Regional Health Information Organization 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

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.

Sustainability strategies for regional health information organization startups

ObjectivesSimilar to other Western healthcare systems, the U.S. has sought to build a national infrastructure to enable widespread electronic health information exchange (HIE). The 2009 U.S. HITECH Act׳s State HIE Cooperative Agreement Program (SHIECAP) was a short-term catalyst for bottom-up HIE initiatives by states and regional health information organizations (HIOs). Given the high failure rates of regional U.S. HIOs in the past, our primary objective is to identify the key characteristics of HIO startups that became operational and demonstrated sustainability with non-renewable SHIECAP funding in a state environment with very minimal prior HIE activities. MethodsBased on interview data we collected from 22 stakeholders in New Jersey (NJ) at the state, HIO, and hospital levels, we apply grounded theory techniques to identify cross-case similarities and differences. ResultsAlthough the three NJ HIOs that became operational during the SHIECAP grant period faced similar startup challenges, the two HIOs that demonstrated sustainability pursued distinct technology and sustainability strategies to develop HIE capabilities to fit their very different regional needs: an HIE capability to improve the population health of an underserved urban population, and an HIE capability to enable the transition to a healthcare landscape that rewards care coordination across suburban hospitals and physician practices. ConclusionsWe propose two models of technology and sustainability strategies for developing bottom-up HIE capabilities for different regional populations. Future research within and beyond U.S. contexts needs to take into account these key characteristics to improve our understanding of effective policy levers and government funding mechanisms.

Health information exchange in the wild: the association between organizational capability and perceived utility of clinical event notifications in ambulatory and community care.

Event notifications are real-time, electronic, automatic alerts to providers of their patients' health care encounters at other facilities. Our objective was to examine the effects of organizational capability and related social/organizational issues upon users' perceptions of the impact of event notifications on quality, efficiency, and satisfaction. We surveyed representatives (n = 49) of 10 organizations subscribing to the Bronx Regional Health Information Organization's event notification services about organizational capabilities, notification information quality, perceived usage, perceived impact, and organizational and respondent characteristics. The response rate was 89%. Average item scores were used to create an individual domain summary score. The association between the impact of event notifications and organizational characteristics was modeled using random-intercept logistic regression models. Respondents estimated that organizations followed up on the majority (83%) of event notifications. Supportive organizational policies were associated with the perception that event notifications improved quality of care (odds ratio [OR] = 2.12; 95% CI, = 1.05, 4.45), efficiency (OR = 2.06; 95% CI = 1.00, 4.21), and patient satisfaction (OR = 2.56; 95% CI = 1.13, 5.81). Higher quality of event notification information was also associated with a perceived positive impact on quality of care (OR = 2.84; 95% CI = 1.31, 6.12), efficiency (OR = 3.04; 95% CI = 1.38, 6.69), and patient satisfaction (OR = 2.96; 95% CI = 1.25, 7.03). Health care organizations with appropriate processes, workflows, and staff may be better positioned to use event notifications. Additionally, information quality remains critical in users' assessments and perceptions.

Use of Health Information Exchange and Repeat Imaging Costs

PurposeThe aim of this study was to quantify the association between health information exchange (HIE) use and cost savings attributable to repeat imaging. MethodsImaging procedures associated with HIE were compared with concurrent controls on the basis of propensity score matching over the period from 2009 to 2010 in a longitudinal cohort study. The study sample (n = 12,620) included patients ages 18 years and older enrolled in the two largest commercial health plans in a 13-county region of western New York State served by the Rochester Regional Health Information Organization. The primary outcome was a continuous measure of costs associated with repeat imaging. The determinant of interest, HIE use, was defined as system access after the initial imaging procedure and before repeat imaging. ResultsHIE use was associated with an overall estimated annual savings of $32,460 in avoided repeat imaging, or $2.57 per patient. Basic imaging (radiography, ultrasound, and mammography) accounted for 85% of the estimated avoided cases of repeat imaging. Advanced imaging (CT and MRI) accounted for 13% of avoided procedures but constituted half of the estimated savings (50%). ConclusionsHIE systems may reduce costs associated with repeat imaging. Although inexpensive imaging procedures constituted the largest proportion of avoided repeat imaging in our study, most of the estimated cost savings were due to small reductions in repeated advanced imaging procedures. HIE systems will need to be leveraged in ways that facilitate greater reductions in advanced imaging to achieve appreciable cost savings.

