Health Information Organizations Research Articles

Challenges, Alternatives, and Paths to Sustainability for Health Information Exchange Efforts Using PROMETHEE Method

Electronic health information sharing and regional health information centres The practise of emergency medicine in the United States can have a significant impact. Regional Health Information Institutes are stakeholder networks that share local or regional information in a specific geographic area. Set up electronic data transfer. Safety of medical care and to improve efficiency across the country regional health information institutions are being created; Public health initiatives, biological surveillance and enhancing the reaction of catastrophe management; and identifying for research enormous databases of aggregate data. However, the economy Organizational issues and including geography to facilitate exchange With the Regional Health Information Organization (RHIO) model They identified challenges. Direct, institutional HIE and such as seller-mediated exchange versus alternative modes of exchange RHIOs vary. Due to political and economic reasons HIE is a difficult task. It is of many types Classified by optional activities; they are for alternatives in judgments The differences between Used to allocate. Under conventional criterion priority functions Using PROMETHEE Choice of health information exchange. This paper proposes that in the final option to check the effect of different optional functions Comparable results are presented. Seven economic and environmental criteria, Four health information and Five decision makers health information exchange problem Major Structures. with decision makers using a five-point Likert scale by personal communication Data was collected. Under the usual criterion function PROMETHEE's algorithm is implemented. The pharmaceutical industry and research, medical trials, healthcare fraud detection, neurological research, and electronic health records are alternatives. Evaluation Parameters are Transparent, Autonomy, Open Source, Anonymity and Decentralized. Health Information Exchange using PROMETHEE. Electronic Health Records, is got third rank, Clinical Research is got first rank, Medical Fraud Detection is got forth rank, Neuroscience Research is got fifth rank and Pharmaceutical Industry and Research is got second rank

Under the influence: system-level effects of alcohol industry-funded health information organizations.

There is now an established body of evidence that the alcohol industry seeks to obstruct public health policies that could affect the availability, affordability or marketing of alcohol. In parallel, the alcohol industry is active in funding corporate social responsibility initiatives, with a particular focus on 'responsible drinking' campaigns, often facilitated by national-level charities established and/or funded by the alcohol industry and associated organizations. While evidence continues to grow regarding biases in the content produced by such health information organizations, they remain active in partnerships with government health departments on national health promotion campaigns and provide a range of health-related information to the public, community organizations and schools. To understand the implications of such access for policymakers, researchers and the public, there is a need to consider the wider, system-level influences of such organizations and their place in wider alcohol industry strategies. In this article, we describe evolving evidence of the direct and indirect strategic effects of such organizations and demonstrate how they serve key roles in the alcohol industry through their existence, content, partnerships and public profiles. We end by considering the implications for how we conceptualize charities established or funded (entirely or partly) by harmful commodity industries, and to what extent current conflicts of interest guidelines are sufficiently effective.

Expanding Psychiatric Treatment in Primary Care Settings: Improved Care Through the Wisconsin Child Psychiatry Consultation Program.

The national shortage of child psychiatrists has resulted in the necessity of primary care providers (PCPs) managing increased mental health concerns of youth. The Wisconsin Child Psychiatry Consultation Program (WI CPCP) is one of several programs throughout the United States which provide PCPs with education, consultation, and resource support related to pediatric mental health. To evaluate initial impact of the program, data from 190 pediatricians and family practitioners from the Wisconsin Health Information Organization (WHIO) were analyzed. Enrollment in the WI CPCP was associated with a significant increase in rates of mental health diagnoses within primary care visits. In addition, the number of providers who made any mental health diagnosis increased from 56% of PCPs pre-enrollment to over 99% post-enrollment. These data provide additional support for pediatric psychiatry consultation programs within primary care.

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.

MP54-15 ASSOCIATION BETWEEN PRE-OPERATIVE OPIOID EXPOSURE AND POST-OPERATIVE OPIOID PRESCRIBING PATTERNS FOLLOWING MAJOR CANCER SURGERY

