National Health Information Network Research Articles

Evaluating trends in pharmacist e-prescribing: 2019–2022

BackgroundPharmacists have some prescriptive authority in all fifty states through dependent and independent prescribing. Data describing the volume and characteristics of pharmacist prescribing are not widely available, and these insights are critical to gauge the impact of regulations supporting pharmacist prescriptive authority. ObjectiveTo identify trends in pharmacist prescribing and compare them to primary care provider (PCP) prescribing trends by analyzing e-prescriptions initiated from electronic health records systems from 2019 through 2022. MethodsThis cross-sectional study used e-prescriptions from a national health information network to identify e-prescriptions ordered by pharmacists and PCPs from January 7, 2019, to January 1, 2023. E-prescriptions ordered by pharmacists and PCPs were analyzed to identify annual volume by prescriber type and most prescribed therapeutic classes. States with the highest volume of e-prescriptions ordered by pharmacists were identified. ResultsThe number of e-prescriptions prescribed by a pharmacist increased 47% from 2019 (n = 814,726) to 2022 (n = 1,199,601). The number of pharmacists prescribing in 2019 was 1650, and this increased by 122% to 3664 in 2022. The number of e-prescriptions prescribed by PCPs increased by 4% from 2019 (n = 927,890,123) to 2022 (n = 965,803,376) while the number of PCPs prescribing increased by 8% from 2019 (n = 364,995) to 2022 (n = 394,753). ConclusionPharmacist e-prescribing increased across the 4 years studied while PCP e-prescribing modestly increased. Factors like access to technology, such as electronic health records, state regulations, and reimbursement impact a pharmacist’s ability to prescribe.

Developing A General Framework for National Health Information Network for Developing Countries

Background: The National Health Information Network (NHIN) is one of the key issues in health information systems in any country. However, the development of this network should be based on an appropriate framework. Unfortunately, the conducted projects of health information systems in the Ministry of Health of Iran do not fully comply with the concept of NHIN. The present study was aimed to develop a general framework for NHIN in Iran. Materials and Methods: In this study, in the first stage, the required information about the concept of the NHIN framework and related NHIN documents in the USA and the UK were collected based on a literature review. Then, according to the results of the first stage and with regards to the structure of the Iranian health system, a general framework for Iranian NHIN was proposed. The Delphi technique was conducted to verify the framework. Results: The proposed framework for Iranian NHIN includes three dimensions; components, principles, and architecture. Over 80% of experts have evaluated all three aspects of the framework at an acceptable scale. In total, the proposed framework has been evaluated by 83.8% of the experts at an acceptable scale. Conclusion: The proposed framework was expected to serve as the starting point for moving towards the design and creation of Iranian NHIN. At any rate, the framework could be criticized, and it could only be used for the countries whose health system is similar to the structure of the health system in Iran. [GMJ.2020;9:e1792]

Challenges to using electronic health records to enhance patient safety, in a Small Island Developing State (SIDS) context

PurposeThis paper is based on a study done to investigate patient safety in two of the largest hospitals in the Maldives, and part of that study was on challenges faced by nurses in using electronic health records (EHRs) to enhance patient safety. Patient safety is a vital component of an established patient safety culture (PSC).Design/methodology/approachThis study was conducted among nurses who also work as patient safety champions/link nurses from hospitals in Central Malé area, in the Maldives, by using focus group discussions. A purposive sampling technique was adopted, and five nurses from each hospital participated in the discussion.FindingsKey findings included poor usability of EHRs; importance of training to use EHRs; and importance of information sharing.Research limitations/implicationsThe implications for positive social change include establishing an EHR, which has the capacity to collaborate with the National Health Information Network while providing access to every patient in the Maldives.Practical implicationsEHR systems can help in collaboration among health-care professionals resulting in better patient outcomes which can contribute to establishing a PSC. Most of the patient documentation is done as paperwork in this clinical area; EHRs can contribute to minimizing paperwork and contributing quality time for better patient care. Establishing an EHR which has the capacity to collaborate with the national health information network while providing access to every patient in the Maldives.Social implicationsEstablishing an EHR which has the capacity to collaborate with the national health information network while providing access to every patient in the Maldives.Originality/valueNurses are the bridge between patients and clinicians during patient care and therefore require as much information as possible to improve patient outcomes. While the EHRs in these two hospitals were electronic patient records (EPRs) developed by staff within the hospitals for their own use, the findings from such a bottom-up approach to develop and use EPRs can be relevant, to ensure patient safety targets of EHRs are met.

