Interoperable Health Information Technology Research Articles

Primary Care Physicians’ Satisfaction With Interoperable Health Information Technology

Enabling widespread interoperability-the ability of health information technology systems to exchange information and to use that information without special effort-is a primary focus of public policy on health information technology. More information on clinicians' experience using that technology can serve as one measure of the impact of that policy. To assess primary care physician perspectives on the state of interoperability. A cross-sectional survey of family medicine physicians in the US was conducted from December 12, 2021, to October 12, 2022. A sample of family medicine physicians who completed the Continuous Certification Questionnaire (CCQ), a required part of the American Board of Family Medicine certification process, which has a 100% response rate, were invited to participate. Eighteen items on the CCQ assessed experience accessing and using various information from outside organizations, including medications, immunizations, and allergies. A total of 2088 physicians (1053 women [50%]; age reported categorically as either ≥50 years or <50 years) completed the CCQ interoperability questions in 2022. Of these respondents, 35% practiced in hospital or health system-owned practices, while 27% practiced in independently owned practices. Eleven percent were very satisfied with their ability to electronically access all 10 types of information from outside organizations included on the questionnaire, and a mean of 70% were at least somewhat satisfied. A total of 23% of family medicine physicians reported information from outside organizations was very easy to use, and an additional 65% reported that information was somewhat easy to use. Only 8% reported that information from different electronic health record (EHR) developers' products was very easy to use compared with 38% who reported information from the same EHR developer's product was very easy to use. This survey study of family medicine physicians found modest and uneven improvement in physicians' experience with interoperability. These findings suggest that substantial heterogeneity in satisfaction by information type, source of information, EHR, practice type, ownership, and patient population necessitates diverse policy and strategies to improve interoperability.

Technology-facilitated care coordination in rural areas: What is needed?

BackgroundHealth is poorer in rural areas and a major challenge is care coordination for complex chronic conditions. The HITECH and 21st Century Cure Acts emphasize health information exchange which underpins activities required to improve care coordination. Objective and methodsUsing semi-structured interviews and surveys, we examined how providers experience electronic health information exchange during care coordination since these Acts were implemented, with a focus on rural settings where health disparities exist. We used a purposive sample that included primary care, acute care hospitals, and community health services in the United States. FindingsWe identified seven themes related to care coordination and information exchange: ‘insufficient trust of data’; ‘please respond’; ‘just fax it’; ‘care plans’; ‘needle in the haystack’; ‘re-documentation’; and ‘rural reality’. These gaps were magnified when information exchange was required between unaffiliated electronic health records (EHRs) about shared patients, which was more pronounced in rural settings. ConclusionPolicy and incentive modifications are likely needed to overcome the observed health information technology (HIT) shortcomings. Rural settings in the United States accentuate problems that can be addressed through international medical informatics policy makers and the implementation and evaluation of interoperable HIT systems.

Sustainable Information Infrastructures: Insights from a Realist Synthesis.

Policy makers and health system managers in many countries are advocating the deployment of inter-operable health information technology systems, spanning organisations in a health economy, believing that they will be clinically effective. The case for investments has not, however, been made to date. This paper presents early results from a systematic review of the effects of inter-operable systems on patient safety. The review uses the realist synthesis method, which focuses on evidence about the decisions and actions that link interventions and outcomes, as well as the evidence about those outcomes. The evidence base is sufficient to identify plausible arguments for investments in inter-operable systems. This said, there is limited empirical evidence about each of the steps in the sequences of events. We comment on implications for the design of sustainable socio-technical solutions. We suggest that current gaps in the evidence base are in areas where informatics field methods can make a valuable contribution to our understanding of the role of inter-operable systems in patient safety.

Organizational implications of implementing a new adverse drug event reporting system for care providers and integrating it with provincial health information systems.