You have accessJournal of UrologyCME1 Apr 2023MP54-15 ASSOCIATION BETWEEN PRE-OPERATIVE OPIOID EXPOSURE AND POST-OPERATIVE OPIOID PRESCRIBING PATTERNS FOLLOWING MAJOR CANCER SURGERY Emily Serrell, Jessica Schumacher, Manasa Venkatesh, Randi Cartmill, Robert Tyllo, Daniel Shapiro, Kyle Richards, E. Jason Abel, David Jarrard, and Tudor Borza Emily SerrellEmily Serrell More articles by this author , Jessica SchumacherJessica Schumacher More articles by this author , Manasa VenkateshManasa Venkatesh More articles by this author , Randi CartmillRandi Cartmill More articles by this author , Robert TylloRobert Tyllo More articles by this author , Daniel ShapiroDaniel Shapiro More articles by this author , Kyle RichardsKyle Richards More articles by this author , E. Jason AbelE. Jason Abel More articles by this author , David JarrardDavid Jarrard More articles by this author , and Tudor BorzaTudor Borza More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003307.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Most post-operative opioid prescribing guidelines are restricted to opioid naïve populations due to a dearth of data regarding pre-operative opioid use. We aim to quantify pre- and post-operative opioid prescribing patterns among patients undergoing a major cancer surgery and measure the association between pre-operative opioid exposure and post-operative prescribing. METHODS: We used the Wisconsin Health Information Organization database, which includes commercial-payer, Medicare Advantage and Medicaid claims and captures over 75% of Wisconsin’s population. We collected demographic data on adult patients undergoing radical prostatectomy and partial or radical nephrectomy between 1/1/2017 and 12/31/2021. We evaluated pre- and post-operative opioid prescriptions, quantified opioid exposure in morphine milligram equivalents (MME), and compared prescribing characteristics between opioid naïve and opioid exposed patients (defined as those with a filled prescription in 6 months before surgery). RESULTS: We identified 3,693 patients (2,306 prostatectomy; 1,387 partial or radical nephrectomy). 23% of patients were exposed to opioids prior to surgery (18% prostatectomy, 30% nephrectomy). The median pre-operative dose was 202 MME (IQR 100-600), and fills occurred at a median time of 42 days (IQR 18-91), with increasing frequency in the weeks prior to surgery (Figure 1). After surgery, 55% of patients filled an initial opioid prescription, with a median first dose of 171 MME (IQR 100-334), equivalent to 23 oxycodone 5mg tablets. Opioid exposed patients had a significantly higher two-week post-operative dose (238 vs 142 MME, p<0.001) and number of prescriptions filled (1.46 vs 1.23, p<0.001). CONCLUSIONS: Nearly one quarter of prostatectomy and partial or radical nephrectomy patients are exposed to opioids prior to surgery. Post-operative prescribing remains at levels twice the guideline recommendations for all patients, even higher in patients with prior exposure. Understanding the implications of prior opioid exposure on the management of postoperative pain and opioid use is imperative to inform real-world care and guideline recommendations. Source of Funding: AHRQ K08HS028474 award © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e759 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Emily Serrell More articles by this author Jessica Schumacher More articles by this author Manasa Venkatesh More articles by this author Randi Cartmill More articles by this author Robert Tyllo More articles by this author Daniel Shapiro More articles by this author Kyle Richards More articles by this author E. Jason Abel More articles by this author David Jarrard More articles by this author Tudor Borza More articles by this author Expand All Advertisement PDF downloadLoading ...

MP28-20 STATEWIDE OPIOID STEWARDSHIP POLICIES ASSOCIATED WITH MINIMAL CHANGES IN OPIOID PRESCRIBING FOLLOWING UROLOGIC SURGERY

