scholarly journals Hospital adoption of multiple health information exchange approaches and information accessibility

2020 ◽  
Vol 27 (4) ◽  
pp. 577-583
Author(s):  
Jordan Everson ◽  
Evan Butler
Keyword(s):  
Health Information ◽  
Information Integration ◽  
Information Exchange ◽  
Fixed Effects ◽  
Health Information Exchange ◽  
The United States ◽  
Secure Messaging ◽  
American Hospital ◽  
American Hospital Association ◽  
Percentage Points

Abstract Objective Hospital engagement in electronic health information exchange (HIE) has increased over recent years. We aimed to 1) determine the change in adoption of 3 types of information exchange: secure messaging, provider portals, and use of an HIE; and 2) to assess if growth in each approach corresponded to increased ability to access and integrate patient information from outside providers. Methods Panel analysis of all nonfederal, acute care hospitals in the United States using hospital- and year-fixed effects. The sample consisted of 1917 hospitals that responded to the American Hospital Association Information Technology Supplement every year from 2014 to 2016. Results Adoption of each approach increased by 9–15 percentage points over the study period. The average number of HIE approaches used by each hospital increased from 1.0 to 1.4. Adoption of each approach was associated with increased likelihood that providers routinely had necessary outside information of 4.2–12.7 percentage points and 4.5–13.3 percentage points increase in information integration. Secure messaging was associated with the largest increase in both. Adoption of 1 approach increased the likelihood of having outside information by 10.3 percentage points, while adopting a second approach further increased the likelihood by 9.5 percentage points. Trends in number of approaches and integration were similar. Discussion/Conclusion No single HIE tool provided high levels of usable, integrated health information. Instead, hospitals benefited from adopting multiple tools. Policy initiatives that reduce the complexity of enabling high value HIE could result in broader adoption of HIE and use of information to inform care.

scholarly journals Do Market Characteristics Matter? Factors Associated with Health Information Exchange

2021 ◽  
Vol 18 (22) ◽  
pp. 11976
Author(s):  
Na-Eun Cho ◽  
KiHoon Hong ◽  
Jongwha Chang
Keyword(s):  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Digital Information ◽  
Hospital Level ◽  
Ownership Type ◽  
Depth Level ◽  
American Hospital ◽  
American Hospital Association ◽  
Factors Associated

This study explores factors associated with the breadth (extent) and depth (level of detail) of digital information exchange among stakeholders in health information technology (IT) systems. Annual and IT surveys of the American Hospital Association and the U.S. Census Bureau’s small-area income and poverty estimates from 2014–2016 were analyzed for associations between key factors and breadth and depth of information exchange. OLS Regression was used with a sample consisting of 10,040 year-hospital observations. We found that hospital-level variables such as size, ownership type, system affiliation, physician-hospital arrangement, and revenue model affect information exchange. We further found that market-level variables such as concentration ratio, urbanness, and median household income, although they directly affect information exchange, do not moderate the relationship between hospital-level variables and information exchange. Our study fills a gap in the previous literature arising from the lack of research on the determinants of health information exchange.

Regional and Community Health Information Exchange in the United States

2011 ◽  
pp. 198-218 ◽  
Author(s):  
Adi V. Gundlapalli ◽  
Jonathan H. Reid ◽  
Jan Root ◽  
Wu Xu
Keyword(s):  
United States ◽  
Patient Care ◽  
Community Health ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Business Case ◽  
The United States ◽  
Healthcare Systems ◽  
Secure Information

A fundamental premise of continuity in patient care and safety suggests timely sharing of health information among different providers at the point of care and after the visit. In most healthcare systems, this is achieved through exchange of written medical information, phone calls and conversations. In an ideal world, this exchange of health information between disparate providers, healthcare systems, laboratories, pharmacies and payers would be achieved electronically and seamlessly. The potential benefits of electronic health exchange are improved patient care, increased efficiency of the healthcare system and decreased costs. The reality is that health information is electronically exchanged only to a limited extent within local communities and regions, much less nationally and internationally. One main challenge has been the inability of health information exchange organizations to develop a solid business case. Other challenges have been socio-political in that data ownership and stewardship have not been clearly resolved. Technological improvements over the past 20 years have provided significant advances towards safe and secure information exchange. This chapter provides a general overview of community health information exchange in the United States of America, its history and details of challenges faced by stakeholders. The lessons learned from successes and failures, research and knowledge gaps and future prospects are also discussed. Current and future technologies to facilitate and invigorate health information exchange are highlighted. Two examples of successful regional health information exchanges in the US states of Utah and Indiana are highlighted.