Cross-sector collaborations between academia, government, and private industry, known as Triple Helix configurations, are increasingly common. In the health Information Technology (IT) sector, such configurations often also include health delivery organizations where technology is implemented and used. The complexity of collaborating within and between multiple organizations can present hurdles for innovators that are seldom discussed in the literature. We outline challenges we encountered in cross-sector collaboration and offer some guiding principles for decision-makers, academics, industry partners, and health delivery organizations to successfully negotiate divergent approaches to innovation and implementation. We discuss an innovative project that aims to implement a researcher-designed adverse drug event reporting system into clinical care and integrate it with provincial and health authority IT systems. Based on our experience, implementing an interoperable health IT system must extend beyond technical integration to encompass meaningful stakeholder engagement to ensure utility for end-users and beneficial impact for participating organizations.

Adoption of Health Information Technology Among US Nursing Facilities

ObjectivesNursing facilities have lagged behind in the adoption of interoperable health information technology (ie technologies that allow the sharing and use of electronic patient information between different information systems). The objective of this study was to estimate the nationwide prevalence of electronic health record (EHR) adoption among nursing facilities and to identify the factors associated with adoption. DesignCross-sectional survey. Setting & participantsWe surveyed members of the Society for Post-Acute & Long-Term Care Medicine (AMDA) about their organizations’ health information technology usage and characteristics. MeasurementsUsing questions adopted from existing instruments, the survey measured nursing home's EHR adoption, the ability to send, receive, search and integrate electronic information, as well as barriers to usage. Additionally, we linked survey responses to public use secondary data sources to construct measurements for 8 determinants known to be associated with organizational adoption: innovativeness, functional differentiation, role specialization, administrative intensity, professionalism, complexity, technical knowledge resources, and slack resources. A series of regression models estimated the association between potential determinants and technology adoption. Results84% of nursing facilities reported using an EHR. After controlling for all other factors, respondents who characterized their organization as more innovative had more than 6 times the odds (adjusted odds ratio = 6.39, 95% confidence interval = 2.69, 15.21) of adopting an EHR. Organization innovativeness was also associated with an increased odds of being able to send, integrate, and search for electronic information. The most commonly identified barrier to sharing clinical information among nursing facilities with an EHR was a reported absence of interoperability (57%). Conclusions/ImplicationsAn organizational culture that fosters innovation and awareness campaigns by professional societies may facilitate further adoption and effective use of technology. This will be increasingly important as policy makers continue to emphasize the use of EHRs and interoperability to improve the quality of care in nursing facilities.

Complementary Initiatives from the NIDDK to Advance Kidney Health.

Despite the high prevalence and burden of acute and chronic kidney diseases, our understanding of appropriate clinical care and underlying disease pathology is far from complete. Nephrology clinical practice guidelines are littered with weak recommendations on the basis of low or very low evidence.

Integrating health care for high-need medicaid beneficiaries with serious mental illness and chronic physical health conditions at managed care, provider, and consumer levels.

Policies supporting value-based care and alternative payment models, notably in the Affordable Care Act and the Medicare Access & CHIP Reauthorization Act of 2015, offer hope to advance care integration for individuals with behavioral and chronic physical health conditions. The potential for integration to improve quality while managing costs for individuals with high needs, coupled with the remaining financial, operational, and policy challenges, underscores a need for continued discussion of integration programs' preliminary outcomes and lessons. The authors describe the early efforts of the HealthChoices HealthConnections pilot program for adult Medicaid beneficiaries with serious mental illness and co-occurring chronic conditions, which used a navigator model in 3 southeastern Pennsylvania counties. The authors conducted a difference-in-differences analysis of emergency department (ED) visits, hospitalizations, and readmissions using Medicaid claims data and collected data about program implementation. ED visits decreased 4% among study group members (n = 4,788) while increasing almost 6% in the comparison group (n = 7,039) during the intervention period (p = .036); there were no statistically significant differences in hospitalizations or readmissions. This pilot demonstrated the promise of nurse navigators (care managers) to bridge gaps between the physical and mental health care systems, and the success of a private-public partnership developing a member profile to share behavioral and physical health information in the absence of an interoperable health information technology system. The implementation lessons can inform state Medicaid Health Home models as well as accountable care organizations considering incorporation of behavioral health care. (PsycINFO Database Record

Do Pediatric Patients Who Receive Care Across Multiple Health Systems Have Higher Levels of Repeat Testing?