You have accessJournal of UrologyCME1 May 2022MP28-20 STATEWIDE OPIOID STEWARDSHIP POLICIES ASSOCIATED WITH MINIMAL CHANGES IN OPIOID PRESCRIBING FOLLOWING UROLOGIC SURGERY Tudor Borza, Jeremy Goodman, Manasa Venkatesh, Emi Serrell, Elise Lawson, Sudha Quamme, Kyle Richards, E. Jason Abel, David Jarrard, Caprice Greenberg, Corrine Voils, and Jessica Schumacher Tudor BorzaTudor Borza More articles by this author , Jeremy GoodmanJeremy Goodman More articles by this author , Manasa VenkateshManasa Venkatesh More articles by this author , Emi SerrellEmi Serrell More articles by this author , Elise LawsonElise Lawson More articles by this author , Sudha QuammeSudha Quamme More articles by this author , Kyle RichardsKyle Richards More articles by this author , E. Jason AbelE. Jason Abel More articles by this author , David JarrardDavid Jarrard More articles by this author , Caprice GreenbergCaprice Greenberg More articles by this author , Corrine VoilsCorrine Voils More articles by this author , and Jessica SchumacherJessica Schumacher More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002571.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Post-operative overprescribing of opioids contributes to the ongoing opioid epidemic. We evaluate the impact of statewide mandatory opioid stewardship initiatives (Prescription Drug Monitoring Plan verifications for prescriptions exceeding 3 days duration and opioid specific continuing medical education) implemented in 2017 on prescribing patterns following common urologic procedures. METHODS: We used Wisconsin Health Information Organization data, an all-payer claims database covering 75% of Wisconsin’s population, to identify patients undergoing stone (ureteroscopy, ESWL), endoscopic (TURP, TURBT) and major (prostatectomy, nephrectomy and cystectomy) surgeries statewide between January 1, 2016 and December 31, 2017. We captured filled opioid prescriptions within 7 days of a discharge and identified dose (median morphine milligram equivalents (MME)) and duration (median days) for the initial prescription. We compared prescribing between July and December 2016 to the same months in 2017 to allow for an appropriate wash-in period and control for seasonality. RESULTS: We identified 3,788 patients (1,641 ureteroscopy, 581 ESWL, 600 TURP, 438 TURBT, 277 prostatectomy, 225 nephrectomy, and 26 cystectomy) undergoing our procedures of interest in the last 6 months of 2016 and 3,589 patients (1,498 ureteroscopy, 499 ESWL, 629 TURP, 400 TURBT, 312 prostatectomy, 231 nephrectomy, and 20 cystectomy) in the last six months of 2017. In 2016, prescriptions contained a median MME of 150 (IQR=100-150) and 4-day duration (IQR=3-4). In 2017, prescriptions contained a median MME of 112 (IQR=75-112.5) and 3-day duration (IQR=2-3. Median MME decreased for all procedure (p<0.001) while prescription duration decreased from 4 to 3 days for major surgery (p<0.001) and remained at 3 days for the other categories. CONCLUSIONS: In Wisconsin, mandatory statewide opioid stewardship policies implemented in 2017 were associated with a decrease in prescription duration for major procedures but not endoscopic or stone procedures to comply with the policy. Modest changes in the dose prescribed occurred but prescribing remained in excess of guideline recommendations. Direct surgeon engagement and surgeon-led local initiatives may be better positioned to achieve continued improvements in opioid stewardship. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e468 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tudor Borza More articles by this author Jeremy Goodman More articles by this author Manasa Venkatesh More articles by this author Emi Serrell More articles by this author Elise Lawson More articles by this author Sudha Quamme More articles by this author Kyle Richards More articles by this author E. Jason Abel More articles by this author David Jarrard More articles by this author Caprice Greenberg More articles by this author Corrine Voils More articles by this author Jessica Schumacher More articles by this author Expand All Advertisement PDF DownloadLoading ...

A Survey Of Health Information Exchange Organizations In Advance Of A Nationwide Connectivity Framework.

After more than a decade of investment in electronic health information exchange (HIE), the Office of the National Coordinator for Health Information Technology is advancing a national framework-the Trusted Exchange Framework and Common Agreement-to connect islands of electronic data sharing. This national framework creates new potential opportunities and challenges for state and local health information organizations (HIOs). We undertook our sixth national HIO survey to assess the current state of HIOs and to newly examine anticipated responses to the Trusted Exchange Framework and Common Agreement. We identified eighty-nine operational HIOs, down from 106 in 2014. Although more than half of HIOs struggled with financial viability and competition from health information technology vendor-based HIE networks, many are large in scale, offer a breadth of services to diverse participants, and engage in network-to-network connectivity. Looking ahead, 56percent of HIOs planned to participate in the Trusted Exchange Framework and Common Agreement, and 41percent were unsure. As the Trusted Exchange Framework and Common Agreement advances basic network-to-network connectivity, HIOs that have experience with such connectivity while also offering value-added services will be well positioned for sustainability and growth.

Organizational characteristics and perceptions of clinical event notification services in healthcare settings: a study of health information exchange.

