereas critical access hospitals (AOR 0.1, 95% CI 0.02-0.6) were less likely to participate in HIE than their counterparts reimbursed by the prospective payment system. Hospitals with greater ratios of Medicare or Medicaid inpatient days to total inpatient days also reported higher odds of HIE participation. Despite the majority of hospitals reporting HIE participation in 2020, barriers to exchange and interoperability remained, including lack of provider contacts (27/40, 68%), difficulty in finding patient health information (27/40, 68%), adapting different vendor platforms (26/40, 65%), difficulty matching or identifying same patients between systems (23/40, 58%), and providers that do not typically exchange patient data (23/40, 58%). HIE participation has been widely adopted in SC hospitals. Our findings highlight the need to incentivize optimization of HIE and seamless information exchange by facilitating and implementing standardization of health information across various HIE systems and by addressing other technical issues, including providing providers' addresses and training HIE stakeholders to find relevant information. Policies and efforts should include more collaboration with vendors to reduce platform compatibility issues and more user engagement and technical training and support to facilitate effective, accurate, and efficient exchange of provider contacts and patient health information.

Blockchain innovation for consent self-management in health information exchanges

With the increasing digitalization of health data, patients need to make informed decisions about the online sharing of their protected health information. This necessitates a robust technical infrastructure that enables patients to self-manage consent and the trusted exchange of this information across sharing entities. Unfortunately, current health information exchange systems in the U.S. are limited in both these regards. While there is recent work on digital patient consent management, there is limited work that provides effective solutions for patient self-management of consent. Further, interoperability issues in the way health information exchanges are currently architected and differences in regulations across localities exacerbate the challenges of consent management. In this research, we survey potential patients' willingness to self-manage healthcare-related consent. Having established the desire for consent self-management, we propose a solution that enables the seamless sharing of patient consent across different healthcare providers and health information exchanges. Specifically, we use a rigorous design science approach to create a blockchain-based, self-managed patient consent system and we evaluate the design through an instantiated prototype. The results of our study should be useful to researchers in healthcare information management as well as to practitioners designing consent management systems. Our research contributes to design science research with an innovative, rigorously evaluated, design principles-based artifact that addresses a critical problem of sharing protected health information.

Use of Health Information Exchange in the Continuity of Care as Viewed by Patients and Nurses: A Cross-Sectional Study.

Patients' attitudes toward sharing their personal health information are critical for implementation of health information exchange. Nurses contribute significantly to information sharing within the care continuum in hospitals and community. This study aimed to examine the awareness and readiness of patients with chronic illness and nurses to the use health information exchange. A cross-sectional study was conducted among 314 inpatients with a chronic illness, 110 nurses working in internal wards, and 55 contact nurses working in a large health maintenance organization. The findings showed that the mean level of awareness was low across all three groups. Contact nurses expressed more positive attitudes than internal ward nurses or patients and were more willing than patients to share information with healthcare workers. Knowledge, attitudes, and being a nurse predicted the intention to share information with medical healthcare providers and with agents not involved in direct care. Before implementation of a health information exchange system, it is important to raise awareness, readiness, and intention to use it among the public, nurses, and other medical staff. Policy makers should organize national campaigns under the auspices of the Ministry of Health to present the advantages and provide detailed information about the system.

1375. Validation of a Syndromic Surveillance Query for Lyme Carditis – New York, 2017-2021

Abstract Background Lyme carditis is a rare and potentially fatal manifestation of Lyme disease. Although Lyme disease is nationally notifiable, data on specific clinical manifestations are not collected systematically. We sought to use a novel syndromic surveillance query to identify patients with Lyme carditis in New York State (excluding New York City) during 2017-2021. Methods Using the National Syndromic Surveillance Program’s BioSense Platform, we developed a query using a combination of diagnosis codes and chief complaint terms to identify emergency department visits related to Lyme carditis. We systematically reviewed and abstracted key information in each identified individual medical record through New York’s regional health information exchange system, requesting supplemental records when needed. Two physicians independently assigned a clinical case status (confirmed; probable; not a case) to each abstracted record; when adjudications differed, an infectious disease physician provided a final adjudication. Positive predictive value for the query was calculated and characteristics of cases and non-cases were described. Results The query identified 175 individuals. Records were available for review for 139 individuals. Among these, 37% (n = 52) were classified as confirmed, 17% (n = 24) as probable, and 45% (n = 63) as not a case. In total, we identified 76 cases of confirmed or probable Lyme carditis for which records were available; the positive predictive value of the query was 45%. Cases occurred in 28 of New York’s 57 counties (excluding New York City); most (64%) occurred during May–September. Median age was 60 years for cases (IQR 33 – 73) and 67 years for non-cases (IQR 42 – 78) (p = 0.13); 29% of cases and 38% of non-cases were female (p = 0.23). Among cases, 76% had positive IgG or IgM immunoblots and 37% had second- or third-degree atrioventricular block. Conclusion Using a syndromic surveillance query, we detected 76 cases of Lyme carditis, a rare disease of public health importance. Syndromic surveillance using this query may provide a useful marker for Lyme-endemic states to use to detect changing disease patterns, including temporal or spatial clusters of severe Lyme disease manifestations. Disclosures All Authors: No reported disclosures.

