Transactions of 2019 International Conference on Health Information Technology Advancement Vol. 4 No. 1

The Fourth International Conference on Health Information Technology Advancement Kalamazoo, Michigan, October 31 - Nov. 1, 2019. Conference Co-Chairs Bernard T. Han and Muhammad Razi, Department of Business Information Systems, Haworth College of Business, Western Michigan University Kalamazoo, MI 49008 Transaction Editor Dr. Huei Lee, Professor, Department of Computer Information Systems, Eastern Michigan University Ypsilanti, MI 48197 Volume 4, No. 1 Hosted by The Center for Health Information Technology Advancement, WM

Marshfield Clinic: Health Information Technology Paves the Way for Population Health Management

Highlights Fund-defined attributes of an ideal care delivery system and best practices, including an internal electronic health record, primary care teams, physician quality metrics and mentors, and standardized care processes for chronic care management

Digital Orthopaedics: A Glimpse Into the Future in the Midst of a Pandemic.

BackgroundThe response to COVID-19 catalyzed the adoption and integration of digital health tools into the health care delivery model for musculoskeletal patients. The change, suspension, or relaxation of Medicare and federal guidelines enabled the rapid implementation of these technologies. The expansion of payment models for virtual care facilitated its rapid adoption. The authors aim to provide several examples of digital health solutions utilized to manage orthopedic patients during the pandemic and discuss what features of these technologies are likely to continue to provide value to patients and clinicians following its resolution.ConclusionThe widespread adoption of new technologies enabling providers to care for patients remotely has the potential to permanently change the expectations of all stakeholders about the way care is provided in orthopedics. The new era of Digital Orthopaedics will see a gradual and nondisruptive integration of technologies that support the patient's journey through the successful management of their musculoskeletal disease

Equivalent Mid-Term Results of Open vs Endoscopic Gluteal Tendon Tear Repair Using Suture Anchors in Forty-Five Patients.

BackgroundLittle is known about the relative efficacy of open (OGR) vs endoscopic (EGR) gluteal tendon repair of gluteal tendon tears in minimizing pain and restoring function. Our aim is to compare these 2 surgical techniques and quantify their impact on clinical outcomes.MethodsAll patients undergoing gluteal tendon tear repair at our institution between 2015 and 2018 were retrospectively reviewed. Pain scores, limp, hip abduction strength, and the use of analgesics were recorded preoperatively and at last follow-up. The Hip disability and Osteoarthritis Outcome Score Junior and Harris Hip Score Section1 were obtained at last follow-up. Fatty degeneration was quantified using the Goutallier-Fuchs Classification (GFC). Statistical analysis was conducted using one-way analysis of variance and t-tests.ResultsForty-five patients (mean age 66, 87% females) met inclusion criteria. Average follow-up was 20.3 months. None of the 10 patients (22%) undergoing EGR had prior surgery. Of 35 patients (78%) undergoing OGR, 12 (27%) had prior hip replacement (75% via lateral approach). The OGRs had more patients with GFC ≥2 (50% vs 11%, P = .02) and used more anchors (P = .03). Both groups showed statistical improvement (P ≤ .01) for all outcomes measured. GFC >2 was independently associated with a worst limp and Harris Hip Score Section 1 score (P = .05). EGR had a statistically higher opioid use reduction (P < .05) than OGR. Other comparisons between EGR and OGR did not reach statistical significance.ConclusionIn this series, open vs endoscopic operative approach did not impact clinical outcomes. More complex tears were treated open and with more anchors. Fatty degeneration adversely impacted outcomes. Although further evaluation of the efficacy of EGR in complex tears is indicated, both approaches can be used successfully

Optimization of an EHR and Workflow Redesign at a Small Cancer Center in the Michigan Upper Peninsula

This study was performed to examine the efficacy of a newly adopted electronic health record (EHR) system at a small rural cancer center. I evaluated the current system, and interviewed key medical staff members in an attempt to identify issues with the current set up and find solutions to major problems. I uncovered many barriers to the practice success such as user buy in, work redundancy, lack of knowledge and/or training, interoperability and template issues. The physician had issues with obtaining maximum benefit from the system such as inability to generate practice productivity reports and lack of efficiency. In an attempt for optimization, suggestions were made to redesign workflow and focus on key EHR functionalities. Successful optimization of an existing EHR system post implementation is key to efficacious growth of a practice as we move into a new health care environment which is highly reliant on health information technology

The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: a qualitative study of Kaiser Permanente.

BackgroundPatient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain how effects come about is limited.MethodsThis paper uses qualitative methods to advance our understanding of the organizational dynamics that influence the impact of a patient portal on organizational performance and patient health. The study setting is Kaiser Permanente, the world's largest not-for-profit integrated delivery system, which has been using a portal for over ten years. We interviewed eighteen physician leaders and executives particularly knowledgeable about the portal to learn about how they believe the patient portal works and what organizational factors affect its workings. Our analytical framework centered on two research questions. (1) How does the patient portal impact care delivery to produce the documented effects?; and (2) What are the important organizational factors that influence the patient portal's development?ResultsWe identify five ways in which the patient portal may impact care delivery to produce reported effects. First, the portal's ability to ease access to services improves some patients' satisfaction as well as changes the way patients seek care. Second, the transparency and activation of information enable some patients to better manage their care. Third, care management may also be improved through augmented patient-physician interaction. This augmented interaction may also increase the 'stickiness' of some patients to their providers. Forth, a similar effect may be triggered by a closer connection between Kaiser Permanente and patients, which may reduce the likelihood that patients will switch health plans. Finally, the portal may induce efficiencies in physician workflow and administrative tasks, stimulating certain operational savings and deeper involvement of patients in medical decisions. Moreover, our analysis illuminated seven organizational factors of particular importance to the portal's development--and thereby ability to impact care delivery: alignment with financial incentives, synergy with existing IT infrastructure and operations, physician-led governance, inclusive decision making and knowledge sharing, regional flexibility to implementation, continuous innovation, and emphasis on patient-centered design.ConclusionsThese findings show how organizational dynamics enable the patient portal to affect care delivery by summoning organization-wide support for and use of a portal that meets patient needs

