Evaluating public health uses of health information exchange

AbstractHealth information exchange (HIE) initiatives are in various stages of development across the United States. They aim to bring previously unavailable clinical data from patients’ disparate health records, which may be spread over multiple provider and payer networks, to the point of care where clinicians and their patients need it most. The implications of these initiatives on public health are numerous. This article provides general evaluation methods for measuring the impact of HIE on public health in six use cases: (1) mandated reporting of laboratory diagnoses, (2) mandated reporting of physician-based diagnoses, (3) public health investigation, (4) disease-based non-reportable laboratory data, (5) antibiotic-resistant organism surveillance, and (6) population-level quality monitoring

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

The Role of the Basic Health Program in the Coverage Continuum: Opportunities, Risks and Considerations for States

Outlines issues for offering subsidized coverage to those eligible for insurance exchange subsidies by using federal dollars that would otherwise go to those subsidies, including continuity of coverage, impact on exchanges, and financial feasibility

The Quantified Relationship

The growth of self-tracking and personal surveillance has given rise to the Quantified Self movement. Members of this movement seek to enhance their personal well-being, productivity, and self-actualization through the tracking and gamification of personal data. The technologies that make this possible can also track and gamify aspects of our interpersonal, romantic relationships. Several authors have begun to challenge the ethical and normative implications of this development. In this article, we build upon this work to provide a detailed ethical analysis of the Quantified Relationship. We identify eight core objections to the QR and subject them to critical scrutiny. We argue that although critics raise legitimate concerns, there are ways in which tracking technologies can be used to support and facilitate good relationships. We thus adopt a stance of cautious openness toward this technology and advocate the development of a research agenda for the positive use of QR technologies

A Guide to Evaluating Marine Spatial Plans

Marine spatial plans are being developed in over 40 countries around the world, to distribute human activities in marine areas more sustainably and achieve ecological, social, and economic objectives. Monitoring and evaluation are often considered only after a plan has been developed. This guide will help marine planners and managers, monitor and evaluate the success of marine plans in achieving real results and outcomes. This report emphasizes the importance of early integration of monitoring and evaluation in the planning process, the importance of measurable and specific objectives, clear management actions, relevant indicators and targets, and involvement of stakeholders throughout the planning process.

The Public Health Impact of Needle Exchange Programs in the United States and Abroad: Summary, Conclusions, and Recommendations

The goal of the project was: "To assess the public health impact of needle exchange programs." Fourteen research questions were identified; Chapters 5 through 18 of Volume I of the report each address one of these research questions. The study consisted of four components: 1) formal review of existing research, 2) NEP site visits; 3) mail surveys of NEPs not visited; and 4) cost-effectiveness modeling

Alaska 1332 Waiver - Economic Analysis

The four guardrails that a successful 1332 waiver must meet are as follows: 1. Coverage - There must be at least a comparable number of individuals with coverage under the waiver as would have had coverage without the waiver. 2. Affordability – The waiver should not result in an increase in out-of-pocket spending required of residents to obtain coverage, relative to income. 3. Comprehensiveness – The waiver should not decrease the number of individuals with coverage that meets the essential health benefits (EHB) benchmark. 4. Deficit Neutrality – The waiver should not have any negative impact on the federal deficit. In this report, the first three guardrails are briefly discussed to reaffirm that the actuarial analysis conducted by Oliver Wyman demonstrates that the proposed waiver meets them. The actuarial report from Oliver Wyman projects that the proposed waiver will increase the number of individuals taking up insurance in the individual market, lower average premiums, and have no impact on the comprehensiveness of coverage. The numbers reported in the actuarial analysis are then used to help evaluate the impact that the proposed waiver will have on the federal budget.Alaska Division of Insuranc

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)

Making Evaluation Work in the Nonprofit Sector: A Call for Systemic Change

This position paper is a call for systemic changes that will create an ecosystem within which it is straightforward, efficient, and rewarding for nonprofits and funders to invest in evaluation work. It is also intended to further critical conversations to build a nonprofit sector that is more responsive, accountable, and focused on the best ways to support the communities in which they work

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