Evaluation of a Health Information Exchange System for Geriatric Health Care in Rural Areas: Development and Technical Acceptance Study.

BackgroundPatients of geriatrics are often treated by several health care providers at the same time. The spatial, informational, and organizational separation of these health care providers can hinder the effective treatment of these patients.ObjectiveThis study aimed to develop a regional health information exchange (HIE) system to improve HIE in geriatric treatment. This study also evaluated the usability of the regional HIE system and sought to identify barriers to and facilitators of its implementation.MethodsThe development of the regional HIE system followed the community-based participatory research approach. The primary outcomes were the usability of the regional HIE system, expected implementation barriers and facilitators, and the quality of the developmental process. Data were collected and analyzed using a mixed methods approach.ResultsA total of 3 focus regions were identified, 22 geriatric health care providers participated in the development of the regional HIE system, and 11 workshops were conducted between October 2019 and September 2020. In total, 12 participants responded to a questionnaire. The main results were that the regional HIE system should support the exchange of assessments, diagnoses, medication, assistive device supply, and social information. The regional HIE system was expected to be able to improve the quality and continuity of care. In total, 5 adoption facilitators were identified. The main points were adaptability of the regional HIE system to local needs, availability to different patient groups and treatment documents, web-based design, trust among the users, and computer literacy. A total of 13 barriers to adoption were identified. The main expected barriers to implementation were lack of resources, interoperability issues, computer illiteracy, lack of trust, privacy concerns, and ease-of-use issues.ConclusionsParticipating health care professionals shared similar motivations for developing the regional HIE system, including improved quality of care, reduction of unnecessary examinations, and more effective health care provision. An overly complicated registration process for health care professionals and the patients’ free choice of their health care providers hinder the effectiveness of the regional HIE system, resulting in incomplete patient health information. However, the web-based design of the system bridges interoperability problems that exist owing to the different technical and organizational structures of the health care facilities involved. The regional HIE system is better accepted by health care professionals who are already engaged in an interdisciplinary, geriatric-focused network. This might indicate that pre-existing cross-organizational structures and processes are prerequisites for using HIE systems. The participatory design supports the development of technologies that are adaptable to regional needs. Health care providers are interested in participating in the development of an HIE system, but they often lack the required time, knowledge, and resources.

Surgical inter‐hospital transfers: life saver or resource drainer?