scholarly journals State of the Art in Clinical Informatics: Evidence and Examples

2013 ◽  
Vol 22 (01) ◽  
pp. 13-19 ◽  
Author(s):  
A. B. McCoy ◽  
A. Wright ◽  
G. Eysenbach ◽  
B. A. Malin ◽  
E. S. Patterson ◽  
...  
Keyword(s):  
Health Information ◽  
Language Processing ◽  
Information Exchange ◽  
Health Informatics ◽  
Health Information Exchange ◽  
Clinical Decision ◽  
The United States ◽  
Clinical Informatics ◽  
Privacy And Security ◽  
Health Records

Summary Objective: The field of clinical informatics has expanded substantially in the six decades since its inception. Early research focused on simple demonstrations that health information technology (HIT) such as electronic health records (EHRs), computerized provider order entry (CPOE), and clinical decision support (CDS) systems were feasible and potentially beneficial in clinical practice. Methods: In this review, we present recent evidence on clinical informatics in the United States covering three themes: 1) clinical informatics systems and interventions for providers, including EHRs, CPOE, CDS, and health information exchange; 2) consumer health informatics systems, including personal health records and web-based and mobile HIT; and 3) methods and governance for clinical informatics, including EHR usability; data mining, text mining, natural language processing, privacy, and security. Results: Substantial progress has been made in demonstrating that various clinical informatics methodologies and applications improve the structure, process, and outcomes of various facets of the healthcare system. Conclusion: Over the coming years, much more will be expected from the field. As we move past the “early adopters” in Rogers' diffusion of innovations' curve through the “early majority” and into the “late majority,” there will be a crucial need for new research methodologies and clinical applications that have been rigorously demonstrated to work (i.e., to improve health outcomes) in multiple settings with different types of patients and clinicians.

scholarly journals Hospitals’ adoption of intra-system information exchange is negatively associated with inter-system information exchange

2018 ◽  
Vol 25 (9) ◽  
pp. 1189-1196 ◽  
Author(s):  
Joshua R Vest ◽  
Kosali Simon
Keyword(s):  
Health System ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
American Hospital ◽  
Organizational Information ◽  
System Information ◽  
Types Of Information ◽  
The Relationship ◽  
Over Time

Abstract Introduction U.S. policy on interoperable HIT has focused on increasing inter-system (ie, between different organizations) health information exchange. However, interoperable HIT also supports the movement of information within the same organization (ie, intra-system exchange). Methods We examined the relationship between hospitals’ intra- and inter-system information exchange capabilities among health system hospitals included in the 2010-2014 American Hospital Association’s Annual Health Information Technology Survey. We described the factors associated with hospitals that adopted more intra-system than inter-system exchange capability, and explored the extent of new capability adoption among hospitals that reported neither intra- or inter-system information capabilities at baseline. Results The prevalence of exchange increased over time, but the adoption of inter-system information exchange was slower; when hospitals adopt information exchange, adoption of intra-system exchange was more common. On average during our study period, hospitals could share 4.6 types of information by intra-system exchange, but only 2.7 types of information by inter-system exchange. Controlling for other factors, hospitals exchanged more types of information in an intra-system manner than inter-system when the number of different inpatient EHR vendors in use in health system is larger. Conclusion Consistent with the U.S. goals for more widely accessible patient information, hospitals’ ability to share information has increased over time. However, hospitals are prioritizing within-organizational information exchange over exchange between different organizations. If increasing inter-system exchanges is a desired goal, current market incentives and government policies may be insufficient to overcome hospitals’ motivations for pursuing an intra-system-information-exchange-first strategy.

