Electronic health information exchange in underserved settings: examining initiatives in small physician practices & community health centers.

BackgroundHealth information exchange (HIE) is an important tool for improving efficiency and quality and is required for providers to meet Meaningful Use certification from the United States Centers for Medicare and Medicaid Services. However widespread adoption and use of HIE has been difficult to achieve, especially in settings such as smaller-sized physician practices and federally qualified health centers (FQHCs). We assess electronic data exchange activities and identify barriers and benefits to HIE participation in two underserved settings.MethodsWe conducted key-informant interviews with stakeholders at physician practices and health centers. Interviews were recorded, transcribed, and then coded in two waves: first using an open-coding approach and second using selective coding to identify themes that emerged across interviews, including barriers and facilitators to HIE adoption and use.ResultsWe interviewed 24 providers, administrators and office staff from 16 locations in two states. They identified barriers to HIE use at three levels-regional (e.g., lack of area-level exchanges; partner organizations), inter-organizational (e.g., strong relationships with exchange partners; achieving a critical mass of users), and intra-organizational (e.g., type of electronic medical record used; integration into organization's workflow). A major perceived benefit of HIE use was the improved care-coordination clinicians could provide to patients as a direct result of the HIE information. Utilization and perceived benefit of the exchange systems differed based on several practice- and clinic-level factors.ConclusionsThe adoption and use of HIE in underserved settings appears to be impeded by regional, inter-organizational, and intra-organizational factors and facilitated by perceived benefits largely at the intra-organizational level. Stakeholders should consider factors both internal and external to their organization, focusing efforts in changing modifiable factors and tailoring HIE efforts based on all three categories of factors. Collective action between organizations may be needed to address inter-organizational and regional barriers. In the interest of facilitating HIE adoption and use, the impact of interventions at various levels on improving the use of electronic health data exchange should be tested

Organizational Strategies for the Adoption of Electronic Medical Records: Toward an Understanding of Outcome Variation in Nursing Homes

[Excerpt] An important element in president-elect Obama\u27s economic stimulus proposal is his plan to invest a significant proportion of federal dollars in installing electronic medical records (EMR) in U.S. healthcare institutions. In emphasizing the need for EMR, Obama is following the advice of numerous healthcare experts who have pointed out that the healthcare sector lags behind other industries in the use of computer technology. They believe the widespread use of EMR would help reduce medical errors, control the costs of healthcare, and lead to significant improvements in the quality of care Americans receive. In this paper we present preliminary results of an ongoing study of the introduction of EMR in 20 nursing homes in the New York City area. Although most observers believe EMR holds great promise for the improvement of healthcare, in fact recent studies have found mixed evidence regarding the effect of EMR on patient outcomes. The evidence we have gathered to date suggests that whether EMR has beneficial effects on the costs and quality of healthcare depends very much on the purposes and objectives nursing home managers and administrators intend to achieve through its use. That is, management strategy and style, we believe, strongly influences healthcare outcomes associated with technological innovation

An Examination of Physician Resistance Related to Electronic Medical Records Adoption

The 2009 American Recovery and Reinvestment Act, signed under the Obama administration, mandated physicians to complete certification for electronic medical records (EMRs). Despite these mandates and the increased access to information technology, slow adoption rates persist on the use of EMRs. Guided by the theory of planned behavior and the technology acceptance model, the purpose of this quantitative study was to examine the relationship between the independent variables perceived ease of use, perceived usefulness, perceived behavioral control, perceived social influence, attitudes toward EMR, and the dependent variable user acceptance. This study identified physicians in the United States as end-users of EMRs. In this study, 76 randomly selected physicians in the United States, identified as end-users of EMRs, completed an electronic survey requiring responses to a 5-point Likert Scale model. Standard multiple regression analysis served as the means used to analyze the regression model. Despite the regression model being statistically significant, none of the individual independent variables had statistical significance in predicting user acceptance. Interdependence and homoscedasticity likely contributed to this phenomenon. Social change implications include understanding of physician perceptions and beliefs--how physician perceptions and beliefs affect EMR adoption. Because adoption rates did not achieve 100% certification by end-users, another social change implication includes the necessity of examining how end-user acceptance could decrease medical errors, increase efficiencies in physician workload, and improve communication within the health care industry

Predictive Modeling in Action: How 'Virtual Wards' Help High-Risk Patients Receive Hospital Care at Home

Describes a program to reduce hospitalizations by providing multidisciplinary case management and coordinated preventive care at home to chronic disease patients found to be at risk of emergency hospitalization by predictive modeling. Outlines challenges