As to diseases, make a habit of two things – to help, or at least to do no harm. The Hippocratic Corpus1 IHTs may be necessary for multiple reasons. These include lack of appropriate resources at the index hospital, higher acuity of care requirement, or need for complex multidisciplinary specialist care to ensure adequate patient management.4, 9 The process of IHT is complicated, requiring effective dialogue between the referring and receiving teams to ensure pertinent clinical information is communicated and patient-specific needs relayed.8, 10 Each transfer requires individualized shared decision making with patient safety and medical stability foremost in mind, taking into consideration the indication for transfer, capabilities of the health-care settings, distance and mode of transportation.10 The inherent intricate nature of the transfer process highlights the importance of having a robust, repeatable and dependable system to ensure optimal patient outcomes. This need has become increasingly apparent in recent years due to the trend of increasing preoperative IHT of surgical patients.11 This is likely due to increasing specialization of urban hospitals and the increased resource demands associated with sophisticated preoperative and intraoperative care.4, 12 However, there is limited evidence on the widespread benefits of surgical IHTs. Many groups of transferred surgical patients have poorer outcomes compared to their non-transferred counterparts, including increased hospital admission length, healthcare costs and in-hospital mortality.9, 13 Transferred patients have twice the associated health-care costs and three times the in-hospital mortality compared with their non-transferred counterparts.9, 13 These poorer outcomes have been demonstrated in a range of surgical pathologies and specialties.5-9 Proposed contributing factors relate to patients (e.g. older age, lower SES), disease (e.g. life-threatening illness) and transportation (e.g. mode of transport, distance travelled).9 Postponement of surgery due to delay in transfer or increased preoperative transfer time due to remoteness of the referring hospital is a major contributor to poorer surgical outcomes.5-7 There are several proposals to address and overcome the barriers associated with effective IHTs. Utilizing an appropriate mode of transportation concordant with the distance needing to be traversed, the geography of the region, the equipment and expertise of available transfer crew, and the medical stability of the patient have been shown to improve survival.10 Developing a systematic and rigorous health information exchange and handover system between facilities improve patient outcomes by ensuring accurate and up-to-date patient clinical data and diagnosis is available.10 The presence of specialized and experienced staff during transfer has also been shown to reduce transport morbidity.4 Patients with myocardial infarction or stroke experience improved outcomes following IHTs, likely due to standardized transfer protocols and expedited interventions.9 These success stories demonstrate the potential positive consequences of effective IHTs. Particularly in the dynamic climate of COVID-19, an evidence-based approach must be utilized to improve IHTs in Australia.14 There remains a need for further investigation into factors affecting the negative trajectory of surgical patients that undergo IHTs. It is imperative that factors resulting in futile transfers are identified to ensure best patient care and that scarce regional resources are not squandered. A national surgical audit database, such as the Australian and New Zealand Audit of Surgical Mortality, captures data from all surgical mortality in Australia and may play a key role in discovering relevant avoidable factors contributing to patient mortality during IHT.15 Recent reviews of this data identified that IHTs were involved in up to 30% of cases of surgical mortality11. IHTs to provide necessary patient care is inevitable due to the unique challenges of the Australian geography, population density and health-care system. Current evidence demonstrates that IHTs are an independent risk factor for mortality in surgical presentations. Avoidable transport-associated factors have been identified, however the current rate of mortality in IHT suggest further research into attributable factors should be performed to minimize patient harm and reduce surgical mortality. IHTs have the potential to be a lifeline for the unwell surgical patient, and careful planning is imperative to ensure it is not an unintended resource drainer. Open access publishing facilitated by The University of Adelaide, as part of the Wiley - The University of Adelaide agreement via the Council of Australian University Librarians. Ishraq Murshed: Conceptualization; investigation; writing – original draft; writing – review and editing. Aashray K. Gupta: Conceptualization; investigation; writing – review and editing. Joshua G. Kovoor: Conceptualization; investigation; writing – review and editing. Guy J. Maddern: Conceptualization; investigation; supervision; writing – review and editing.

Integrated Health Record Viewers and Reduction in Duplicate Medical Imaging: Retrospective Observational Analysis.

BackgroundHealth information exchange and multiplatform health record viewers support more informed medical decisions, improve quality of care, and reduce the risk of adverse outcomes due to fragmentation and discontinuity in care during transition of care. An example of a multiplatform health record viewer is the VA/DoD Joint Longitudinal Viewer (JLV), which supports the Department of Veterans Affairs (VA) and Department of Defense (DoD) health care providers with read-only access to patient medical records integrated from multiple sources. JLV is intended to support more informed medical decisions such as reducing duplicate medical imaging when previous image study results may meet current clinical needs.ObjectiveWe estimated the impact of provider usage of JLV on duplicate imaging for service members transitioning from the DoD to the VA health care system.MethodsWe conducted a retrospective cross-sectional study in fiscal year 2018 to examine the relationship between providers’ use of JLV and the likelihood of ordering duplicate images. Our sample included recently separated service members who had a VA primary care visit in fiscal year 2018 within 90 days of a DoD imaging study. Patients who received at least one imaging study at VA within 90 days of a DoD imaging study of the same imaging mode and on the same body part are considered to have received potentially duplicate imaging studies. We use a logistic regression model with “JLV provider” (providers with 1 or more JLV audits in the prior 6 months) as the independent variable to estimate the relationship between JLV use and ordering of duplicate images. Control variables included provider image ordering rates in the prior 6 months, provider type, patient demographics (age, race, gender), and clinical characteristics (Elixhauser comorbidity score).ResultsProviders known to utilize JLV in the prior 6 months order fewer duplicate images relative to providers not utilizing JLV for similar visits over time (odds ratio 0.44, 95% CI 0.24-0.78; P=.005). This effect is robust across multiple specifications of linear and logistic regression models. The provider’s practice pattern of ordering image studies and the patient’s health status are powerful confounders.ConclusionsThis study provides evidence that adoption of a longitudinal viewer of health records from multiple electronic health record systems is associated with a reduced likelihood of ordering duplicate images. Investments in health information exchange systems may be effective ways to improve the quality of care and reduce adverse outcomes for patients experiencing fragmentation and discontinuity of care.