ObjectiveEvent notification systems are an approach to health information exchange (HIE) that notifies end-users of patient interactions with the healthcare system through real-time automated alerts. We examined associations between organizational capabilities and perceptions of event notification system use.Materials and MethodsWe surveyed representatives (n = 196) from healthcare organizations (n = 96) that subscribed to 1 of 3 Health Information Organizations’ event notification services in New York City (response rate = 27%). The survey was conducted in Fall 2017 and Winter 2018. Surveys measured respondent characteristics, perceived organizational capabilities, event notification use, care coordination, and care quality. Exploratory factor analysis was used to identify relevant independent and dependent variables. We examined the relationship between organizational capabilities, care coordination, and care quality using multilevel linear regression models with random effects.ResultsRespondents indicated that the majority of their organizations provided follow-up care for emergency department visits (66%) and hospital admissions (73%). Perceptions of care coordination were an estimated 57.5% (β = 0.575; P < 0.001) higher among respondents who reported event notifications fit within their organization’s existing workflows. Perceptions of care quality were 46.5% (β = 0.465; P < 0.001) higher among respondents who indicated event notifications fit within existing workflows and 23.8% (β = 0.238; P < 0.01) higher where respondents reported having supportive policies and procedures for timely response and coordination of event notifications.Discussion and ConclusionHealthcare organizations with specific workflow processes and positive perceptions of fit are more likely to use event notification services to improve care coordination and care quality. In addition, event notification capacity and patient consent procedures influence how end-users perceive event notification services.

A process-based approach to exploring the information behavior of informal caregivers of people living with dementia

Introduction and purposeInformal caregivers of persons living with dementia have significant unmet information needs that, if met, would better equip them to provide effective care. Despite the existence of health information technologies, websites, resources, and organizations dedicated to dementia caregiving, caregivers continue to report unmet information needs. Caregivers’ continued unmet information needs suggest a misalignment between information products, and caregivers’ information behavior—how caregivers generate, acquire, manage, use, communicate, and seek information. Researchers have developed conceptual models for understanding caregivers’ information behavior, but these models are limited in that they are task-oriented, and they assume that caregivers’ information needs will be met if they engage in information behavior. To address these limitations, the present study sought to explore caregivers’ information behavior as a sociotechnical-systems-based process. MethodsWe conduced semi-structured interviews with 30 self-identified caregivers to explore their daily experience of caregiving activities, including their information behavior. We applied a process-based conceptual framework that takes into account inputs, processes, outputs, and feedback mechanisms within a sociotechnical system to guide analysis. The process of interest was caregivers’ information behavior as modeled by the information-seeking and communication model (ISCM). We conducted a deductive content analysis guided by the components of the ISCM. We then used team-based affinity diagramming to collapse and categorize the ISCM components into inputs, processes, outputs, and feedback. ResultsWe developed a conceptual model to depict caregivers’ information behavior as a sociotechnical-systems-based process of inputs, processes, and outputs that feedback into the system. The conceptual model consisted of three inputs (i.e., information users, information providers, and information products), three information seeking and communication processes (i.e., information access, information interaction, and information assessment and processing), two outputs (i.e., utility and credibility), and feedback. Discussion and conclusionBuilding on and addressing the gaps in previous information behavior models, our conceptual framework advances the previous task-level understandings of caregivers’ information behavior into a comprehensive feedback-driven, process-level perspective consisting of context-based inputs, information seeking and communication processes, outputs, and feedback. A sociotechnical-systems-based understanding of caregivers’ information behavior allows for misalignments between information providers and products, and caregivers’ information behavior not only to be illuminated, but systematically addressed.

Detection of Recurrent Hepatitis C Viremia Using Surveillance Data, New York City.

The introduction of direct-acting antivirals for treating hepatitis C virus (HCV) infection has greatly improved cure rates. However, persons with past HCV infection who engage in high-risk behaviors can be reinfected. Surveillance data from the New York City (NYC) Health Department were used to detect and investigate individuals cured during January 2014 to December 2016 who had a subsequent positive RNA test (recurrence) by April 2018. Clinical interpretation of recurrence was obtained using provider interviews and review of medical records available through Regional Health Information Organizations. Among 6938 cured individuals, 209 recurrence events were detected (2.7 per 100 person-years). Investigations were completed for 62 (30%) events. Of 38 investigated events occurring less than 12 months postcure, 17 (45%) were relapses; of 24 events occurring 12 or more months postcure, only one (4%) was a relapse. Understanding the timing, frequency, and clinical interpretation of HCV recurrence will guide HCV prevention and elimination efforts for NYC.

