scholarly journals HL7 CCD - Clinical Interoperability to Improve Quality and the Point-of-Care of EHR

2010 ◽  
Author(s):  
Gunjan Patel
Keyword(s):  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Point Of Care ◽  
Clinical Information ◽  
Reference Information ◽  
Information Models ◽  
Clinical Document ◽  
Future Technologies ◽  
Organization Boundaries

We think about interoperability only in today’s terms. Looking ahead, the demands that future technologies will make on health information exchange could be large, as could the health because of interoperability. This paper would present the description on Healthcare Information System organizations and communities as a standard to underpin clinical information exchange. A number of significant problems results are directly from the way the computable entries in clinical documents exchange represented currently. In this paper, the information exchange with other system and also supporting communication of electronic healthcare records across organization boundaries. The CCD is an XML-based specification for exchange of clinical summary information. The HL7 Reference Information Models expressed in the Clinical Document Architecture Release 2 (CDA R2), an information exchange specification generic to any type of clinical information. Hence, the patient’s health information is easily communicated points of care and improves quality services.

scholarly journals Clinical Information Systems – Seen through the Ethics Lens

2020 ◽  
Vol 29 (01) ◽  
pp. 104-114
Author(s):  
Ursula H. Hübner ◽  
Nicole Egbert ◽  
Georg Schulte
Keyword(s):  
Information Systems ◽  
Health Information ◽  
Information Exchange ◽  
Ethics Education ◽  
Health Information Exchange ◽  
Evaluation Studies ◽  
Clinical Information ◽  
Clinical Decision ◽  
Clinical Information Systems ◽  
Smart Systems

Objective: The more people there are who use clinical information systems (CIS) beyond their traditional intramural confines, the more promising the benefits are, and the more daunting the risks will be. This review thus explores the areas of ethical debates prompted by CIS conceptualized as smart systems reaching out to patients and citizens. Furthermore, it investigates the ethical competencies and education needed to use these systems appropriately. Methods: A literature review covering ethics topics in combination with clinical and health information systems, clinical decision support, health information exchange, and various mobile devices and media was performed searching the MEDLINE database for articles from 2016 to 2019 with a focus on 2018 and 2019. A second search combined these keywords with education. Results: By far, most of the discourses were dominated by privacy, confidentiality, and informed consent issues. Intertwined with confidentiality and clear boundaries, the provider-patient relationship has gained much attention. The opacity of algorithms and the lack of explicability of the results pose a further challenge. The necessity of sociotechnical ethics education was underpinned in many studies including advocating education for providers and patients alike. However, only a few publications expanded on ethical competencies. In the publications found, empirical research designs were employed to capture the stakeholders’ attitudes, but not to evaluate specific implementations. Conclusion: Despite the broad discourses, ethical values have not yet found their firm place in empirically rigorous health technology evaluation studies. Similarly, sociotechnical ethics competencies obviously need detailed specifications. These two gaps set the stage for further research at the junction of clinical information systems and ethics.

scholarly journals Enabling health information exchange at a US Poison Control Center

2020 ◽  
Vol 27 (7) ◽  
pp. 1000-1006
Author(s):  
Mollie R Cummins ◽  
Guilherme Del Fiol ◽  
Barbara I Crouch ◽  
Pallavi Ranade-Kharkar ◽  
Aly Khalifa ◽  
...  
Keyword(s):  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Poison Control ◽  
Poison Center ◽  
Poison Control Center ◽  
Control Center ◽  
Clinical Document ◽  
Informatics Infrastructure ◽  
Workflow Integration