Health information exchange in relation to point-of-care testing in home care: Issues in Japan

Laboratory tests, especially point-of-care testing (POCT), and related health information exchange (HIE) are necessary for patient management in the home care setting, where clinic-hospital cooperation and interprofessional collaboration are important. We raised the issues ahead of HIE in relation to POCT in home care in Japan, including issues in electronic medical record use, localized interprofessional collaboration networks with information and communication technology, personal health record use and open connectivity. HIE system may depend on the initiatives of expert communities with non-expert partnership, as well as national healthcare policies. We promote future challenges in this growing area.

Benefits and concerns associated with blockchain-based health information exchange (HIE): a qualitative study from physicians' perspectives

BackgroundBlockchain technology has the potential to revolutionize information sharing in companies. Many studies suggest using blockchain-powered platforms to replace existing mechanisms for health information exchange (HIE) across healthcare organizations. However, very few blockchain-based projects have been implemented in the healthcare sector. This study takes a qualitative approach to explore benefits, concerns, and barriers to the rollout of blockchain in HIE projects from physicians' perspectives.MethodsThe Promoting Action on Research Implementation in Health Services (PARIHS) framework was used to help us better understand root causes, existing problems, perceived risks, perceived benefits, and suggestions. In-depth interviews have been conducted with 38 physicians in six months. The data were analyzed and coded using NVIVO to classify conceptually similar themes mentioned by the interviewees.ResultsIn total, seven themes have been identified. The key benefits are categorized into three themes: innovative technological features, collaborative ecosystem, and system performance. The main concerns and risks are categorized into four themes: individual, organizational, technological, and market-related issues. The findings can contribute to knowledge by highlighting key values expected from blockchain technology in HIEs. The results also explore obstacles to leveraging the blockchain in healthcare from the perspectives of an important stakeholder (physicians).ConclusionsThe results show that although blockchain technology may create several benefits (e.g., innovative technological features, collaborative ecosystem, and system performance), its applications in healthcare are still in their early stages. The perceptions of the individual issues (e.g., lack of knowledge), organizational issues (e.g., implementation issues), technological issues (e.g., blockchain model types), and market-related issues (e.g., regulatory concerns) indicate that blockchain-based applications in healthcare continue to be an emerging field. This study has practical implications as understanding these concerns can help developers and healthcare managers identify potential issues in the planning, developing, and implementing blockchain-based HIE systems. Addressing these barriers would support the widespread use of blockchain-based HIEs in different healthcare settings and facilitate interoperability and connectivity in regional and community health information networks.

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.

Return visits to the emergency department: An analysis using group based curve models.

Stratification modeling in health services is useful to identify differential patient risk groups, or latent classes. Given the frequency and costs, repeated emergency department (ED) may be an appropriate candidate for risk stratification modeling. We applied a method called group-based trajectory modeling (GBTM) to a sample of 37,416 patients who visited an urban, safety-net ED between 2006 and 2016. Patients had up to 10 ED visits during the study period. Data sources included the hospital's electronic health record (EHR), the state-wide health information exchange system, and area-level social determinants of health factors. Results revealed three distinct trajectory groups. Trajectories with a higher risk of revisit were marked by more patients with behavioral diagnoses, injuries, alcohol & substance abuse, stroke, diabetes, and other factors. The application of advanced computational techniques, like GBTM, provides opportunities for health care organizations to better understand the underlying risks of their large patient populations. Identifying those patients who are likely to be members of high-risk trajectories allows healthcare organizations to stratify patients by level of risk and develop early targeted interventions.