Regional and Community Health Information Exchange in the United States

2011 ◽  
pp. 1470-1490
Author(s):  
Adi V. Gundlapalli ◽  
Jonathan H. Reid ◽  
Jan Root ◽  
Wu Xu
Keyword(s):  
United States ◽  
Patient Care ◽  
Community Health ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Business Case ◽  
The United States ◽  
Healthcare Systems ◽  
Secure Information

A fundamental premise of continuity in patient care and safety suggests timely sharing of health information among different providers at the point of care and after the visit. In most healthcare systems, this is achieved through exchange of written medical information, phone calls and conversations. In an ideal world, this exchange of health information between disparate providers, healthcare systems, laboratories, pharmacies and payers would be achieved electronically and seamlessly. The potential benefits of electronic health exchange are improved patient care, increased efficiency of the healthcare system and decreased costs. The reality is that health information is electronically exchanged only to a limited extent within local communities and regions, much less nationally and internationally. One main challenge has been the inability of health information exchange organizations to develop a solid business case. Other challenges have been socio-political in that data ownership and stewardship have not been clearly resolved. Technological improvements over the past 20 years have provided significant advances towards safe and secure information exchange. This chapter provides a general overview of community health information exchange in the United States of America, its history and details of challenges faced by stakeholders. The lessons learned from successes and failures, research and knowledge gaps and future prospects are also discussed. Current and future technologies to facilitate and invigorate health information exchange are highlighted. Two examples of successful regional health information exchanges in the US states of Utah and Indiana are highlighted.

scholarly journals Surveillance of Stillbirth and Syphilis Screening Using Electronic Health Records

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Brian E Dixon ◽  
Jane Wang ◽  
Timothy E O'Connor ◽  
Janet N Arno
Keyword(s):  
Public Health ◽  
Electronic Health Records ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Congenital Syphilis ◽  
The United States ◽  
Health Records ◽  
Syphilis Testing ◽  
Electronic Health

Objective: To measure stillbirth delivery rates and syphilis screening rates among women with a stillbirth delivery using electronic health record data available in a health information exchange.Introduction: Reports of infants born with congenital syphilis have increased in the United States every year since 2012. Prevention depends on high performing surveillance systems and compliance with the U.S. Centers for Disease Control and Prevention (CDC) recommendations to perform syphilis testing early in pregnancy, in the third trimester and at delivery if a woman is at high risk, and following a stillbirth delivery. These guidelines exist, because untreated syphilis is associated with adverse fetal outcomes including central nervous system infection and death.Surveillance of congenital syphilis and stillbirth is challenging because available data sources are limited. Assessment of compliance with testing guidelines is particularly challenging, since public health agencies often lack access to comprehensive cohorts of tested individuals as most public health laws only require reporting of positive disease case information.Methods: Using integrated electronic health records available in a community-based health information exchange, we examined syphilis testing patterns for women with a stillbirth delivery in Indiana between 2010-2016. The cohort was examined to determine whether the women received syphilis testing in accordance with the CDC recommendations. During this time period, Indiana recorded around 84,000 live births per year.Data were extracted from electronic health records, including encounter data, laboratory test results and procedure data, captured by the Indiana Network for Patient Care (INPC), one of the largest community-based HIE networks in the United States. The INPC connects over 90 health care facilities, including hospitals, physicians’ practices, pharmacy networks, long-term post-acute care facilities, laboratories, and radiology centers. In addition to clinical care, the INPC supports surveillance of STIs1.Women with a stillbirth delivery were identified using International Classification of Disease (ICD) Clinical Modification (CM) codes from the 9thand 10th editions (ICD-CM-9 and ICD-CM-10). Inclusion codes: ICD-CM-9 codes 656.4, 779.9, V27.1, V27.3, V27.4, V27.6, V27.7, V32.01, V32.1, V32.2, V36.1; and ICD-CM-10 codes P95, P96.9, O36.4, Z37.1, Z37.3, Z37.4, Z37.9.Using the master person index for the INPC, we linked stillbirth deliveries with pregnancy encounters and laboratory testing data. We analyzed documentation of syphilis testing during the pregnancy (up to 270 days prior to the stillbirth delivery) as well as after the stillbirth delivery (up to 30 days). Broad time ranges were utilized to account for potential delays in reporting of either the stillbirth delivery or the syphilis test results. Documentation could include either presence of a result from a laboratory test for syphilis or a CPT code (80055, 86780, 86781, 86592, 86593) indicating performance of a syphilis test.Results: A total of 4,361 stillbirth deliveries attributable to 4,265 unique women were identified in the INPC between 2010-2016; representing a rate of 7.44 stillbirths per 1,000 live births during the same time period. Of the stillbirth deliveries, syphilis testing occurred within 270 days prior to or 30 days after delivery for 2,763 (63.4%) cases. Figure 1 displays the number of stillbirth cases observed each year and the number of cases in which syphilis testing occurred during the pregnancy or after delivery.Conclusions: Using integrated electronic health records data, we discovered that fetal deaths occurred more frequently (7.44 versus 4.09 per 1,000) than previously estimated2 through fetal death reporting mechanisms in Indiana. Furthermore, we observed increasing rates of stillbirth within Indiana in recent years. Integrated data further enabled measurement of syphilis testing rates for stillbirth cases, which were similar to those reported by Patel et al.3using a large, national administrative data set. Testing rates in Indiana are well below the targets set by national and international public health organizations. Accessing more complete data on populations using a health information exchange is valuable, although doing so may uncover a more negative picture of health in one’s community. Deeper analysis of these trends is warranted to explore factors related to increasing rates as well as limited testing in this population.