Repetition by clinicians of the same tests for a given patient is common. However, not all repeat tests are necessary for optimal care and can result in unnecessary hardship. Limited evidence suggests that an electronic health record may reduce redundant laboratory testing and imaging by making previous results accessible to physicians. The purpose of this study is to establish a baseline by characterizing repeat testing in a pediatric population and to identify significant risk factors associated with repeated tests, including the impact of using multiple health systems. A population-based retrospective cross-sectional design was used to examine initial and repeat test instances, defined as a second test following an initial test of the same type for the same patient. The study population consisted of 8760 children with 1-25 test claims over a 1-year period. The study setting included all health care service organizations in Minnesota that generated these claims. In all, 17.2% of tests met the definition of repeat test instances, with several risk factors associated with per patient repeat test levels. The incidence of repeat test instances per patient was significantly higher when patients received care from more than 1 health system (adjusted incidence rate ratio 1.4; 95% confidence interval: 1.3-1.5). Repeat test levels are significant in pediatric populations and potentially actionable. Interoperable health information technology may reduce the incidence of repeat test instances in pediatric populations by making prior test results readily accessible. (Population Health Management 2016;19:102-108).

Public and private sector roles in health information technology policy: Insights from the implementation and operation of exchange efforts in the United States

ObjectivesIn the US, the federal and state governments are supporting interoperable health information technology (HIT) and health information exchange (HIE) through policy interventions and financial investments. However, private healthcare organizations and partnerships have also been active in establishing exchange activities, promoting interoperability, and developing technologies. This combination of influence from different actors has resulted in a rapidly changing healthcare environment. In this context, we sought insights into the optimal roles for the public and private sectors in HIT/HIE policy development and implementation. MethodsWe leveraged the concurrency of federal and New York State initiatives to spur HIT/HIE adoption by interviewing HIT experts (n=17). Interviewees represented federal and state government agencies, healthcare providers, and exchange organizations. A semi-structured interview guide with open-ended questions covered the domains of organization, value, privacy, security, and evaluation. We analyzed transcripts using a general inductive and comparative approach. ResultsInterviewees assigned roles for standard setting and funding to the federal government and suggested states were better positioned to offer implementation support. Interviewees forwarded a public–private partnership model as a potential solution to the limitations facing the private and public sectors. ConclusionsHIT/HIE policy is a complex issue involving standards, privacy, funding and implementation. When New York State began funding HIT, significant federal intervention did not exist. Since the launch of New York State’s program and the subsequent federal Meaningful Use criteria, interviewees expressed distinct but complementary roles for both state and federal governments and saw an avenue to include the private sector through public–private partnerships.

Development and initial validation of a content taxonomy for patient records in general dentistry

ObjectiveDevelop and validate an initial content taxonomy for patient records in general dentistry. MethodsPhase 1 – obtain 95 de-identified patient records from 11 general dentists in the United States. Phase 2 – extract individual data fields (information items), both explicit (labeled) and implicit (unlabeled), from records, and organize into categories mirroring original field context. Phase 3 – refine raw list of information items by eliminating duplicates/redundancies and focusing on general dentistry. Phase 4 – validate all items regarding inclusion and importance using a two-round Delphi study with a panel of 22 general dentists active in clinical practice, education, and research. ResultsAnalysis of 76 patient records from 9 dentists, combined with previous work, yielded a raw list of 1509 information items. Refinement reduced this list to 1107 items, subsequently rated by the Delphi panel. The final model contained 870 items, with 761 (88%) rated as mandatory. In Round 1, 95% (825) of the final items were accepted, in Round 2 the remaining 5% (45). Only 45 items on the initial list were rejected and 192 (or 17%) remained equivocal. ConclusionGrounded in the reality of clinical practice, our proposed content taxonomy represents a significant advance over existing guidelines and standards by providing a granular and comprehensive information representation for general dental patient records. It offers a significant foundational asset for implementing an interoperable health information technology infrastructure for general dentistry.

LTC Information-Technology Challenges Remain, But Experts Say to Get on Board

LTC Information-Technology Challenges Remain, But Experts Say to Get on Board

Overview: HTM Professionals And Electronic Health Records

Revolutionary changes in healthcare delivery systems are impacting every facet of healthcare itself, including clinical engineering. While basic equipment services will always be needed, more time and human resources must be dedicated to emerging markets within health IT as a part of a large delivery team. Now is the time to initiate the changes necessary to promote the evolution of health IT.