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.

Barriers and facilitators to a health information exchange system between general practitioners and hospitals: a qualitative study in Southern Switzerland.

Health information exchange (HIE) systems are computer tools that healthcare providers use to share patients' medical information electronically. Our study aimed to identify barriers and facilitators perceived by general practitioners (GPs) when using an HIE system in the Canton of Ticino, a region in southern Switzerland. We performed a qualitative study using semi-structured interviews. Ten GPs participated in the study. We analysed transcripts using thematic content analysis and following an abductive approach (a mix of deductive and inductive approaches). Our findings indicate the following main facilitators of the HIE system: (a) the perception of having to do with a secure system; (b) the possibility of delegating its management to secretaries and healthcare assistants; (c) technical support and training; (d) high quality of the information exchanged; (e) positive impact on clinical practice; and (f) regional context. However, major challenges still persist, and GPs reported the following main barriers to using an HIE system: (a) a frequent lack of all the patient documentation they needed; (b) no effective workflow improvements; and (c) lack of some technical features. The results of our study provide a qualitative perspective of opinions and experiences of GPs that can inform improvements of the current HIE system and future federal and cantonal HIE initiatives in Switzerland and elsewhere.

Health Information Exchange between Specialists and General Practitioners Benefits Rural Patients.

Health information exchange (HIE) may improve diagnostic accuracy, treatment efficacy, and safety by providing treating physicians with expert advice. However, most previous studies on HIE have been observational in nature. To examine whether collaboration between specialists and general practitioners (GPs) in rural areas via HIE can improve outcomes among patients at low-to-moderate risk of cardiovascular disease, kidney disease, and stroke. In this randomized controlled trial, the Miyagi Medical and Welfare Information Network was used for HIE. We evaluated the clinical data of 1,092 patients aged ≥65 years living in the rural areas of the Miyagi Prefecture and receiving care from GPs only. High-risk patients were immediately referred to specialists, whereas low-to-moderate risk patients were randomly assigned to an intervention group in which GPs were advised by specialists through HIE (n = 518, 38% male, mean age = 76 ± 7 years) or a control group in which GPs received no advice by specialists (n = 521, 39% male, mean age = 75 ± 7 years). In the intention-to-treat analysis, all-cause mortality and cumulative incidence of serious adverse events (e.g., hospital admission or unexpected referral to specialists) did not differ between the groups. However, per-protocol analysis controlling for GP adherence with specialist recommendations revealed significantly reduced all-cause mortality (p = 0.04) and cumulative serious adverse event incidence (p = 0.04) in the intervention group compared with the control group. HIE systems may improve outcomes among low-to-moderate risk patients by promoting greater collaboration between specialists and GPs, particularly in rural areas with few local specialists.

The Impact of the Health Information Exchange System for the hospital management in Japan

The Impact of the Health Information Exchange System for the hospital management in Japan

MEXchange: A Privacy-Preserving Blockchain-Based Framework for Health Information Exchange Using Ring Signature and Stealth Address

Health information exchange (HIE) refers to the integrated management and secure sharing of health information among healthcare entities. HIE improves healthcare quality and streamline healthcare administrative work. These advantages have propelled health-care stakeholders to implement HIE. However, challenged by issues such as security, privacy, and costs, HIE is not widespread. Recent studies have suggested blockchain-based HIE for solving security and privacy issues. Unfortunately, existing blockchain-based HIE studies do not consider the privacy issues caused by analyzing senders and receivers of transactions in the blockchain. In this work, we suggest MEXchange, a novel blockchain-based privacypreserving HIE that prevents the privacy issue by obscuring the sender and concealing receiver addresses. We propose smart contracts and workflow that use ring signature and stealth address for blockchainbased HIE. Software components and implementation of MEXchange on the Ethereum private network are discussed. We evaluate MEXchange quantitatively by measuring the transaction latency and throughput of exchanging. Also, we evaluate MEXchange qualitatively using the requirements of the Office of National Coordinator for Health Information Technology (ONC). Moreover, we proceed threat modeling based on STRIDE. Finally, we compare MEXchange with Ancile, FHIRChain, Integrating the Healthcare Enterprise Cross-Enterprise Document Sharing (IHE XDS), and MedRec. The MEXchange lowers barriers to the application of blockchain-based HIE systems by mitigating privacy and security issues among healthcare stakeholders.