scholarly journals The benefits of health information exchange: an updated systematic review

2018 ◽  
Vol 25 (9) ◽  
pp. 1259-1265 ◽  
Author(s):  
Nir Menachemi ◽  
Saurabh Rahurkar ◽  
Christopher A Harle ◽  
Joshua R Vest
Keyword(s):  
Systematic Review ◽  
New York ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Care Delivery ◽  
The United States ◽  
Current Systematic Review ◽  
Meta Analyses ◽  
The Impact

Abstract Objective Widespread health information exchange (HIE) is a national objective motivated by the promise of improved care and a reduction in costs. Previous reviews have found little rigorous evidence that HIE positively affects these anticipated benefits. However, early studies of HIE were methodologically limited. The purpose of the current study is to review the recent literature on the impact of HIE. Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct our systematic review. PubMed and Scopus databases were used to identify empirical articles that evaluated HIE in the context of a health care outcome. Results Our search strategy identified 24 articles that included 63 individual analyses. The majority of the studies were from the United States representing 9 states; and about 40% of the included analyses occurred in a handful of HIEs from the state of New York. Seven of the 24 studies used designs suitable for causal inference and all reported some beneficial effect from HIE; none reported adverse effects. Conclusions The current systematic review found that studies with more rigorous designs all reported benefits from HIE. Such benefits include fewer duplicated procedures, reduced imaging, lower costs, and improved patient safety. We also found that studies evaluating community HIEs were more likely to find benefits than studies that evaluated enterprise HIEs or vendor-mediated exchanges. Overall, these finding bode well for the HIEs ability to deliver on anticipated improvements in care delivery and reduction in costs.

scholarly journals Health systems’ use of enterprise health information exchange vs single electronic health record vendor environments and unplanned readmissions

2019 ◽  
Vol 26 (10) ◽  
pp. 989-998
Author(s):  
Joshua R Vest ◽  
Mark Aaron Unruh ◽  
Seth Freedman ◽  
Kosali Simon
Keyword(s):  
Electronic Health Record ◽  
Health System ◽  
Health Information ◽  
Health Systems ◽  
Information Exchange ◽  
Fixed Effects ◽  
Health Information Exchange ◽  
Health Record ◽  
Single Vendor ◽  
Electronic Health

Abstract Objective Enterprise health information exchange (HIE) and a single electronic health record (EHR) vendor solution are 2 information exchange approaches to improve performance and increase the quality of care. This study sought to determine the association between adoption of enterprise HIE vs a single vendor environment and changes in unplanned readmissions. Materials and Methods The association between unplanned 30-day readmissions among adult patients and adoption of enterprise HIE or a single vendor environment was measured in a panel of 211 system-member hospitals from 2010 through 2014 using fixed-effects regression models. Sample hospitals were members of health systems in 7 states. Enterprise HIE was defined as self-reported ability to exchange information with other members of the same health system who used different EHR vendors. A single EHR vendor environment reported exchanging information with other health system members, but all using the same EHR vendor. Results Enterprise HIE adoption was more common among the study sample than EHR (75% vs 24%). However, adoption of a single EHR vendor environment was associated with a 0.8% reduction in the probability of a readmission within 30 days of discharge. The estimated impact of adopting an enterprise HIE strategy on readmissions was smaller and not statically significant. Conclusion Reductions in the probability of an unplanned readmission after a hospital adopts a single vendor environment suggests that HIE technologies can better support the aim of higher quality care. Additionally, health systems may benefit more from a single vendor environment approach than attempting to foster exchange across multiple EHR vendors.

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