Proposed Usage of ICT and Big Data in Healthcare of Madhya Pradesh

Abstract: This paper gives an insight of how information and communications technology (ICT) in combination with big data analytics can help to improve healthcare services in Madhya Pradesh, which is a state in India having approximately 75 million populations. With ongoing projects like ‘Digital India’ which will allow computerization of hospitals and digitization of healthcare data. Digital India coupled with ICT, can play an indispensable role in providing effective healthcare services through e-health application like electronic health record, e-prescription, computerized physician order entry, telemedicine, mhealth along with the network like State wide area network (SWAN) and National health information network which will allow sharing of healthcare records across the network. Data stored through e-health application is of huge size having different formats which makes it difficult to perform analytics on it. But with big data analytics we can perform analytics on large voluminous healthcare data and useful result obtained from data analytics, patients can be given better and specific treatments. It will also help doctors to exchange their knowledge and treatment practices. This paper also illustrates a case study on M.Y. hospital located in Indore, Madhya Pradesh. Keywords: ICT, E-health, Digital India, SWAN, CUG, Big Data Analytics.

Iran's National Health Information Network: Developing an Architectural Model

Aim: This study was conducted to develop a model for the architecture of Iran's National Health Information Network (NHIN).
 Method: In this study, based on the literature review, the necessary information was obtained about the concept of the architecture of the NHIN; then, documents related to NHIN architecture in the United States and the United Kingdom were collected. In the second stage, according to the information obtained in the previous stage and considering the structure of Iran's health system, an architectural model for the NHIN of Iran was presented. Then, the Delphi technique was used to validate the proposed architecture. 
 Results: The proposed architecture of the NHIN of Iran includes three dimensions of nodes or network members, ' 'member's interfaces, and finally, communication with the environment (confidentiality and security). 90% of the experts evaluated each dimension of the proposed architecture on an acceptable scale. In general,, the proposed architecture was evaluated by 90% of experts on an acceptable scale.
 Conclusion: In proposing the architecture of Iran's NHIN, attention was paid to the experiences of the two leading countries, approaches to NHIN design, and the structure of Iran's health system. However, the proposed architecture is critical and can be used for the countries whose health system structure is almost similar to Iran.

Developing A General Framework for National Health Information Network for Developing Countries.

Background: The National Health Information Network (NHIN) is one of the key issues in health information systems in any country. However, the development of this network should be based on an appropriate framework. Unfortunately, the conducted projects of health information systems in the Ministry of Health of Iran do not fully comply with the concept of NHIN. The present study was aimed to develop a general framework for NHIN in Iran. Materials and Methods: In this study, in the first stage, the required information about the concept of the NHIN framework and related NHIN documents in the USA and the UK were collected based on a literature review. Then, according to the results of the first stage and with regards to the structure of the Iranian health system, a general framework for Iranian NHIN was proposed. The Delphi technique was conducted to verify the framework. Results: The proposed framework for Iranian NHIN includes three dimensions; components, principles, and architecture. Over 80% of experts have evaluated all three aspects of the framework at an acceptable scale. In total, the proposed framework has been evaluated by 83.8% of the experts at an acceptable scale. Conclusion: The proposed framework was expected to serve as the starting point for moving towards the design and creation of Iranian NHIN. At any rate, the framework could be criticized, and it could only be used for the countries whose health system is similar to the structure of the health system in Iran.