Using IS/IT to Support the Delivery of Chinese Medicine: The Design of a Chinese Medicine Clinic System

Using Information System/Information Technology (IS/IT) in Chinese Medicine (CM) has not been discussed much, if at all, in the literature. This is unlike the numerous references to the role for IS/IT to support various aspects of western medicine practice. Though the diagnosis and treatments between western medicine and CM are different, the clinical processes are similar. Thus, we believe that by implementing IS/IT system solutions, CM practice can also enjoy many benefits. CM practice relies on expert knowledge, hence applying knowledge management (KM) concepts to any proposed Chinese Medicine Clinic System (CMCS) is a necessary critical factor in the design of suitable IS/IT solutions in this context. This paper serves to identify a role for IS/IT in assisting CM clinic daily key processes as well as identify key system features and functions for a suitable CMCS

The Promise of Health Information Technology: Ensuring that Florida's Children Benefit

Substantial policy interest in supporting the adoption of Health Information Technology (HIT) by the public and private sectors over the last 5 -- 7 years, was spurred in particular by the release of multiple Institute of Medicine reports documenting the widespread occurrence of medical errors and poor quality of care (Institute of Medicine, 1999 & 2001). However, efforts to focus on issues unique to children's health have been left out of many of initiatives. The purpose of this report is to identify strategies that can be taken by public and private entities to promote the use of HIT among providers who serve children in Florida

The Impact of the Electronic Medical Record on Health Information Management Staff in Two Southeastern States

Health information management (HIM) staffs in health care facilities have a long history of managing medical records in a paper format. Since 2009, with the passage of the Health Information Technology for Economic and Clinical Health Act (HITECH), health care facilities have been rapidly changing from a paper medical record system to an electronic system. The adoption of electronic record systems has reduced or eliminated paper medical record forms which consequently changed many HIM staff’s jobs. A survey of HIM professionals was conducted in two southeastern states to determine any increase or decrease in HIM staff numbers and to identify any changes in required HIM skill levels. While the response rate of the survey was low, the survey results yielded much information about the actual changes HIM staffs are experiencing with the adoption of electronic record systems in their health care facilities. This information will be valuable to HIM professionals by aiding them in developing realistic strategic plans for the future of their HIM departments

Making Medical Homes Work: Moving From Concept to Practice

Explores practical considerations for implementing a medical home program of physician practices committed to coordinating and integrating care based on patient needs and priorities, such as how to qualify medical homes and how to match patients to them

An evaluation of an Electronic Medical Record (EMR) based system to characterize and correlate physician burnout and EMR use

Burnout disproportionately affects healthcare workers and continues to rise, contributing to cost, quality, and patient safety risk in an already overburdened United States healthcare system. While the causes of burnout are complex, evidence suggests that Electronic Medical Record use (EMR) is one major contributor due to the increased clerical burden that decreases patient contact time and disrupts the provider clinical workflow. The challenge of improving the physician EMR experience is exacerbated both by variability across venues and specialty. Targeted training and optimization efforts are generally deployed one-time at a clinic or specialty level but are challenging to deploy longitudinally and in surveillance mode due to the cost and effort of administering traditional survey instruments. To address this challenge, we deployed a single-item burnout measure (SIBM) at the University of Missouri Healthcare, an academic medical center (AMC), to test the feasibility and reliability of capturing longitudinal physician self-reported burnout through the EMR. We further evaluated the utility of the proposed EMR event logging data to discriminate presumed differences in workflow between venues (inpatient, outpatient, and emergency department) and specialty groups (primary care, surgical, non-surgical medical, and emergency) and then correlated the EMR data with the burnout data to demonstrate how this EMR-based longitudinal platform can be used to understand how varying EMR use correlated to burnout.Includes bibliographical references

The Electronic Health Record Scorecard: A Measure of Utilization and Communication Skills

As the adoption rate of electronic health records (EHRs) in the United States continues to grow, both providers and patients will need to adapt to the reality of a third actor being present during the visit encounter. The purpose of this project is to provide insight on “best” practice patterns for effective communication and efficient use of the EHR in the clinical practice setting. Through the development of a comprehensive scorecard, this project assessed current status of EHR use and communication skills among health care providers in various clinical practice settings. Anticipated benefits of this project are increased comfortability in interfacing with the EHR and increased satisfaction on the part of the provider as well as the patient. Serving as a benchmark, this assessment has the potential to help guide future health information technology development, training, and education for both students and health care providers