Low-income, ethnically diverse consumers' perspective on health information exchange and personal health records

We surveyed low-income, ethnically diverse consumers regarding their attitudes towards providers' use of electronic health information exchange (HIE) and consumer use of HIE through personal health records (PHRs). Amongst respondents (n = 214), 48% had an annual household income below $15,000 and 62% spoke a language other than English at home. A majority indicated that they supported providers' use of HIE (61%). Support for providers' use of HIE was independently associated with consumer willingness to permit health care providers other than their primary care doctor to view their electronic medical record information (odds ratio (OR) = 2.92, 95% confidence interval (CI) = 1.31–6.50) and beliefs that electronic health record use would improve quality of care (OR = 2.70, 95% CI = 1.18–6.18). Seventy-eight percent would potentially use PHRs. Potential PHR use was independently associated with Internet usage rates, (OR = 4.46, 95% CI = 1.77–11.22), belief that PHR use would improve their understanding of their own healthcare (OR = 3.12, 95% CI = 1.27–7.67) and comfort with sharing PHR data with their primary care doctor (OR = 2.79, 95% CI = 1.09–7.11). Low-income, ethnically diverse consumers affected by interoperable health information technology (IT) initiatives largely support using PHRs and HIE, provided these systems demonstrate benefits and address the privacy and security of their electronic health information. Although we found interest in PHRs comparable or higher than nationally representative populations, support for HIE was lower, and thus efforts will need to be made to engage low-income and ethnically diverse consumers to participate in interoperable health IT initiatives.

HIT Leaders Tout Multiple Benefits, Improved Privacy Protections

Back to table of contents Previous article Next article Government NewsFull AccessHIT Leaders Tout Multiple Benefits, Improved Privacy ProtectionsRich DalyRich DalySearch for more papers by this authorPublished Online:16 Jul 2010https://doi.org/10.1176/pn.45.14.psychnews_45_14_019AbstractCompanies that make health information technology products are pressing federal regulators to expedite creation of national regulations on electronic medical record systems—despite continuing concerns by physician groups—maintaining that the promised benefits outweigh the misgivings of critics.Neal Neuberger, executive director of the Institute for e-Health Policy, calls for expedited regulations to implement a federal electronic medical record incentive program. Goals are to improve patient health and catch up to the information-sharing capabilities of other industrialized nations.Credit: Rich DalyLeaders of the many companies that build and implement health information technology (HIT) systems were in Washington, D.C., in June to lobby Congress and urge regulators to speed up development of rules to implement a federal program aimed at spurring nationwide adoption of digital medical information systems. Physician concerns have helped slow the process of issuing regulations to implement provisions of the American Recovery and Reinvestment Act of 2009 (ARRA, PL 111-5), which included $17 billion in grants to encourage clinicians to use electronic medical records (EMRs)—a central component of HIT systems.APA and other physician groups have criticized the federal program, in part because of concerns that federal regulators have underestimated the high cost to physician practices of EMR adoption and continuing HIT system maintenance. Physician advocates warn that the true cost to physicians of HIT systems that would comply with all of the proposed regulations could dwarf federal assistance provided through the ARRA.But the HIT industry, which manufactures and installs costly EMR systems, said such concerns do not warrant further delays in the completion of the regulations and launch of the multibillion-dollar incentive program.“We need to implement these tools as quickly as possible,” said Barry Chaiken, M.D., chair of the Healthcare Information Management Systems Society, at a June 15 press conference in Washington, D.C. “We believe these goals are not—repeat, not—too aggressive.”The technology companies emphasized that nationwide adoption of HIT systems would provide a range of benefits to patients and physicians through improved record keeping, reduction in medical errors, and expedited access by medical personnel to critical information that could save lives.“We want to fundamentally change the way we deliver care,” said David Muntz, a member of the board of trustees of the College of Healthcare Information Management Executives.The health-technology leaders continue to reach out to physicians, who not only will spend billions of federal and their own dollars on new record systems as part of the federal goal for every American to have an EMR by 2014, but also can provide critical information to their colleagues on which HIT system they prefer. To that end, the HIT manufacturers are also urging federal officials to maintain antitrust exemptions for physicians that would allow them to communicate with each other regarding adoption and implementation of HIT systems.“Physicians no longer talk about walking away from the technology; now they embrace it,” Muntz said.The HIT providers also stressed the improvements that they have made to the privacy protections included in their electronic data systems. For example, EMRs now allow patients to view “audit trails” of their records to see who has viewed the information. Physician and patient-privacy advocates have repeatedly warned that existing law and technology standards provide insufficient security and patient control of their health data. This is particularly troubling to mental health advocates, due to the societal stigma often directed at people with mental illness.Generally, the HIT leaders don't expect additional federal funding beyond the $19 billion in federal incentives for hospitals and physicians that will be provided under the ARRA; however, more federal money could be directed at encouraging adoption of EMRs in specific areas of medicine. For example, Rep. Patrick Kennedy (D-R.I.), co-chair of the 21st Century Health Care Caucus in Congress, introduced the Health Information Technology Extension for Behavioral Health Services Act (HR 5040) in April to provide incentives and grants to mental health care providers and psychiatric hospitals that establish interoperable HIT systems.More information on the Health Information Technology Extension for Behavioral Health Services Act can be accessed at <http://thomas.loc.gov> by searching on the bill number, HR 5040. ISSUES NewArchived