Design and Implementation of Compressed Medical Data over an Authenticated Secured Channel

Ideally, secure transmission of medical image data is one of the major challenges in health sector. The National Health Information Network has to protect the data in confidential manner. Storage is also one of the basic concern along with secure transmission. In this paper we propose an algorithm that supports confidentiality, authentication and integrity implementation of the scrambled data before transmitting on the communication medium. Before communication the data is compressed while keeping data encrypted. The research work demonstrate with simulation results. The results shows that the proposed work effectively maintains confidentiality, authentication and integrity. The experimental results evaluated medical image quality like PSNR, MSE, SC, and NAEetc.

The Nationwide Health Information Network: The Case of the Expansion of Health Information Exchanges in the United States.

The Nationwide Health Information Network (NHIN) implemented secure exchange of health records through utilization of the Internet. The NHIN has greatly assisted in achieving the goals of the Health Information Technology for Economic and Clinical Health Act by promoting the adoption of Meaningful Use. Epic introduced a Health Information Exchange platform, Care Everywhere, which has facilitated Health Information Exchange availability. The purpose of this research was to determine the impact of NHIN and Epic Care's Care Everywhere on health care to determine whether their use in the emergency department (ED) has increased. The methodology for this study utilized a literature review. Twenty-eight sources were referenced for this study. With the NHIN implementation, repeated visits were decreased, visit times became faster, and charges were lower. Emergency department reported significant benefits with sharing clinical information. The NHIN implementation throughout the ED has increased the quality of health care; duplicated tests and drug usage were determined, and a reduction of the ED length of stay was also achieved.

Key Health Information Technologies and Related Issues for Iran: A Qualitative Study.

Background and Objective:Planning for the future of Health Information Technology (HIT) requires applying a systematic approach when conducting foresight studies. The aim of this study was to identify key health information technologies and related issues for Iran until 2025.Methods:This was a qualitative study and the participants included experts and policy makers in the field of health information technology. In-depth semi-structured interviews were conducted and data were analyzed by using framework analysis and MAXQDA software.Results:The findings revealed that the development of national health information network, electronic health records, patient health records, a cloud-based service center, interoperability standards, patient monitoring technologies, telehealth, mhealth, clinical decision support systems, health information technology and mhealth infrastructure were found to be the key technologies for the future. These technologies could influence the economic, organizational and individual levels. To achieve them, the economic and organizational obstacles need to be overcome.Conclusion:In this study, a number of key technologies and related issues were identified. This approach can help to focus on the most important technologies in the future and to priorities these technologies for better resource allocation and policy making.

Barriers to Pediatric Health Information Exchange.

* Abbreviations: CMS — : Centers for Medicare & Medicaid Services DM — : direct messaging EHR — : electronic health record HIE — : health information exchange MU — : meaningful use ONC — : Office of the National Coordinator The Office of the National Coordinator (ONC) included in stage 2 meaningful use (MU) the requirement for eligible providers to transmit a summary of care record electronically for at least 10% of patients referred or transferred to another setting of care or provider of care.1 The transmission of summary of care records, particularly from ambulatory pediatricians to specialists in tertiary care centers or in hospitals caring for children, would be extremely helpful to children and pediatricians and would improve safety and quality of care. Such transmissions would also reduce costs through avoidance of unnecessary testing, duplicate procedures, and allergic reactions, as well as radiation exposure from unnecessary duplicate radiology tests. Regrettably, means to exchange health information among health care entities remain complex, inefficient, and grossly underutilized.2–5 Outpatient pediatricians have 3 ways to exchange records: (1) participate in the Nationwide Health Information Network; (2) use exchange capabilities available through regional delivery networks through electronic health record (EHR) systems with some health information exchange (HIE) capabilities; or (3) direct messaging (DM), a secure and relatively inexpensive method designed for exchange of patient health information across different networks theoretically available to every provider or facility using a certified EHR. None of these options is widely pursued. Neither referring organizations nor outpatient pediatricians have made participating … Address correspondence to Christoph U. Lehmann, MD, Vanderbilt University Medical Center, Suite 1475, 2525 West End Ave, Nashville, TN 37203. E-mail: culehmann{at}gmail.com