Health Information Exchange as a Multisided Platform: Adoption, Usage, and Practice Involvement in Service Co-Production

Health Information Exchanges (HIE) are becoming integral parts of the national healthcare reform efforts, chiefly because of their potential impact on cost reduction and quality enhancement in healthcare services. However, the potential of an HIE platform can only be realized when its multiple constituent users actively participate in using its variety of services. In this research, we model HIE systems as multisided platforms that incorporate self-service technologies whose value to the users depends on both user-specific and network-specific factors. We develop a model of adoption, use, and involvement of clinical practices in the coproduction of the HIE services. This model is grounded in social network theory, service operations theory, and institutional isomorphism theory. A longitudinal study of actual adoption and use behaviors of 2,054 physicians within 430 community medical practices in Western New York over a three-year period has been carried out to evaluate the proposed model. This study has been supported by HEALTHeLINK, the Regional Health Information Organization of Western New York, which has an extensive database comprising over half a million transactions on patient records by the HIE users. We extracted panel data on adoption, use, and service coproduction behaviors from this database and carried out a detailed analysis using metrics derived from the foundational theories. Positioning practices within two distinct but interrelated networks of patients and practitioners, we show that adoption, use, and service coproduction behaviors are influenced by the topographies of the two networks, isomorphic effects of large practices on the smaller ones, and practice labor inputs in HIE use. Our findings provide a comprehensive view of the drivers of HIE adoption and use at the level of medical practices. These results have implications for marketing and revenue management of HIE platforms, as well as public health and national/regional healthcare policy making.

Health Information Exchange as a Multi-Sided Platform: Adoption, Usage and Practice Involvement in Service Co-Production

Health Information Exchanges (HIE) are becoming integral parts of the national healthcare reform efforts, chiefly owing to their potential impact on cost reduction and quality enhancement in healthcare services. However, the potential of a HIE platform can only be realized when its multiple constituent users actively participate in using its variety of services. In this research, we model HIE systems as multisided platforms that incorporate self-service technologies whose value to the users depends on both user-specific and network-specific factors. We develop a model of adoption, usage and the involvement of clinical practices in the co-production of the HIE services. This model is grounded in social network theory, service operations theory, and institutional isomorphism theory. A longitudinal study of actual adoption and usage behaviors of 2054 physicians within 430 community medical practices in Western New York over a three year period has been carried out to evaluate the proposed model. This study has been supported by HEALTHeLINK, the Regional Health Information Organization of Western New York, with an extensive database comprising of over half a million transactions on patient records by the HIE users. We extracted panel data on adoption, usage and service co-production behaviors from this database and carried out a detailed analysis using metrics derived from the foundational theories. Positioning practices within two distinct but interrelated networks of patients and practitioners, we show that adoption, usage and service co-production behaviors are influenced by the topographies of the two networks, isomorphic effects of large practices on the smaller ones, and practice labor inputs in HIE usage. Our findings provide a comprehensive view of the drivers of HIE adoption and usage at the level of medical practices. These results have implications for marketing and revenue management of HIE platforms, besides public health and national/regional healthcare policy making.

Security Enforcement with query routing Information Brokering in Distributed Information Sharing

Information brokering system (IBS) shares information via on-demand access. IBS connect large- scale loosely federated data sources via a brokering overlay. It is a peer-to-peer overlay network that comprises diverse data servers and brokering components, that helps client queries to locate the data server(s). Peer-to-peer (P2P) systems are gaining increasing popularity as a scalable means to share data among a large number of autonomous nodesand to balance the load. Here brokers routes the decisions to direct client queries to the requested data servers. The proposed novel approach is to preserve privacy of multiple stakeholders involved in the information brokering process. The system defines two privacy attacks, namely attribute- correlation attack and inference attack. The Privacy-Preserving Information Brokering in Distributed Information Sharing is achieved by an innovative automaton segmentation scheme and query segment encryption scheme. I. Introduction Along with the explosion of information collected by organizations in many realms ranging from business to government agencies, there is an increasing need for inter organizational information sharing to facilitate extensive collaboration. The effort spent for reunite data heterogeneity and interoperability providing. Balancing peer autonomy and system coalition is still challenging. Most of the existing systems work on on-demand information access, where peers are fully autonomous peers and managed by a unified DBMS. Take healthcare information systems as example. Regional Health Information Organization (RHIO) aims to facilitate access to and retrieval of clinical data across collaborative healthcare providers that include a number of regional hospitals, outpatient clinics, payers, etc. The provider requires full control on the data and the access to the data. A healthcare provider requesting data from other providers expects to preserve her privacy (e.g., identity or interests) in the querying process.