Abstract Objective The objective of this project was to enable poison control center (PCC) participation in standards-based health information exchange (HIE). Previously, PCC participation was not possible due to software noncompliance with HIE standards, lack of informatics infrastructure, and the need to integrate HIE processes into workflow. Materials and Methods We adapted the Health Level Seven Consolidated Clinical Document Architecture (C-CDA) consultation note for the PCC use case. We used rapid prototyping to determine requirements for an HIE dashboard for use by PCCs and developed software called SNOWHITE that enables poison center HIE in tandem with a poisoning information system. Results We successfully implemented the process and software at the PCC and began sending outbound C-CDAs from the Utah PCC on February 15, 2017; we began receiving inbound C-CDAs on October 30, 2018. Discussion With the creation of SNOWHITE and initiation of an HIE process for sending outgoing C-CDA consultation notes from the Utah Poison Control Center, we accomplished the first participation of PCCs in standards-based HIE in the US. We faced several challenges that are also likely to be present at PCCs in other states, including the lack of a robust set of patient identifiers to support automated patient identity matching, challenges in emergency department computerized workflow integration, and the need to build HIE software for PCCs. Conclusion As a multi-disciplinary, multi-organizational team, we successfully developed both a process and the informatics tools necessary to enable PCC participation in standards-based HIE and implemented the process at the Utah PCC.

scholarly journals Emerging and Established Trends to Support Secure Health Information Exchange

2021 ◽  
Vol 3 ◽  
Author(s):  
Emmanouil G. Spanakis ◽  
Stelios Sfakianakis ◽  
Silvia Bonomi ◽  
Claudio Ciccotelli ◽  
Sabina Magalini ◽  
...  
Keyword(s):  
Health Care ◽  
Information Sharing ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Implementation Strategies ◽  
Clinical Information ◽  
Secure Information ◽  
Extensive Evaluation ◽  
Secure Information Sharing

This work aims to provide information, guidelines, established practices and standards, and an extensive evaluation on new and promising technologies for the implementation of a secure information sharing platform for health-related data. We focus strictly on the technical aspects and specifically on the sharing of health information, studying innovative techniques for secure information sharing within the health-care domain, and we describe our solution and evaluate the use of blockchain methodologically for integrating within our implementation. To do so, we analyze health information sharing within the concept of the PANACEA project that facilitates the design, implementation, and deployment of a relevant platform. The research presented in this paper provides evidence and argumentation toward advanced and novel implementation strategies for a state-of-the-art information sharing environment; a description of high-level requirements for the transfer of data between different health-care organizations or cross-border; technologies to support the secure interconnectivity and trust between information technology (IT) systems participating in a sharing-data “community”; standards, guidelines, and interoperability specifications for implementing a common understanding and integration in the sharing of clinical information; and the use of cloud computing and prospectively more advanced technologies such as blockchain. The technologies described and the possible implementation approaches are presented in the design of an innovative secure information sharing platform in the health-care domain.

scholarly journals Adoption of Health Information Exchange by Emergency Physicians at Three Urban Academic Medical Centers

2011 ◽  
Vol 02 (03) ◽  
pp. 263-269 ◽  
Author(s):  
J. Shapiro ◽  
S. Vaidya ◽  
G. Kuperman ◽  
N. Genes
Keyword(s):  
New York ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Clinical Information ◽  
Data Availability ◽  
Emergency Physicians ◽  
Structured Interviews ◽  
Successful Retrieval ◽  
Data Elements

Summary Objectives: Emergency physicians are trained to make decisions quickly and with limited patient information. Health Information Exchange (HIE) has the potential to improve emergency care by bringing relevant patient data from non-affiliated organizations to the bedside. NYCLIX (New York CLinical Information eXchange) offers HIE functionality among multiple New York metropolitan area provider organizations and has pilot users in several member emergency departments (EDs). Methods: We conducted semi-structured interviews at three participating EDs with emergency physicians trained to use NYCLIX. Among “users” with > 1 login, responses to questions regarding typical usage scenarios, successful retrieval of data, and areas for improving the interface were recorded. Among “non-users” with ≤1 login, questions about NYCLIX accessibility and utility were asked. Both groups were asked to recall items from prior training regarding data sources and availability. Results: Eighteen NYCLIX pilot users, all board certified emergency physicians, were interviewed. Of the 14 physicians with more than one login, half estimated successful retrieval of HIE data affecting patient care. Four non-users (one login or less) cited forgotten login information as a major reason for non-use. Though both groups made errors, users were more likely to recall true NYCLIX member sites and data elements than non-users. Improvements suggested as likely to facilitate usage included a single automated login to both the ED information system (EDIS) and HIE, and automatic notification of HIE data availability in the EDIS All respondents reported satisfaction with their training. Conclusions: Integrating HIE into existing ED workflows remains a challenge, though a substantial fraction of users report changes in management based on HIE data. Though interviewees believed their training was adequate, significant errors in their understanding of available NYCLIX data elements and participating sites persist.

