Performance Measures Using Electronic Health Records: Five Case Studies

Presents the experiences of five provider organizations in developing, testing, and implementing four types of electronic quality-of-care indicators based on EHR data. Discusses challenges, and compares results with those from traditional indicators

The breadth of primary care: a systematic literature review of its core dimensions

Background: Even though there is general agreement that primary care is the linchpin of effective health care delivery, to date no efforts have been made to systematically review the scientific evidence supporting this supposition. The aim of this study was to examine the breadth of primary care by identifying its core dimensions and to assess the evidence for their interrelations and their relevance to outcomes at (primary) health system level. Methods: A systematic review of the primary care literature was carried out, restricted to English language journals reporting original research or systematic reviews. Studies published between 2003 and July 2008 were searched in MEDLINE, Embase, Cochrane Library, CINAHL, King's Fund Database, IDEAS Database, and EconLit. Results: Eighty-five studies were identified. This review was able to provide insight in the complexity of primary care as a multidimensional system, by identifying ten core dimensions that constitute a primary care system. The structure of a primary care system consists of three dimensions: 1. governance; 2. economic conditions; and 3. workforce development. The primary care process is determined by four dimensions: 4. access; 5. continuity of care; 6. coordination of care; and 7. comprehensiveness of care. The outcome of a primary care system includes three dimensions: 8. quality of care; 9. efficiency care; and 10. equity in health. There is a considerable evidence base showing that primary care contributes through its dimensions to overall health system performance and health. Conclusions: A primary care system can be defined and approached as a multidimensional system contributing to overall health system performance and health

Addendum to Informatics for Health 2017: Advancing both science and practice

This article presents presentation and poster abstracts that were mistakenly omitted from the original publication

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

International Profiles of Health Care Systems, 2012

This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Iceland, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, care coordination, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views

International Profiles of Health Care Systems, 2011

This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views

Advanced Use of Electronic Health Records in Patient-Centered Medical Homes

Electronic Health Records (EHRs) offer the promise of improved health outcomes through care coordination, in particular for costly and difficult to manage chronic illness. Adoption levels of EHRs in primary care have increased significantly since the recent Meaningful Use policy initiative began incentivizing EHRs in 2011; however, the full benefits of EHRs will only be realized once widespread use of advanced EHR functions is achieved. Patient-Centered Medical Homes (PCMHs) are considered the pinnacle of primary care and are expected to rely heavily on EHRs to coordinate care across settings. The goals of this dissertation are to describe and discuss overall EHR adoption and use in PCMH practices, including the practices’ progress towards meeting advanced criteria for the Meaningful Use policy, and to identify and explain the specific PCMH practice characteristics and contextual factors associated with advanced EHR use. This dissertation utilizes innovative data on PCMHs to create and evaluate an advanced EHR use index and explore the iterative differences distinguishing advanced EHR use from no advanced use in PCMHs. The EHR index is the dependent variable defining the levels of advanced EHR use by the PCMH. Four models of advanced EHR use are created and variations in the models are explored to validate the EHR index and identify the PCMH practice characteristics associated with advanced EHR use at higher levels of the EHR index. This dissertation indicates higher EHR adoption and use levels for PCMHs compared to other office-based and primary care practices in the current literature. Practice size, type, and location (rural versus non-rural) of the PCMH demonstrate unique associations with advanced EHR use. Contrary to prior studies, this dissertation indicates that larger PCMHs as well as federally-funded centers are less likely to be advanced EHR users and that practice affiliation (being part of a network) has no association with advanced use; also, smaller and non-rural PCMHs practices that are physician or hospital/system-owned are more likely to be using advanced EHR functions, which is also contrary to previous research. These findings have significant implications for future policies, practice, and research. As advanced EHR use becomes more widespread, the findings from this study provide future researchers with robust baseline data on PCMHs. The measures of EHR adoption and use levels in this study, as well as the various models tested, provide frameworks for future studies to evaluate and track advanced EHR use in primary care

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

Preventive youth health care in 11 European countries: an exploratory analysis

Objective: To systematically identify similarities and differences in the way preventive youth health care (YHC) is organized in 11 European countries. - \ud Method: Questionnaire survey to EUSUHM (European Union for School and University Health and Medicine) representatives. - \ud Results: The greatest similarities were found in the age range of the YHC target group and the separation of curative and preventive services. Croatia, Germany and Switzerland show the greatest differences when compared to other European countries, for example, in the access to medical records, YHC professional input and the number of examinations, immunizations and screenings. In eight countries YHC is financed by national insurances or taxation. In Germany, FYR Macedonia, the Netherlands, Russia and Switzerland, different forms of financing exist in parallel. - Conclusion The results should be interpreted as a preliminary step in mapping organizational features of YHC in Europe

Community Health Centers in an Era of Health System Reform and Economic Downturn: Prospects and Challenges

Reviews 2008 legislation reauthorizing community health centers and the factors affecting their role as providers for the uninsured, publicly insured, and underinsured. Outlines health centers' patient mix, quality of care, revenues, and challenges