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

Health information exchange (HIE) is a promising approach to improving the cost and quality of healthcare. We sought to identify the strengths and weaknesses of organizational models to achieve exchange, and what can be done to ensure the sustainability and effectiveness of exchange efforts. We interviewed state and national health informatics policy experts (n = 17). Data were collected as part of an evaluation of the Health Care Efficiency and Affordability Law for New Yorkers (HEAL NY) program and included respondents from both the private and public sectors. Data were analyzed using a general inductive and comparative approach with open coding of themes. Interviewees generally viewed HIE as a public or societal good to be valued. However, they identified challenges with the regional health information organization (RHIO) model of facilitating exchange including: economics, organizational issues, and geography. RHIOs were contrasted against alternative methods of exchange such as Direct, enterprise HIE, and vendor-mediated exchange. HIE is a difficult undertaking due to political and economic reasons. Alternatives to the RHIO model have features that may be more attractive to participants, but may be of less public benefit. Using states as intermediaries and mandating exchange under public health law may avoid the challenges facing exchange efforts. Moving forward, policies will have to address the shortcomings of each HIE model to ensure information is effectively shared between providers to maximize health benefits.

Geographical distribution of patients visiting a health information exchange in New York City.

ObjectiveFor a health information exchange (HIE) organization to succeed in any given region, it is important to understand the optimal catchment area for the patient population it is serving. The objective of this analysis was to understand the geographical distribution of the patients being served by one HIE organization in New York City (NYC).Materials and MethodsPatient demographic data were obtained from the New York Clinical Information Exchange (NYCLIX), a regional health information organization (RHIO) representing most of the major medical centers in the borough of Manhattan in NYC. Patients’ home address zip codes were used to create a research dataset with aggregate counts of patients by US county and international standards organization country. Times Square was designated as the geographical center point of the RHIO for distance calculations.ResultsMost patients (87.7%) live within a 30 mile radius from Times Square and there was a precipitous drop off of patients visiting RHIO-affiliated facilities at distances greater than 100 miles. 43.6% of patients visiting NYCLIX facilities were from the other NYC boroughs rather than from Manhattan itself (31.9%).DiscussionMost patients who seek care at members of NYCLIX live within a well-defined area and a clear decrease in patients visiting NYCLIX sites with distance was identified. Understanding the geographical distribution of patients visiting the large medical centers in the RHIO can inform the RHIO's planning as it looks to add new participant organizations in the surrounding geographical area.

The development of a health information exchange to enhance care and improve patient outcomes among HIV+ individuals in rural North Carolina

BackgroundThe Regional Health Information Integration Project (RHIIP) has developed the Carolina HIV Information Cooperative regional health information organization (CHIC RHIO). The CHIC RHIO was implemented to improve patient care and health outcomes by enhancing communication among geographically disconnected networks of HIV care providers in rural North Carolina. CHIC RHIO comprises one medical clinic and five AIDS Service Organizations (ASOs) serving clients in eight rural counties. MethodsCommunication among the CHIC RHIO members is facilitated by CAREWare software. The RHIIP team assessed organizational readiness to change, facilitated relationship-building for CHIC RHIO, created the CHIC RHIO and used both qualitative and quantitative approaches to evaluate the process-related effects of implementing a data-sharing intervention. ResultsWe found the CHIC RHIO member organizations were ready to engage in the IT intervention prior to its implementation, which most likely contributed to its successful adoption. The qualitative findings indicate that CHIC RHIO members personally benefited – and perceived their clients benefited – from participation in the information exchange. The quantitative results echoed the qualitative findings; following the CHIC RHIO intervention, quality improvements were noted in the ASO and medical clinic relationships, information exchange, and perceived level of patient care. Furthermore, hopes for what data sharing would accomplish were overly high at the beginning of the project, thus requiring a recalibration of expectations as the project came to a close. ConclusionsInnovative strategies for health information exchange can be implemented in rural communities to increase communication among providers. With this increased communication comes the potential for improved health outcomes and, in turn, healthier communities.

Shifts in the architecture of the Nationwide Health Information Network

In the midst of a US $30 billion USD investment in the Nationwide Health Information Network (NwHIN) and electronic health records systems, a significant change in the architecture of the NwHIN is taking place. Prior to 2010, the focus of information exchange in the NwHIN was the Regional Health Information Organization (RHIO). Since 2010, the Office of the National Coordinator (ONC) has been sponsoring policies that promote an internet-like architecture that encourages point to-point information exchange and private health information exchange networks. The net effect of these activities is to undercut the limited business model for RHIOs, decreasing the likelihood of their success, while making the NwHIN dependent on nascent technologies for community level functions such as record locator services. These changes may impact the health of patients and communities. Independent, scientifically focused debate is needed on the wisdom of ONC's proposed changes in its strategy for the NwHIN.