PD09-09 EVALUATION OF POSTOPERATIVE OPIOID PRESCRIBING FOLLOWING COMMON UROLOGIC PROCEDURES IN THE STATE OF WISCONSIN

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety II (PD09)1 Apr 2020PD09-09 EVALUATION OF POSTOPERATIVE OPIOID PRESCRIBING FOLLOWING COMMON UROLOGIC PROCEDURES IN THE STATE OF WISCONSIN Aravind Viswanathan*, Caprice Greenberg, Jessica Schumacher, Manasa Venkatesh, Jonathan Kohler, Elise Lawson, Kyle Richards, Edwin Abel, Tracy Downs, David Jarrard, and Tudor Borza Aravind Viswanathan*Aravind Viswanathan* More articles by this author , Caprice GreenbergCaprice Greenberg More articles by this author , Jessica SchumacherJessica Schumacher More articles by this author , Manasa VenkateshManasa Venkatesh More articles by this author , Jonathan KohlerJonathan Kohler More articles by this author , Elise LawsonElise Lawson More articles by this author , Kyle RichardsKyle Richards More articles by this author , Edwin AbelEdwin Abel More articles by this author , Tracy DownsTracy Downs More articles by this author , David JarrardDavid Jarrard More articles by this author , and Tudor BorzaTudor Borza More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000836.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Postoperative opioid prescribing is associated with a 6% new persistent use rate in previously opioid naïve patients and accounts for significant supply available for diversion to the illicit market. Increased awareness of the opioid epidemic has let to various efforts to curb overprescribing. To assess the effect of these efforts we evaluated prescribing patterns following common urologic procedures in the state of Wisconsin. METHODS: We used Wisconsin Health Information Organization data, an all-payer claims database covering 75% of Wisconsin’s population to identify patients undergoing common urologic procedures (Major: cystectomy, prostatectomy, nephrectomy and Minor: vasectomy, prostate biopsy, ESWL, ureteroscopy, TURP, TURBT). We limited our analysis to Medicaid and commercial insurance data to ensure complete ascertainment of prescription fills. We measured the opioid dose prescribed within 7 days of discharge and identified surgeon level variation in prescribing following both Major and Minor procedures. RESULTS: We identified 11,139 patients undergoing Minor procedures and 937 patients undergoing Major procedures. Initial fill rates ranged from 3.6% (prostate biopsy) to 70.6% (prostatectomy, Table). Higher initial doses were prescribed following Major surgery with a median range of 200-247 morphine milligram equivalents (MME) compared to Minor surgery, where the median range was 75-146 MME. We noted significant surgeon level variation within Minor and Major procedures (Figure). CONCLUSIONS: Opioid prescribing remains common after the majority of common urologic procedures. Significant surgeon level variation exists within the state of Wisconsin in regards to initial postoperative opioid prescriptions. Understanding drivers of this variation is critical to ongoing efforts attempting to address opioid overprescribing. Source of Funding: Pilot grant from Wisconsin Urologic Society © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e177-e178 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aravind Viswanathan* More articles by this author Caprice Greenberg More articles by this author Jessica Schumacher More articles by this author Manasa Venkatesh More articles by this author Jonathan Kohler More articles by this author Elise Lawson More articles by this author Kyle Richards More articles by this author Edwin Abel More articles by this author Tracy Downs More articles by this author David Jarrard More articles by this author Tudor Borza More articles by this author Expand All Advertisement PDF downloadLoading ...

Developing Specialized Graduate Curricula for Health Information Professionals: Integrated Findings of a Scoping Review and an Employer Survey

With the aim of informing specialized graduate curriculum development, this two-phase study seeks to identify and bridge gaps in expectation and preparation between and among employers of health information professionals (HIPs), aspiring HIPs, and library and information science (LIS) graduate curricula. Building upon a scoping review of emerging HIP professional roles, an online survey further explored what professional competencies and qualifications employers in various health information organizations expected or desired of entry-level HIPs. The integrated findings of these two phases revealed that the training that HIPs receive in LIS graduate programs may not accurately reflect employers’ priorities and expectations: While research and professional associations identified the same general skill sets as important, employers also valued competencies such as instructional experience, web skills, “soft” and interpersonal skills, and particular subsets of discipline-specific knowledge as well as a foundation in the complex professional contexts that characterize health-sciences workplaces. These results indicate ways in which LIS programs might develop, adapt, and expand specialized graduate curricula and dynamic professionalization opportunities for students in order to better align learning outcomes with professional core competencies and employer expectations, and to better prepare students for both the technical and interpersonal demands of the job field.