scholarly journals Improving Access to Longitudinal Patient Health Information within an Emergency Department

2012 ◽  
Vol 03 (03) ◽  
pp. 290-300 ◽  
Author(s):  
S. Shen ◽  
D.A. Dorr ◽  
G. Hripcsak ◽  
L. Heermann ◽  
S.P. Narus ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
User Authentication ◽  
Tracking System ◽  
Clinical Information ◽  
Before And After ◽  
Patient Health ◽  
The Impact

SummaryWe designed and implemented an electronic patient tracking system with improved user authentication and patient selection. We then measured access to clinical information from previous clinical encounters before and after implementation of the system. Clinicians accessed longitudinal information for 16% of patient encounters before, and 40% of patient encounters after the intervention, indicating such a system can improve clinician access to information. We also attempted to evaluate the impact of providing this access on inpatient admissions from the emergency department, by comparing the odds of inpatient admission from an emergency department before and after the improved access was made available. Patients were 24% less likely to be admitted after the implementation of improved access. However, there were many potential confounders, based on the inherent pre-post design of the evaluation. Our experience has strong implications for current health information exchange initiatives.

scholarly journals How could health information exchange better meet the needs of care practitioners?

2014 ◽  
Vol 05 (04) ◽  
pp. 861-877 ◽  
Author(s):  
R. Kaushal ◽  
J.R. Vest ◽  
P. Kierkegaard
Keyword(s):  
New York ◽  
Health Information ◽  
Patient Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Point Of Care ◽  
New York State ◽  
Multiple Sources ◽  
Healthcare Organizations ◽  
York State

SummaryBackground: Health information exchange (HIE) has the potential to improve the quality of health-care by enabling providers with better access to patient information from multiple sources at the point of care. However, HIE efforts have historically been difficult to establish in the US and the failure rates of organizations created to foster HIE have been high.Objectives: We sought to better understand how RHIO-based HIE systems were used in practice and the challenges care practitioners face using them. The objective of our study were to so investigate how HIE can better meet the needs of care practitioners.Methods: We performed a multiple-case study using qualitative methods in three communities in New York State. We conducted interviews onsite and by telephone with HIE users and non-users and observed the workflows of healthcare professionals at multiple healthcare organizations participating in a local HIE effort in New York State.Results: The empirical data analysis suggests that challenges still remain in increasing provider usage, optimizing HIE implementations and connecting HIE systems across geographic regions. Important determinants of system usage and perceived value includes users experienced level of available information and the fit of use for physician workflows.Conclusions: Challenges still remain in increasing provider adoption, optimizing HIE implementations, and demonstrating value. The inability to find information reduced usage of HIE. Healthcare organizations, HIE facilitating organizations, and states can help support HIE adoption by ensuring patient information is accessible to providers through increasing patient consents, fostering broader participation, and by ensuring systems are usable.Citation: Kierkegaard P, Kaushal R, Vest JR. How could health information exchange better meet the needs of care practitioners? Appl Clin Inf 2014; 5: 861–877http://dx.doi.org/10.4338/ACI-2014-06-RA-0055

scholarly journals Best Paper Selection

2017 ◽  
Vol 26 (01) ◽  
pp. e3-e4
Keyword(s):  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Point Of Care ◽  
Personal Health Record ◽  
Pediatric Emergency ◽  
Personal Health ◽  
Genomic Information ◽  
Electronic Personal Health Record ◽  
Quasi Experimental