Physicians’ potential use and preferences related to health information exchange

Purpose To characterize physician attitudes and preferences towards health information exchange (HIE), which is the ability to transmit health information electronically across institutions, and identify factors that influence physicians’ interest in using HIE for their clinical work. Methods A survey was conducted of physicians affiliated with institutions that are stakeholders of a regional health information organization in the United States (U.S.). Surveys were administered between May and October, 2009 at educational conferences and on site at physician practices. Results Of the 328 physicians asked to participate, 44% ( n = 144) completed the survey. Sixty-eight percent ( n = 88) of physicians expressed interest in using HIE for their clinical work. Most physicians expected HIE to improve provider communication (89%), coordination and continuity of care (87%) and efficiency (87%). Potential barriers to adopting or using HIE included start-up costs (57%) and resources to select and implement a system (38%). A majority reported that technical assistance (70%) and financial incentives to use (65%) or purchase (54%) health IT systems would positively influence their adoption and use of HIE. Physicians who believe that financial incentives would be helpful, that HIE would be easy to use, or who prefer viewing patient health information electronically were found to be at least three times more likely to indicate they would adopt and use HIE. Conclusions These findings suggest that providers largely consider HIE as potentially valuable and a majority would be willing to use HIE. Recent U.S. federal health IT policies that provide financial incentives as well as technical assistance may address potential barriers to adoption and usage of HIE.

Consumer Support for Health Information Exchange and Personal Health Records: A Regional Health Information Organization Survey

In order to characterize consumer support for electronic health information exchange (HIE) and personal health records (PHRs) in a community where HIE is underway, we conducted a survey of English speaking adults who visited primary care practices participating in a regional community-wide clinical data exchange, during August, 2008. Amongst the 117 respondents, a majority supported physicians' use of HIE (83%) or expressed interest in potentially using PHRs (76%). Consumers' comfort sending personal information electronically over the Internet and their perceptions regarding the potential benefits of HIE were independently associated with their support for HIE. Consumers' prior experience using the Internet to manage their healthcare, perceptions regarding the potential benefits of PHRs and college education were independently associated with potential PHR use. Bolstering consumer support for HIE and PHRs will require addressing privacy and security concerns, demonstrating clinical benefits, and reaching out to those who are less educated and computer literate.

Characteristics associated with Regional Health Information Organization viability

Regional Health Information Organizations (RHIOs) will likely play a key role in our nation's effort to catalyze health information exchange. Yet we know little about why some efforts succeed while others fail. We sought to identify factors associated with RHIO viability. Using data from a national survey of RHIOs that we conducted in mid-2008, we examined factors associated with becoming operational and factors associated with financial viability. We used multivariate logistic regression models to identify unique predictors. We classified RHIOs actively facilitating data exchange as operational and measured financial viability as the percent of operating costs covered by revenue from participants in data exchange (0-24%, 25-74%, 75-100%). Predictors included breadth of participants, breadth of data exchanged, whether the RHIO focused on a specific population, whether RHIO participants had a history of collaborating, and sources of revenue during the planning phase. Exchanging a narrow set of data and involving a broad group of stakeholders were independently associated with a higher likelihood of being operational. Involving hospitals and ambulatory physicians, and securing early funding from participants were associated with a higher likelihood of financial viability, while early grant funding seemed to diminish the likelihood. Finding ways to help RHIOs become operational and self-sustaining will bolster the current approach to nationwide health information exchange. Our work suggests that convening a broad coalition of stakeholders to focus on a narrow set of data is an important step in helping RHIOs become operational. Convincing stakeholders to financially commit early in the process may help RHIOs become self-sustaining.

Progress along developmental tracks for electronic health records implementation in the United States.

The development and implementation of electronic health records (EHR) have occurred slowly in the United States. To date, these approaches have, for the most part, followed four developmental tracks: (a) Enhancement of immunization registries and linkage with other health records to produce Child Health Profiles (CHP), (b) Regional Health Information Organization (RHIO) demonstration projects to link together patient medical records, (c) Insurance company projects linked to ICD-9 codes and patient records for cost-benefit assessments, and (d) Consortia of EHR developers collaborating to model systems requirements and standards for data linkage. Until recently, these separate efforts have been conducted in the very silos that they had intended to eliminate, and there is still considerable debate concerning health professionals access to as well as commitment to using EHR if these systems are provided. This paper will describe these four developmental tracks, patient rights and the legal environment for EHR, international comparisons, and future projections for EHR expansion across health networks in the United States.