Embedded Pharmacists in Primary Care

As healthcare delivery moves from a provider-centric approach to a more patient-centric approach, systems and payers need to reimagine how care and team-based care is delivered to patients and reimbursed. Thus, the goal should be to see the right patient, by the right provider, in the right place, for the right price, and where appropriate, with the use of the right pharmaceutical(s) – “5 P’s”. There continues to be a reduction in physicians that are pursuing primary care roles in the United States, thus exacerbating the ability to meet patient demand. Most patient encounters begin with or end with the prescribing of medication. Thus, a future where pharmacists are embedded in primary care settings allows these pharmacists to collaborate at the point-of-prescribing (i.e., in-clinic) and provides tremendous benefits to providers and patients. The pharmacist workforce is educated at the doctoral level, yet vastly underutilized and can assist in a collaborative approach in primary care. The collection of articles in the Special Issue “Embedded Pharmacists in Primary Care” highlight examples of models that have included pharmacists in the ambulatory setting providing services in chronic disease management, comprehensive medication management, and care of specific conditions such as diabetes

Early Primary Care Provider Follow-Up for High Readmission Risk Native Hawaiian Health Project Patients at the Queen's Meidcal Center.

D.N.P. Thesis. University of Hawaiʻi at Mānoa 2018

A Cloud Telemedicine Platform Based on Workflow Management System: A Review of an Italian Case Study

The paper aims to describe a new technological and organizational approach in order to manage teleconsultation and telemonitoring processes involving a Physician, who remotely interacts with one or more Specialists, in order to evaluate and discuss the specific clinical conditions of a patient, based primarily on the sharing of digital clinical data, reports and diagnostic images. In the HINT project (Healthcare INtegration in Telemedicine), a teleconsultation and telemonitoring cloud platform has been developed using a Hub and Spoke architecture, based on a Business Process Management System (BPMS). The specialized clinical centres (Hubs) operate in connection with the territorial hospital centres (Spokes), which receive specific diagnostic consultations and telemonitoring data from the appropriate Specialist, supported by advanced AI systems. The developed platform overcomes the concepts of a traditional and fragmented teleconsultation and consequently the static organization of Hubs and Spokes, evolving towards an integrated clinical workflow management. The project platform adopts international healthcare standards, such as HL7 FHIR, IHE (XDS and XDW) and DICOM for the acquisition and management of healthcare data and diagnostic images. A Workflow Management System implemented in the platform allows to manage multiple and contemporaneous processes through a single platform, correctly associating the tasks to the Physicians responsible for their execution, monitoring the status of the health activities and managing possible clinical issues

A Quality Improvement Project to Improve Patients\u27 Satisfaction with Telemedicine Use in the General Hematology-Oncology Setting

Abstract The COVID-19 pandemic has accelerated the use of synchronous telemedicine in oncology. While telemedicine can increase access to care, decrease care costs, and reduce hospitalizations, patients’ satisfaction with telemedicine is critical to telemedicine’s sustainability. However, limited research exists on telemedicine use and patients\u27 satisfaction in oncology. The scholarly project had a quality improvement design that determined the factors affecting patients\u27 satisfaction using secondary data from patients\u27 satisfaction surveys. Using the Donabedian Structure, Process, Outcomes Model as a framework, the project involved three general hematology-oncology clinics at a large urban, academic medical center. Three-hundred ninety-four patient satisfaction surveys with at least one comment from April 2020 to September 2021 were analyzed, which yielded 665 comments to provide context. Surveys with no comments were excluded from the analysis. The independent variables were age, race, and gender. The dependent variables were ease of scheduling, therapeutic communication by the care providers, audio/video quality, and the overall assessment of telemedicine use. One-way analysis of variance (ANOVA) evaluated the differences in the mean scores with age and race. An independent t-test assessed the mean scores for gender. A statistical difference existed between age groups in the satisfaction scores regarding ease of scheduling and audio/video quality of telemedicine. In race or gender, neither the one-way ANOVA nor the independent t-test demonstrated any statistical significance in satisfaction scores. The analysis of the comments guided the quality improvement recommendations. The recommendations to positively impact patient satisfaction with the oncology clinic telemedicine workflow were: Build adequate systems capabilities and clinic infrastructure; establish workflow and evaluate staff resources; provide resources for patients and providers by creating a telemedicine champion; leverage community resources and partnerships; assess the patient population; evaluate rules and regulations. The sustainability of synchronous telemedicine will depend on many factors, including patient satisfaction. Because patient satisfaction is crucial to clinical outcomes and reimbursements, it will continue to play a vital role in the sustainability of many initiatives in healthcare in today’s healthcare landscape. Keywords: telemedicine, synchronous telemedicine, patient satisfaction