Health care reform legislation: Momentous implications for shaping pharmacy's future

AphA–AppM Anyone who travels has heard or asked this question along the way. Are we there yet? The question implies that one is moving forward, is engaged in the process, and is a little impatient for the destination. Does this sound like our experiences with health care reform (HCR)? Many milestones have occurred in the journey toward the landmark HCR legislation. Most notable for pharmacists was the Pharmacy Principles for Health Care Reform1 document, which was supported by major pharmacy organizations and stakeholders. We reached a consensus among a large and diverse group of pharmacy stakeholders and rallied all pharmacists in support of a set of cardinal principles that included (1) quality and safety, (2) infrastructure to support access to medications and pharmacy services, and (3) interoperable health information technology accessible by pharmacists. We worked together to effectively interact with legislators through the many iterations of the bills in the House of Representatives and Senate. We collaborated, we focused our issues, and we were proactive. Promising opportunities exist for pharmacy in the HCR legislation that was passed, including those afThese may include pharmacy-related services such as “conducting comprehensive medication review and management including, if appropriate, counseling and self-management support.” In Section 3201, medication therapy management (MTM), which is envisioned in terms more extensive than those required under Medicare Part D, will support care coordination and management performance bonuses for Medicare Advantage plans. Pharmacists are included explicitly in the health care workforce in Section 5101, which establishes a National Health Care Workforce Commission. These and other opportunities in PPACA will support quality improvement strategies, prevention and wellness initiatives, and workforce programs.

HEAL NY: Promoting Interoperable Health Information Technology In New York State

Through a novel, ambitious program called HEAL NY, New York State plans to invest $250 million in health information technology (IT) that can be linked electronically to other health IT systems. In contrast to high rates of closure by other organizations attempting health information exchange (HIE), 100 percent of HEAL NY Phase 1 grantees still existed two years after awards were announced, 85 percent were still pursuing HIE, and 35 percent had actual users. The number of grantees meeting basic criteria for regional health information organizations (RHIOs) increased. Although it is early, lessons learned can inform state-based initiatives nationwide.