Informatics: The Electronic Health Record: Will Nursing Be on Board When the Ship Leaves?

Citation: Thede, L., (Aug 18, 2008) Electronic Health Record: Will Nursing Be on Board When the Ship Leaves? OJIN: The Online Journal of Issues in Nursing Vol. 13 No. 3. Available: www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/Columns/Informatics/ElectronicHealthRecord.aspx You and your care team in the emergency room have just received an unconscious, air-flighted, car-accident victim. Yet even before she arrived, you had learned, in addition to the information about her new injuries provided by the paramedics and nurse aboard the helicopter, the name of her primary physician, the source of her insurance, that she was from a town 1,500 miles away, that her blood type was A positive, and that she was on an anticoagulant and had had a hip replacement six months ago after which she developed a deep vein thrombus. Sound far fetched? The technology to make this happen is with us today, and in some countries it is already a reality. The technology used in communicating the information in the scenario above included a healthcare smartcard and an electronic health record (See Table). Electronic health records are designed to provide nationwide access to designated information compiled from data found in medical records created by various providers regardless of whether providers are in the same healthcare system, or as in the case of the accident victim described above, in a different system far from the patient's home. You are probably already familiar with at least some components that will be included in an electronic health record. Your agency may already be using computerized provider order entry (CPOE), or have implemented other computerized systems, such as a medication administration system. These components are all building blocks for a complete agency record that is labeled the electronic medical record (EMR) (See Table) (National Alliance for Health Information Technology, 2008) that is owned by the provider that has created it. In contrast, an electronic health record (EHR) (See Table) is created when information from records created by a variety of agencies that are under different ownership is made available to other healthcare providers within a network. The EHR allows those healthcare providers designated by the patient to obtain healthcare information related to past episodes of healthcare. It is hoped that such a record will eventually be a birth-to-death electronic healthcare record. Sharing healthcare information between unrelated providers will probably start with the creation of a Regional Health Information Organization (RHIO) in which providers in the same area share information. This step involves the electronic exchange of health-related information between organizations in the same geographical area using agreed-upon standards, protocols, and other criteria (National Alliance for Health Information Technology, 2008). Eventually, the RHIOs will be combined into larger entities until all the healthcare providers are connected in a National Health Information Network (NHIN) throughout the United States. This network will provide access to patient-designated healthcare information for clinical decision making nationwide (United States Department of Health and Human Services, n.d.). As you can imagine, there are many technical issues involved in creating the NHIN, including data security, data access, patient identification, and the ability for all systems to communicate with one another. Information technology specialists are currently addressing these issues. Additional issues that will affect nursing even more directly are the types of nursing data that will be included in electronic health records, and the terminologies used to convey this data. In the past, and currently, nursing notes, unless used institutionally in infection control reports, quality improvement projects, or for legal issues, are filed upon patient discharge in medical records departments and then are generally ignored. …

RHIOs as the foundation for emergency disaster management response

This research explores the regional health information organization (RHIO) framework and models for organization in response to emergencies. The increasing threats from weather-related phenomenon, disease outbreaks, and bioterrorism have focused the national agenda on emergency management and response. The creation of a national health information network is being replicated with state level efforts to create a support structure for emergency management. Efforts by state agencies to create statewide health information infrastructure network can be the foundation for a RHIO model. This article will develop RHIO formation models as well as explore data issues on quality and security. Beyond the focus on stakeholders, RHIOs must establish trust at various levels and provide credible and current information for usage to increase. Stakeholders must be included in RHIO formation. Data must be rich to provide emergency responders with relevant information to coordinate responses. The limited success of RHIOs needs to be reexamined and repositioned as Federal and State initiatives to respond to disasters. RHIOs need to be an integral part of the electronic health record (EHR) rollout to physicians to make them more interoperable and beneficial to regional health planning and response.

Another Lesson From Santa Barbara

In this commentary, Don Holmquest, speaking from the perspective of a statewide regional health information organization (RHIO), responds to papers by Robert Miller and Bradley Miller and by David Brailer on lessons learned from the Santa Barbara County Care Data Exchange project and its subsequent demise. He posits that one of the critical lessons learned through the Santa Barbara experience is the need for a careful analysis of who benefits from health information exchange as part of creating a sustainable business model for health information exchange projects.