Bahous MC, Shadmi E. Health information exchange and information gaps in referrals to a pediatric emergency department. Int J Med Inform 2016;87:68-74 https://linkinghub.elsevier.com/retrieve/pii/S1386-5056(15)30078-2 Esmaeilzadeh P, Sambasivan M. Health Information Exchange (HIE): A literature review, assimilation pattern and a proposed classification for a new policy approach. J Biomed Inform 2016;64:74-86 http://www.sciencedirect.com/science/article/pii/S1532046416301241?via%3Dihub Massoudi BL, Marcial LH, Tant E, Adler-Milstein J, West SL. Using health information exchanges to calculate clinical quality measures: A study of barriers and facilitators. Healthc (Amst) 2016;4(2):104-8 https://linkinghub.elsevier.com/retrieve/pii/S2213-0764(15)30057-9 Toscos T, Daley C, Heral L, Doshi R, Chen YC, Eckert GJ, Plant RL, Mirro MJ. Impact of electronic personal health record use on engagement and intermediate health outcomes among cardiac patients: a quasi-experimental study. J Am Med Inform Assoc 2016;23(1):119-28 https://academic.oup.com/jamia/article-lookup/doi/10.1093/jamia/ocv164 Warner JL, Rioth MJ, Mandl KD, Mandel JC, Kreda DA, Kohane IS, Carbone D, Oreto R, Wang L, Zhu S, Yao H, Alterovitz G. SMART precision cancer medicine: a FHIR-based app to provide genomic information at the point of care. J Am Med Inform Assoc 2016;23(4):701-10 https://academic.oup.com/jamia/article-lookup/doi/10.1093/jamia/ocw015

scholarly journals Best Paper Selection

2017 ◽  
Vol 26 (01) ◽  
pp. 82-83
Keyword(s):  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Point Of Care ◽  
Personal Health Record ◽  
Pediatric Emergency ◽  
Personal Health ◽  
Genomic Information ◽  
Electronic Personal Health Record ◽  
Quasi Experimental

Bahous MC, Shadmi E. Health information exchange and information gaps in referrals to a pediatric emergency department. Int J Med Inform 2016;87:68-74 https://linkinghub.elsevier.com/retrieve/pii/S1386-5056(15)30078-2 Esmaeilzadeh P, Sambasivan M. Health Information Exchange (HIE): A literature review, assimilation pattern and a proposed classification for a new policy approach. J Biomed Inform 2016;64:74-86 http://www.sciencedirect.com/science/article/pii/S1532046416301241?via%3Dihub Massoudi BL, Marcial LH, Tant E, Adler-Milstein J, West SL. Using health information exchanges to calculate clinical quality measures: A study of barriers and facilitators. Healthc (Amst) 2016;4(2):104-8 https://linkinghub.elsevier.com/retrieve/pii/S2213-0764(15)30057-9 Toscos T, Daley C, Heral L, Doshi R, Chen YC, Eckert GJ, Plant RL, Mirro MJ. Impact of electronic personal health record use on engagement and intermediate health outcomes among cardiac patients: a quasi-experimental study. J Am Med Inform Assoc 2016;23(1):119-28 https://academic.oup.com/jamia/article-lookup/doi/10.1093/jamia/ocv164 Warner JL, Rioth MJ, Mandl KD, Mandel JC, Kreda DA, Kohane IS, Carbone D, Oreto R, Wang L, Zhu S, Yao H, Alterovitz G. SMART precision cancer medicine: a FHIR-based app to provide genomic information at the point of care. J Am Med Inform Assoc 2016;23(4):701-10 https://academic.oup.com/jamia/article-lookup/doi/10.1093/jamia/ocw015

scholarly journals Gaps in health information exchange between hospitals that treat many shared patients