National Health Information Network: Lessons Learned From the USA and the UK

National Health Information Network (NHIN) is a network in which all health care organizations, government agencies and other health-related organizations are connected to each other to exchange information about health. Due to the necessity of a framework for NHIN development, in this paper, according to the literature review, a definition for NHIN framework was provided, and then the NHIN related projects were reviewed in the United States of America (USA) and the United Kingdom (UK), NHIN and National Programme for Information Technology in the NHS (NPfIT), respectively. The Review of NHIN framework in the countries studied show some similarities and differences in each dimension that are discussed in this framework. NHIN guiding principles in the NHS NPfIT were not regarded or were considered incomplete, compared to the US. NHIN architecture in the US is decentralized while it is centralized in the UK. Based on the review of NHIN framework, these two countries represent important points that can be used in many other countries. However, it can be said that the development of NHIN does not only mean the implementation of national system or systems, or the binding of local health information systems, but It also needs to build on a framework in which many of the issues related to the formation of NHIN would be considered; including the cooperation between government, private sector and stakeholders with regard to local, national and international needs.

Interoperability In Radiography Data: The Impossible Dream

Background: Technology in healthcare is changing at a very rapid pace. To ensure that technology is used efficiently to combat rising healthcare costs and new federal policies and laws, all technology must be able to communicate with each other. Therefore, interoperability must be obtained. Radiography is no exception considering all the different types of equipment manufactured routinely used today. Some barriers need to be overcome to achieve interoperability within radiography departments. Purpose: To review the literature on the interoperability of healthcare data to determine the barriers that Radiography departments would have to overcome to improve interoperability of their healthcare data. Methods: The methodology of this literature review follows the fundamental principles of a systematic search, conducted in separate stages, but is not a comprehensive systematic review, which was not reasonable due to resource constraints. The stages of the literature search included defining the search strategy, identifying the inclusion criteria, assessing the relevance and validity of the studies retrieved, and data extraction and synthesis. Results: There were attempts to ensure interoperability, such as the use of the Nationwide Health Information Network (NwHIN), but roadblocks such as financial incentives for physicians and costs of implantation have hindered the adoption of the NwHIN. Other barriers that limit interoperability exist. These obstacles included inconsistency of the Digital Imaging and Communication in Medicine (DICOM) standard for medical imaging departments and a complete lack of norms for certain data points such as the exposure index between different vendors. Discussion: Multiple viable options for the improvement of interoperability are prevalent in radiography departments. One such option is cloud computing, which uses multiple various types of hardware and software as resources to help interoperability of healthcare data. Agent-based technologies, which can be used to distribute management of different standards, can also be utilized to communicate between standards. The largest need to ensure interoperability is standards that are well defined and stringent with an infrastructure to map different terminologies across different standards. Conclusion: Various technological advances can be used to improve interoperability such as agent-based technology and cloud computing. However, until a standardization of terms within the DICOM protocol and a standard across vendors, and all data points standardized, it will be impossible to obtain true interoperability.

The Feasibility of the Nationwide Health Information Network.

The Nationwide Health Information Network (NHIN) use in health care facilities was examined for utilization and efficacy; although the advantages are abundant, health care facilities have been reluctant to adopt it because of associated costs. The purpose of this study was to analyze the feasibility of a US NHIN by exploring and determining the benefits of an NHIN and assessing the barriers to its implementation. The research methodology applied in examining the implementation of NHIN in the United States was a qualitative literature review, which followed the basic guidelines of a systematic literature review, partnered with a semistructured interview of a chief information officer of a private, nonprofit, 193-bed hospital located in Westminster, Maryland. A total of 33 sources were referenced. The results of this study suggest that implementation and utilization of NHIN by health care industry stakeholders lead to an increased quality of patient care, increased patient-provider communication, and cost-savings opportunities. Increased quality of care is achieved by reducing adverse drug events and medical errors. Cost-savings opportunities are generated by a reduction in spending and prices that is attributable to electronic health record systems' increased efficiency and effectiveness. Nevertheless, barriers to NHIN implementation and utilization still remain throughout the health care industry, the main one being concerns about interoperability.

