A Patient-Centered Framework for Evaluating Digital Maturity of Health Services: A Systematic Review

© Kelsey Flott, Ryan Callahan, Ara Darzi, Erik Mayer.Background: Digital maturity is the extent to which digital technologies are used as enablers to deliver a high-quality health service. Extensive literature exists about how to assess the components of digital maturity, but it has not been used to design a comprehensive framework for evaluation. Consequently, the measurement systems that do exist are limited to evaluating digital programs within one service or care setting, meaning that digital maturity evaluation is not accounting for the needs of patients across their care pathways. Objective: The objective of our study was to identify the best methods and metrics for evaluating digital maturity and to create a novel, evidence-based tool for evaluating digital maturity across patient care pathways. Methods: We systematically reviewed the literature to find the best methods and metrics for evaluating digital maturity. We searched the PubMed database for all papers relevant to digital maturity evaluation. Papers were selected if they provided insight into how to appraise digital systems within the health service and if they indicated the factors that constitute or facilitate digital maturity. Papers were analyzed to identify methodology for evaluating digital maturity and indicators of digitally mature systems. We then used the resulting information about methodology to design an evaluation framework. Following that, the indicators of digital maturity were extracted and grouped into increasing levels of maturity and operationalized as metrics within the evaluation framework. Results: We identified 28 papers as relevant to evaluating digital maturity, from which we derived 5 themes. The first theme concerned general evaluation methodology for constructing the framework (7 papers). The following 4 themes were the increasing levels of digital maturity: resources and ability (6 papers), usage (7 papers), interoperability (3 papers), and impact (5 papers). The framework includes metrics for each of these levels at each stage of the typical patient care pathway. Conclusions: The framework uses a patient-centric model that departs from traditional service-specific measurements and allows for novel insights into how digital programs benefit patients across the health system

Legal Solutions in Health Reform: Privacy and Health Information Technology

Identifies gaps in the federal health privacy standard and proposes options for strengthening the legal framework for privacy protections in order to build public trust in health information technology. Presents arguments for and against each option

Privacy and Health Information Technology

The increased use of health information technology (health IT) is a common element of nearly every health reform proposal because it has the potential to decrease costs, improve health outcomes, coordinate care, and improve public health. However, it raises concerns about security and privacy of medical information. This paper examines some of the “gaps” in privacy protections that arise out of the current federal health privacy standard, the Health Insurance Portability and Accountability (HIPAA) Privacy Rule, the main federal law which governs the use and disclosure of health information. Additionally, it puts forth a range of possible solutions, accompanied by arguments for and against each. The solutions provide some options for strengthening the current legal framework of privacy protections in order to build public trust in health IT and facilitate its use for health reform. The American Recovery and Reinvestment Act (ARRA) enacted in February 2009 includes a number of changes to HIPAA and its regulations, and those changes are clearly noted among the list of solutions (and ARRA is indicated in the Executive Summary and paper where the Act has a relevant provision)

EVALUATING TELEMEDICINE IN RURAL SETTINGS: ISSUES AND APPLICATIONS

Changes in health care policies, demographics, and technology have presented new opportunities for the delivery of medical care services and information to rural communities. Telemedicinethe use of electronic information and communications technologies to provide and support health care when distances separates the participantsis one technology that has impacted the efficiency of delivery of rural health care services. This paper presents an overview of the telemedicine technologies, government involvement in support of telemedicine, evaluation efforts to date for these technologies, and issues that need to be addressed in designing an economic-based framework to evaluate the net benefits of telemedicine technologies to rural communities and consumers. An evaluation framework needs to be capable of quantifying the tradeoffs among access to health care services, the costs of delivery of a given level of services, and changes in the quality of the service that is being delivered via electronic communications; and how these tradeoffs shift as the level of telemedicine and the technology changes. The framework that is proposed is based on models of consumer behavior that incorporate discrete choices among quality differentiated sites.rural health care, telemedicine, averted costs, economic benefits, telecommunications technology, R0, Community/Rural/Urban Development, Health Economics and Policy, I1,

Is interoperability a hindrance to the nationwide health information exchange (NHIE)?