2018 ◽  
Vol 25 (9) ◽  
pp. 1114-1121 ◽  
Author(s):  
Jordan Everson ◽  
Julia Adler-Milstein
Keyword(s):  
Information Sharing ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Clinical Information ◽  
Patient Volume ◽  
Hospital Referral Region ◽  
Hospital Referral ◽  
Electronic Health Information ◽  
21St Century Cures Act

Abstract Objective Hospitals that routinely share patients are those that most critically need to engage in electronic health information exchange (HIE) with each other to ensure clinical information is available to inform treatment decisions. We surveyed pairs of hospitals in a nationwide sample to describe whether and how hospitals within each hospital referral region (HRR) that have the highest shared patient (HSP) volume engaged in HIE with each other. Methods We used Medicare’s Physician Shared Patient Patterns data to identify hospital pairs with the highest shared patient volume in each hospital referral region. We surveyed a purposeful sample of pairs and then calculated descriptive statistics to compare: (1) HIE with the HSP hospital vs HIE with other hospitals, and (2) HIE with the HSP hospital versus federal measures of HIE engagement that are not partner-specific. Results We received responses from 25.5% of contacted hospitals and 33.5% of contacted pairs, allowing us to examine information sharing among 68 hospitals in 63 pairs. 23% of respondents reported worse information sharing with their HSP hospital than with other hospitals while 17% indicated better sharing with their HSP hospital and 48% indicated no difference. Our HSP-specific measures of HIE differed from federal measures of HIE engagement: while 97% of respondents are classified as routinely sending information electronically in federal measures, in our data only 63% did so with their HSP hospital. Conclusions Despite increased HIE engagement, our descriptive results indicate that HIE is not developing in a way that facilitates information exchange where it might benefit the most patients. New policy efforts, particularly those emerging from the 21st Century Cures Act, need to explicitly pursue strategies that ensure that HSP providers engage in exchange with each other.

scholarly journals Defining Health Information Exchange: Scoping Review of Published Definitions

2017 ◽  
Vol 23 (4) ◽  
pp. 684 ◽  
Author(s):  
Ather Akhlaq ◽  
Aziz Sheikh ◽  
Claudia Pagliari
Keyword(s):  
Health Information ◽  
Information Exchange ◽  
Health Informatics ◽  
Information Science ◽  
Health Information Exchange ◽  
Grey Literature ◽  
Clinical Information ◽  
Scientific Databases ◽  
Literature Searches ◽  
Generic Term

ObjectiveThe term Health Information Exchange (HIE) is often used in health informatics, yet uncertainties remain about its precise meaning. This study aimed to capture and analyse existing definitions in order to map variations in its use and the concepts associated with it.MethodsSystematic literature search to identify published definitions of HIE and equivalent terms such as Clinical Information Exchange. Medline, Web of Science, Library Information Science and Technology Abstracts, EMBASE and CINAHL Plus were searched to identify relevant research, and Google to identify grey literature. Searches were not limited by language or date of publication. In order to warrant inclusion documents had to either define the concept explicitly or do so via a concrete description.  Included references were tabulated by author affiliation, source of quote, year of publication, country of origin and definitions and the definitions themselves were analysed thematically.ResultsSearches revealed 603 scientific articles and 5981 website links. From these, a total of 268 unique definitions of HIE were identified and extracted: 103 from scientific databases and 165 from Google. Eleven constructs emerged from the thematic analysis. Contextual factors influenced the emphasis of the definitions and the framing of HIE as a concept/process, a set of enabling technologies, or an entity/organisation.ConclusionsHIE is a complex and evolving concept and uses of the term vary across settings, presenting challenges for communication.  Developing a generic term is difficult, given the importance of context, but the authors suggest one covering key attributes of HIE, which may be helpful.

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