Improved Safety, Communication Underlie Part D E-Prescribing Rule

Back to table of contents Previous article Next article Professional NewsFull AccessImproved Safety, Communication Underlie Part D E-Prescribing RuleMark MoranMark MoranSearch for more papers by this authorPublished Online:16 May 2008https://doi.org/10.1176/pn.43.10.0002The Centers for Medicare and Medicaid Services (CMS) has issued a final rule on e-prescribing standards for the Part D prescription drug program.The rule, which appeared in the Federal Register on April 7 and becomes effective on April 1, 2009, adopts four standards for use in e-prescribing:Formulary and benefits: This standard allows doctors and other prescribers to communicate with Part D sponsors about which drugs are covered by a Medicare beneficiary's prescription drug plan. Prescribers can also learn which generic prescription drugs might offer lower-cost options for the individual.Medication history: This standard allows doctors and other providers, as well as dispensers and Part D sponsors, to communicate among themselves about prescribed medications a beneficiary has taken or is taking, including those prescribed by other providers.Fill-status notification: This standard allows doctors and other providers to receive an electronic notice from the pharmacy or other dispenser telling them that a patient's prescription has been picked up, has not been picked up, or has been partially filled.Provider identifier: Providers, dispensers, and Part D sponsors must use their National Provider Identifier (NPI) to identify individual health care providers in Part D e-prescribing transactions.CMS says the standards will enhance safety, increase use of lower-cost generic equivalents, and improve communication between doctors and pharmacies. In a statement released with the new standards, CMS Acting Administrator Kerry Weems said they move the health care system closer to interoperable health information technology.“Use of these e-prescribing standards by Part D plan sponsors, providers, and dispensers will directly benefit Medicare-eligible individuals,” said Weems. “They will save time both in their doctor's office and at the pharmacy counter. [Beneficiaries] may even see lower out-of-pocket costs as a result of formulary and benefit information becoming available at the point of care. Prescribers and dispensers will benefit through workflow improvements—freeing up time for interaction with patients.”Prescribers, dispensers, and other providers are not required to implement e-prescribing, but those who do must comply with the new Medicare standards when using e-prescribing to send prescriptions for Part D eligible individuals and prescription-related information for covered drugs.The latest Part D e-prescribing standards supplement a set of“ foundation” standards, published in November 2005, which took effect with the start of Part D on January 1, 2006. Those standards addressed the exchange of information among prescribers, dispensers, and Part D sponsors on such matters as eligibility inquiries and responses; new prescriptions; and changes, renewals, and cancellations of existing prescriptions.This final rule on Part D e-prescribing standards and the earlier final rule establishing e-prescribing foundation standards are posted at<www.cms.hhs.gov/EPrescribing/>. The final rule is also posted in the Federal Register at<http://edocket.access.gpo.gov/2008/08-1094.htm>. More information on HHS's health IT initiatives is posted at<www.hhs.gov/healthit>.▪ ISSUES NewArchived

Commentary

Americans' spending on health care is the highest in the world, yet it does not equate with the value expected. There are disparities in access to care and a wide variation in quality. It is imperative that the US health care payment and delivery system change. The Centers for Medicare and Medicaid Services (CMS) have defined and are implementing the CMS Quality Roadmap, which includes (1) working with stakeholder collaboratives; (2) reporting to the public; (3) reforming the reimbursement systems to reward quality; (4) promoting health information technology and evidence-based medicine; and (5) increasing availability of new treatments, technologies, innovations, and information. This will fit in the value-driven health care initiative of The Department of Health and Human Services. Strategies included (1) developing quality and efficiency metrics for kidney patients, (2) measuring quality at the individual dialysis facility and nephrologist level, (3) reporting outcomes including as consumer/payer choice incentives by the public, (4) reforming the reimbursement system, (5) promoting interoperable health information technology, (6) focusing on health disparities, (7) coordinating the system of care for patients, and (8) changing treatment when indicated by new evidence.

Pursuing Health IT: The Delicate Dance Of Government And The Market

Pursuing Health IT: The Delicate Dance Of Government And The Market

Regions work to exchange health information

President Bush declared a year ago that he wants the government to pave the way for “an interoperable health information technology infrastructure to improve the quality and efficiency of health care.” Such an effort takes time—the Office of the National Coordinator for Health Information Technology is reportedly sorting through some 5000 pages of suggestions for the national health information network—and not all health systems and care providers want to wait for the government. Some of these health systems and care providers envisioned communitywide or regional real-time exchange of patient-specific clinical information years before Bush made his intention known. At least 100 first-generation regional health information organizations (RHIOs) are in development, according to the Bush administration’s leader in health information technology, David Brailer. In fact, the RHIO that Brailer and colleagues in southern California started in 1999 is expected to be fully usable in April or May 2005, said Mike Skinner, executive director of Santa Barbara County Care Data Exchange.