National Health Information Network as a Nationwide Communication Tool

National Health Information Network as a Nationwide Communication Tool

Should medical students track former patients in the electronic health record? An emerging ethical conflict.

Medical students are increasingly using electronic health records (EHRs) in clerkships, and medical educators should seek opportunities to use this new technology to improve training. One such opportunity is the ability to "track" former patients in the EHR, defined as following up on patients in the EHR for educational purposes for a defined period of time after they have left one's direct care. This activity offers great promise in clinical training by enabling students to audit their diagnostic impressions and follow the clinical history of illness in a manner not possible in the era of paper charting. However, tracking raises important questions about the ethical use of protected health information, including concerns about compromising patient autonomy, resulting in a conflict between medical education and patient privacy. The authors offer critical analysis of arguments on both sides and discuss strategies to balance the ethical conflict by optimizing outcomes and mitigating harms. They observe that tracking improves training, thus offering long-lasting benefits to society, and is supported by the principle of distributive justice. They conclude that students should be permitted to track for educational purposes, but only with defined limits to safeguard patient autonomy, including obtaining permission from patients, having legitimate educational intent, and self-restricting review of records to those essential for training. Lastly, the authors observe that this conflict will become increasingly important with completion of the planned Nationwide Health Information Network and emphasize the need for national guidelines on tracking patients in an ethically appropriate manner.

Evaluating and classifying the readiness of technology specifications for national standardization.

The American Recovery and Reinvestment Act (ARRA) of 2009 clearly articulated the central role that health information technology (HIT) standards would play in improving healthcare quality, safety, and efficiency through the meaningful use of certified, standards based, electronic health record (EHR) technology. In 2012, the Office of the National Coordinator (ONC) asked the Nationwide Health Information Network (NwHIN) Power Team of the Health Information Technology Standards Committee (HITSC) to develop comprehensive, objective, and, to the extent practical, quantitative criteria for evaluating technical standards and implementation specifications and classifying their readiness for national adoption. The Power Team defined criteria, attributes, and metrics for evaluating and classifying technical standards and specifications as 'emerging,' 'pilot,' or 'ready for national standardization' based on their maturity and adoptability. The ONC and the HITSC are now using these metrics for assessing the readiness of technical standards for national adoption.

The National Health Information Network and the Future of Medical Information Privacy

The National Health Information Network and the Future of Medical Information Privacy

Developing a common health information exchange platform to implement a nationwide health information network in South Korea.

ObjectivesWe aimed to develop a common health information exchange (HIE) platform that can provide integrated services for implementing the HIE infrastructure in addition to guidelines for participating in an HIE network in South Korea.MethodsBy exploiting the Health Level 7 (HL7) Clinical Document Architecture (CDA) and Integrating the Healthcare Enterprise (IHE) Cross-enterprise Document Sharing-b (XDS.b) profile, we defined the architectural model, exchanging data items and their standardization, messaging standards, and privacy and security guidelines, for a secure, nationwide, interoperable HIE. We then developed a service-oriented common HIE platform to minimize the effort and difficulty of fulfilling the standard requirements for participating in the HIE network. The common platform supports open application program interfaces (APIs) for implementing a document registry, a document repository, a document consumer, and a master patient index. It could also be used for testing environments for the implementation of standard requirements.ResultsAs the initial phase of implementing a nationwide HIE network in South Korea, we built a regional network for workers' compensation (WC) hospitals and their collaborating clinics to share referral and care record summaries to ensure the continuity of care for industrially injured workers, using the common HIE platform and verifying the feasibility of our technologies.ConclusionsWe expect to expand the HIE network on a national scale with rapid support for implementing HL7 and IHE standards in South Korea.

The Evaluation of SEPAS National Project Based on Electronic Health Record System (EHRS) Coordinates in Iran.