Sharing information electronically with other hospitals is associated with increased sharing of patients.

One potential benefit of greater electronic health information exchange is a reduction in the effort required for patients to switch between providers. We therefore assessed whether hospital participation in health information organizations (HIOs) led to increased patient sharing. Secondary data from 2010 to 2016. Using hospital-pair and year fixed effects regression models, we assessed change in patient sharing volume following HIO participation by hospitals and compared the effect by the level of market competition and by hospital size. We used national data on hospital participation in HIOs from the American Hospital Association Information Technology Supplement and data on the volume of Medicare patients shared between pairs of hospitals from 2010 to 2016. The volume of patients shared between hospitals increased by 2.6 percent when both hospitals participated in a health information organization (P=.008, 95% CI: 0.7%-4.5%). This increase was greater in competitive markets (3.1 percent increase, P=.03 95% CI: 0.3%-5.9%) and between large hospitals (4.3 percent increase, P=.007 95% CI: 1.2%-7.3%). Participation by only one hospital in a pair had no effect on patient sharing. Our results suggest that an important policy goal motivating the investment in health information exchange has been at least partially achieved. However, our results also support hospital concerns about the competitive implications of engaging in health information exchange. HIO participation appears to facilitate patient movement between hospitals, likely by lowering switching costs and resulting in greater competition.

Validation of a surveillance-based definition for hepatitis B treatment eligibility.

ObjectiveTo assess the accuracy of a surveillance-based definition for hepatitis B treatment eligibility among New York City residents with chronic hepatitis B infection.IntroductionApproximately 100,000 New York City (NYC) residents are currently diagnosed with chronic hepatitis B virus (HBV) infection.1 Routine monitoring and treatment, where indicated, are necessary to reduce HBV disease progression. Using the 2017 European Association for the Study of the Liver (EASL) 2 guidelines on HBV infection management, we developed a surveillance-based definition for treatment eligibility. Validation of this definition will support the creation of a population-level HBV care continuum, which will allow us to monitor gaps from HBV diagnosis to viral suppression and to develop public health interventions to address these gaps.MethodsLaboratories everywhere are required to electronically report the following HBV tests to the NYC Department of Health and Mental Hygiene (DOHMH) for all NYC residents: positive and negative (as of April 2018) DNA, positive surface antigen, positive e antigen, positive core IgM, and Alanine aminotransferase (ALT) (when ordered at the same time as another reportable HBV test). Using reportable HBV tests, treatment eligibility was defined as ever having an HBV DNA result &gt;2000 IU/mL and ALT&gt;40 U/L. We assessed the accuracy of the surveillance-based definition by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) by applying the definition to the test data of people participating in two DOHMH programs that included clinical information on treatment eligibility: the Enhanced Surveillance Project (provider interviews conducted for 300 randomly selected patients with chronic HBV) and the Check Hep B Patient Navigation Program (program providing HBV-related patient navigation at community organizations, health centers, and hospitals). Everyone meeting inclusion criteria in the Enhanced Surveillance Project who were also identified as being in care and being monitored (two or more HBV DNA results reported at any time) were included in our analysis. For Check Hep B, we included everyone enrolled prior December 31, 2017 who also met our criteria of being in care and being monitored. To determine treatment eligibility using surveillance data, we used all HBV DNA and ALT results reported prior to January 31st, 2016 for the Enhanced Surveillance project and prior to December 31st, 2017 for Check Hep B.ResultsTreatment eligibility was 62.0% (145/234) among people from the Enhanced Surveillance Project (Table 1A) and 40.0% (161/402) among people enrolled in Check Hep B (Table 1B). Sensitivity of the surveillance-based definition was low using both data sources (Enhanced Surveillance Project: 26.2%; Check Hep B: 24.2%) and specificity high (Enhanced Surveillance Project: 92.1%; Check Hep B: 94.2%). PPV was 84.4% and 73.6% for the Enhanced Surveillance project and Check Hep B, respectively, while NPV was 43.4% and 65.0% for the Enhanced Surveillance project and Check Hep B respectively.ConclusionsOur surveillance-based definition had high specificity, indicating that the great majority of patients who were truly not treatment-eligible were correctly classified. However, sensitivity was low, indicating that the surveillance-based definition was unable to accurately identify those considered treatment-eligible from either data source. Low sensitivity suggests that clinicians are likely using other clinical factors not included in laboratory-based reporting to assess a patient’s eligibility for treatment, such as fibrosis and cirrhosis, and that clinicians might be using guidelines other than EASL (e.g., American Association for the Study of Liver Diseases (AASLD)3) to determine treatment eligibility. We will conduct chart reviews to better understand the variability in criteria being used. These chart reviews will allow us to further refine our surveillance-based definition (e.g., by incorporating different HBV tests or for clinical criteria that are not laboratory-based, including information from external sources such as Regional Health Information Organizations (RHIOs)), eventually supporting the creation of an HBV care continuum for NYC.