Introduction: HIE is the exchange of clinical data as well as healthcare data among the providers, healthcare institutions, and data repositories. Nationwide Health Information Network (NHIN), was adopted in the year 2004, under the Office of the National Coordinator for Health Information Technology (ONCHIT) with an objective to share the files electronically securely and in a safe manner. Methodology: The literature review included 40 references in which information relevant to the purpose of this study was scrutinized; these references met the inclusion criterion. The methodology for this study was an extensive and thorough literature review. The sources utilized in this study encompassed primary and secondary data. Results: HIE has significantly increased by 41% from 2008 to 2012. Also, the exchange of health information by type of clinical data has risen from 39% to 55% during the same period. NHIN has been widely recognized in the U.S, but the storage of patient data and the data architectures have remained uncertain among two models the patient-centric or centralized model, in which the patient data for a given patient is stored at one central location. Discussion: To evaluate the effectiveness of the NHIN the hospital exchange activity, costs of implementation and the quality of care were analyzed. From the literature review, there has been a significant increase in the costs spending associated with the NHIN implementation. Conclusion: The literature has suggested that NHIN could achieve cost savings, increase quality of care and communication between physician and the patient

Is the Nationwide Health Information Network Feasible?

Nationwide Health Information Network (NHIN) use in healthcare facilities was examined for utilization and efficacy, although the advantages are abundant, healthcare facilities have been reluctant to adopt it due to associated costs. The purpose of this study was to analyze the feasibility of a U.S NHIN by exploring and determining the benefits of and assessing the barriers to its implementation. The results of this study suggest that implementation and utilization of NHIN by healthcare industry stakeholders leads 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

Understanding Contrasting Approaches to Nationwide Implementations of Electronic Health Record Systems:England, the USA and Australia

As governments commit to national electronic health record (EHR) systems, there is increasing international interest in identifying effective implementation strategies. We draw on Coiera's typology of national programmes - ‘top-down’, ‘bottom-up’ and ‘middle-out’ - to review EHR implementation strategies in three exemplar countries: England, the USA and Australia. In comparing and contrasting three approaches, we show how different healthcare systems, national policy contexts and anticipated benefits have shaped initial strategies. We reflect on progress and likely developments in the face of continually changing circumstances. Our review shows that irrespective of the initial strategy, over time there is likely to be convergence on the negotiated, devolved middle-out approach, which aims to balance the interests and responsibilities of local healthcare constituencies and national government to achieve national connectivity. We conclude that, accepting the current lack of empirical evidence, the flexibility offered by the middle-out approach may make this the best initial national strategy

Identifying Health Facilities outside the Enterprise: Challenges and Strategies for Supporting Health Reform and Meaningful Use

Objective: To support collation of data for disability determination, we sought to accurately identify facilities where care was delivered across multiple, independent hospitals and clinics. Methods: Data from various institutions' electronic health records were merged and delivered as continuity of care documents to the United States Social Security Administration (SSA). Results: Electronic records for nearly 8000 disability claimants were exchanged with SSA. Due to the lack of standard nomenclature for identifying the facilities in which patients received the care documented in the electronic records, SSA could not match the information received with information provided by disability claimants. Facility identifiers were generated arbitrarily by health care systems and therefore could not be mapped to the existing international standards. Discussion: We propose strategies for improving facility identification in electronic health records to support improved tracking of a patient's care between providers to better serve clinical care delivery, disability determination, health reform and meaningful use. Conclusion: Accurately identifying the facilities where health care is delivered to patients is important to a number of major health reform and improvement efforts underway in many nations. A standardized nomenclature for identifying health care facilities is needed to improve tracking of care and linking of electronic health records