Background:Electronic Health Records (EHRs) are secure private lifetime records that can be shared by using interoperability standards between different organizations and units. These records are created by the productive system that is called EHR system. Implementing EHR systems has a number of advantages such as facilitating access to medical records, supporting patient care, and improving the quality of care and health care decisions. The project of electronic health record system in Iran, which is the goal of this study, is called SEPAS. With respect to the importance of EHR and EHR systems the researchers investigated the project from two perspectives: determining the coordinates of the project and how it evolved, and incorporating the coordinates of EHR system in this project.Methods:In this study two evaluation tools, a checklist and a questionnaire, were developed based on texts and reliable documentation. The questionnaire and the checklist were validated using content validity by receiving the experts’ comments and the questionnaire’s reliability was estimated through Test-retest(r =87%). Data were collected through study, observation, and interviews with experts and specialists of SEPAS project.Results:This research showed that SEPAS project, like any other project, could be evaluated. It has some aims; steps, operational phases and certain start and end time, but all the resources and required facilities for the project have not been considered. Therefore it could not satisfy its specified objective and the useful and unique changes which are the other characteristics of any project have not been achieved. In addition, the findings of EHR system coordinates can be determined in 4 categories as Standards and rules, Telecommunication-Communication facilities, Computer equipment and facilities and Stakeholders.Conclusions:The findings indicated that SEPAS has the ability to use all standards of medical terminology and health classification systems in the case of Maksa approval (The reference health coding of Iran). ISO13606 was used as the main standard in this project. Regarding the telecommunication-communication facilities of the project, the findings showed that its link is restricted to health care centers which does not cover other institutions and organizations involved in public health. The final result showed that SEPAS is in the early stages of execution. And the full implementation of EHR needs the provision of the infrastructure of the National Health Information Network that is the same as EHR system.

The Southeastern Minnesota Beacon Project for Community-driven Health Information Technology: Origins, Achievements, and Legacy

Introduction:The Southeastern (SE) Minnesota Beacon organized all the health care providers, county public health organizations, and school districts in the deployment and integration of health information exchange (HIE) and targeted health communication around childhood asthma and diabetes. The community cooperated to establish a clinical data repository for all residents in the 11-county region. Through this community of practice approach that involved traditional and nontraditional providers, the SE Minnesota Beacon was able to realize unique applications of this technology. This manuscript overviews the associated organization and infrastructure of this community collaboration.Background:The Office of the National Coordinator for Health Information Technology (ONC), as part of the American Recovery and Reinvestment Act of 2009 (ARRA) stimulus, established 17 projects throughout the United States targeting the introduction and meaningful use of health information technology (HIT). These 17 communities were intended to serve as an example of what could be accomplished. The SE Minnesota Beacon is one of these communities.Methods:The community ultimately opted for peer-to-peer HIE, using Nationwide Health Information Network (NwHIN) Connect software. The clinical data repository was established using the infrastructure developed by the Regenstrief Institute, which operated as a trusted third party. As an extension to HIE, the consortium of county public health departments created a patient data portal for use by school nurses and parents. Childhood asthma was addressed by creating, exchanging, and maintaining an “asthma action plan” for each affected child, shared throughout the community, including through the patient portal. Diabetes management introduced patient treatment decision tools and patient quality of life measures, facilitating care. Influenza vaccination was enhanced by large-scale community reporting in partnership with the state vaccination registry. The methodology and principles for arriving at these solutions included community engagement, sustainability, scalability, standards, and best practices that fit a variety of organizations—from large, robust providers to small organizations.Findings:The SE Minnesota Beacon demonstrated that all providers for a geographically defined population can cooperate in the development and shared governance of a low-cost, sustainable HIE, and the operation of a community-managed clinical data repository. Furthermore, these infrastructures can be leveraged to collaboratively improve the care of patients, as demonstrated for childhood asthma and adult diabetes mellitus.Conclusion:The shared governance of HIT by a community can palpably change the scope and success of collaborations targeted to improve patient and community health care.