The associations between query-based and directed health information exchange with potentially avoidable use of health care services.

To quantify the impact of two approaches (directed and query-based) to health information exchange (HIE) on potentially avoidable use of health care services. Data on ambulatory care providers' adoption of HIE were merged with Medicare fee-for-service claims from 2008 to 2014. Providers were from 13 counties in New York served by the Rochester Regional Health Information Organization (RHIO). Linear regression models with provider and year fixed effects were used to estimate changes in the probability of utilization outcomes for Medicare beneficiaries attributed to providers adopting directed and/or query-based HIE compared with beneficiaries attributed to providers who had not adopted HIE. Providers' HIE adoption status was determined through Rochester RHIO registration records. RHIO and claims data were linked via National Provider Identifiers. Query-based HIE adoption was associated with a 0.2 percentage point reduction in the probability of an ambulatory care sensitive hospitalization and a 1.1 percentage point decrease in the likelihood of an unplanned readmission. Directed HIE adoption was not associated with any outcome. The Centers for Medicare & Medicaid Services' (CMS) EHR certification criteria includes requirements for directed HIE, but not query-based HIE. Pending further research, certification criteria should place equal weight on facilitating query-based and directed exchange.

The relationship between hospital and ehr vendor market dynamics on health information organization presence and participation

BackgroundHealth Information Organizations (HIOs) are third party organizations that facilitate electronic health information exchange (HIE) between providers in a geographic area. Despite benefits from HIE, HIOs have struggled to form and subsequently gain broad provider participation. We sought to assess whether market-level hospital and EHR vendor dynamics are associated with presence and level of hospital participation in HIOs.Methods2014 data on 4523 hospitals and their EHR vendors were aggregated to the market level. We used multivariate OLS regression to analyze the relationship between hospital and vendor dynamics and (1) probability of HIO presence and (2) percent of hospitals participating in an HIO.Results298 of 469 markets (64%) had HIO presence, and in those markets, 47% of hospitals participated in an HIO on average. In multivariate analysis, four characteristics were associated with HIO presence. Markets with more hospitals, markets with more EHR vendors, and markets with an EHR vendor-led HIE approach were more likely to have an HIO. Compared to markets with low hospital competition, markets with high hospital competition had a 25 percentage point lower probability of HIO presence. Two characteristics were associated with level of hospital HIO participation. Markets with more hospitals as well as markets with high vendor competition (compared to low competition) had lower participation.ConclusionBoth hospital and EHR vendor dynamics are associated with whether a market has an HIO as well as the level of hospital participation in HIOs.

A population ecology perspective on the functioning and future of health information organizations.

Increasingly, health care providers need to exchange information to meet policy expectations and business needs. A variety of health information organizations (HIOs) provide services to facilitate health information exchange (HIE). However, the future of these organizations is unclear. The aim of this study was to explore the environmental context, potential futures, and survivability of community HIOs, enterprise HIEs, and electronic health record vendor-mediated exchange using the population ecology theory. Qualitative interviews with 33 key informants representing each type of HIE organization were analyzed using template analysis. Community HIOs, enterprise HIEs, and electronic health record vendors exhibited a high degree of competition for resources, especially in the area of exchange infrastructure services. Competition resulted in closures in some areas. In response to environmental pressures, each organizational type was endeavoring to differentiate its services and unique use case, as well as pursing symbiotic relationships or attempting resource partitioning. HIOs compete for similar resources and are reacting to environmental pressures to better position themselves for continued survival and success. Our ecological research perspective helps move the discourse away from situation of a single exchange organization type toward a view of the broader dynamics and relationships of all organizations involved in facilitating HIE activities. HIOs are attempting to partition the environment and differentiate services. HIE options should not be construed as an "either/or" decision, but one where multiple and complementary participation may be required.

Diverging views on health information exchange organizations.

IntroductionHealth information exchange (HIE) capabilities meet the demands for a more effective, efficient, and safer health care system. However, organizations and individual providers have pursued different strategies to meet their respective needs for HIE capabilities. Because effective information sharing is necessary to a learning health system, this study sought to explore the perceptions of different approaches' effect on key features of an effective health care system.MethodsAn anonymous web‐based survey was sent to a convenience sample of the membership of the Healthcare Information and Management Systems Society and the Strategic Health Information Exchange Collaborative with knowledge of HIE (n=68). A series of 7‐point Likert‐type items measured perceptions of enterprise health information exchanges (eHIEs) and community health information organizations (cHIOs) in the areas of effect on exchange participation, effect on market dynamics, relationship to DIRECT Secure Messaging and vendor‐mediated exchange, and effect on quality. Also, respondents were asked to rate 13 qualities and services as “more about eHIE” or “more about cHIO.”ResultsRespondents tended to agree on the importance of cHIO and eHIE. Community benefits and support for public health agencies were concepts more often applied to cHIOs.DiscussionThis study affirmed much of the conventional wisdom and anecdotal comments about perceptions of cHIOs and eHIEs. Although the respondents viewed cHIOs and eHIEs differently in terms of broader societal benefit and strategic advantage, nonetheless consistent agreement appeared in areas of importance in relationship to other information sharing strategies and overall effect on the quality of care.

Geography of community health information organization activity in the United States: Implications for the effectiveness of health information exchange.

The United States has invested nearly a billion dollars in creating community health information organizations (HIOs) to foster health information exchange. Community HIOs provide exchange services to health care organizations within a distinct geographic area. While geography is a key organizing principle for community HIOs, it is unclear if geography is an effective method for organization or what challenges are created by a geography-based approach to health information exchange. This study describes the extent of reported community HIO coverage in the United States and explores the practical and policy implications of overlaps and gaps in HIO service areas. Furthermore, because self-reported service areas may not accurately reflect the true extent of HIOs activities, this study maps the actual markets for health services included in each HIO. An inventory of operational community HIOs that included self-reported geographic markets and participating organizations was face-validated using a crowd-sourcing approach. Aggregation of the participating hospitals' individual health care markets provided the total geographic market served by each community HIO. Mapping and overlay analyses using geographic information system methods described the extent of community HIO activity in the United States. Evidence suggests that community HIOs may be inefficiently distributed. Parts of the United States have multiple, overlapping HIOs, while others do not have any providing health information exchange services. In markets served by multiple community HIOs, 45% of hospitals were participants of only one HIO. The current geography of community HIO activity does not provide comprehensive patient information to providers, nor community-wide information for public health agencies. The discord between the self-reported and market geography of community HIOs raises concerns about the potential effectiveness of health information exchange, illustrates the limitations of geography as an organizing principle, and indicates operational challenges facing those leading and working with community HIOs.

Integrating Behavioral and Physical Health Care in New Jersey: Legal Requirements for the Sharing of Patient Health Information Among Treatment Providers

The chorus in favor of integrating behavioral and physical health services is strong and diverse, both at the federal level and in New Jersey. Providers, payers, regulators, patients, and academics are uniting behind the strong clinical behavioral health literature highlighting integration’s positive effects on access and clinical outcomes. But integration requires providers to share health information so they may coordinate care. Health care providers often report experiencing barriers to the exchange of health information with other providers. As care has been siloed, so too have many patient records, and it is not always clear who has the legal authority to access them. The Center for Health & Pharmaceutical Law & Policy at Seton Hall University School of Law (the Center) was asked to conduct a legal analysis, as part of New Jersey’s State Innovation Model Grant, of the barriers related to the sharing of patient health information in connection with the integration of physical and behavioral health care. To inform the legal analysis, the Center conducted a number of interviews with providers, regulators, health information exchanges (HIEs), health information organizations (HIOs), trade and professional associations, consultants, privacy attorneys, advocates, and researchers, to learn more about the specific problems providers face and the questions that need answering. This Report has three main goals: 1. To summarize the Center’s legal analysis of federal and New Jersey laws regarding the sharing of patient health information among treatment providers; 2. To identify challenges to health information sharing among treatment providers that relate to these legal requirements; and 3. To suggest opportunities for the State to support provider exchange of treatment information for integration.