IT Governance for e-Health Applications

The increasing use of e-Health applications in clinical practices is pushing the limits of Health Information Technology. e-Health applications are often considered as integrated healthcare applications that are purposely developed to not onlysupport electronic health information exchange but also to improve the quality and safety of healthcare delivery. However,even as these applications continue to evolve and remain widespread in use in many clinicians’ offices, the applicability ofproper Information Technology (IT) governance structure for their utilization remains a big challenge in the healthcareindustry. In this paper, a literature review is used to explore the applicability of IT governance in e-Health applications. Thepractical and research implications for establishing IT governance structure in e-Health applications are also discussed

The Nationwide Health Information Network: The Case of the Expansion of Health Information Exchanges in the United States

The Nationwide Health Information Network (NHIN) implemented secure exchange of health records through utilization of the Internet. NHIN has greatly assisted in achieving the goals of the HITECH Act by promoting the adoption of Meaningful Use. Epic introduced a Health Information Exchange (HIE) platform, Care Everywhere (CE), which has facilitated HIE availability. The purpose of this research was to determine the impact of NHIN and Epic Care’s CE on healthcare to determine whether their use in the ED has increased. The methodology for this study utilized a literature review. Twenty-nine sources were referenced for this study. With the NHIN implementation, repeated visits were decreased, visit times become faster, and charges were lower. ED reported significant benefits with sharing clinical information. NHIN implementation throughout the ED has increased the quality of healthcare; duplicated tests and drug usage were determined, and a reduction of the ED length of stay was also achieved

Barriers Against Adoption of Electronic Health Record in Italy

This work aims to expose the barriers which work against the satisfactory adoption and utilization of Electronic Health Records (EHRs) in Italy. Experts from six operating areas were involved where barriers associated with practical daily use of EHRs might arise. Experts disclosed different barriers in their operating areas: the low interoperability of healthcare system infrastructures in diagnostic services; the lack of systems able to represent complex processes characterized by uncertainties in hospital wards; the unsatisfactory information exchange between heterogeneous healthcare providers in territorial healthcare; the lack of models and guidelines for administration process management; the lack of Health Information engineers who are recognized as professionals in Italian hospitals; the lack of domain vocabularies and ontologies for conceptual integration in clinical communication. Our findings suggest how future solutions must be designed considering the environment of specific areas

An analysis of the effects of certified electronic health records on organizations and patients.

The growing technological advancement of electronic health records can become an issue with quality and electronic patient information exchange if hospitals do not adhere to federal guidelines. It is recommended that hospitals utilize certified electronic health records (EHRs) to receive financial incentives. This certification is supposedly also associated with the quality of the EHR itself. The certification process is criticized for allowing EHR vendors to meet a set of limited functions known in advance. EHRs can affect healthcare quality and electronic health information exchange. This dissertation explored what is known about the effects of certified EHRs on length of stay (LOS) and patient generated health data (PGHD), the relationship between hospital utilization of certified EHRs and LOS, and the relationship between hospital utilization of certified EHRs with hospital capability of allowing the function of PGHD. The first analysis was a scoping review guided by the PRISMA protocol to explore what is known of the effects of certified EHRs on LOS and PGHD. The second analysis used datasets from the American Hospital Association Survey and Information Technology Supplement and Kentucky Cabinet for Health and Family Services, Office of Health Policy from 2015 to 2019 to understand the relationship between hospital utilization of certified EHRs and LOS through a fixed effects regression model. The final paper analysis used datasets from the American Hospital Association Survey and Information Technology Supplement from 2016 to 2020 to understand the relationship between hospital utilization of certified EHRs and the function of enabling PGHD through a binary logistic regression. There is support amongst researchers on EHRs improving quality, such as, LOS and the function of PGHD improving technology efficiency and others supporting EHRs with more customization and open architecture. There is less known about whether an EHR, certified or non-certified, are different from one another with providing advantages for hospitals. Hospitals with certified EHRs have a longer LOS compared to hospitals with non-certified EHRs. Most hospitals experienced barriers with receiving, sending, or other electronic information exchange. Most hospitals with certified EHRs were more likely to not enable the function for PGHD compared to hospitals with non-certified EHRs. EHRs can be problematic while hospitals are providing hospital care. Although most hospitals possess certified EHRs, most do not enable the function of PGHD. Secondary sources from the survey were completed by the Chief Technology Officer or Chief Information Officer. Further research could be continued with understanding different groups’ health effects with health information technology. Hospitals may be satisfied with their EHRs but not as abreast on how functional the EHR is and how the EHR can benefit patients

Ubiquitous Electronic Medical Record (EMR) for Developing Countries

Around the globe, Healthcare Information Technology (HIT) has been evolved either by governments or healthcare providers. The utilization of these technologies has resulted in the improvement of healthcare services all over the world. This evolution has been characterized by availability, reliability, serviceability to patients, and has been enhanced with increased cost and time efficiency. As such, new systems and terms have been established. Electronic Medical Record (EMR), which can also be used interchangeably with Electronic Health Record (EHR) is considered to be the main transformation in healthcare information technologies. EMR has been aimed to reduce and eliminate existing paper based approaches. Many countries have adopted the use of EMR systems all over the world. However, these systems differ from country to country even though they serve the same purpose. The differentiation of implementing the EMR system often leads to incompatibility, which complicates cooperation between healthcare providers, and also compromises the efficient use and analysis of data that can be gathered from different locations or systems. This thesis highlights and addresses the implementation of EMR on cloud-based systems to enable improvements in HIT. In particular, the scope of this research focuses on the use of EMR or EHR in Saudi Arabia, and establishes clinical information transaction standards that can be easily adopted by the different EMR application architectures available. Furthermore, the implementation of a cloud-based system is proposed for standard EMR to be used by both public and private healthcare providers in Saudi Arabia. The advantage that cloud technologies facilitate is the availability of data regardless of the patient, clinician, or physician’s location. Similarly, these technologies enable a linkage and utilization of the Health Information Exchange (HIE) by healthcare researchers and providers to invest in data through online and offline cooperation. Support for the standardization of the EMR system on cloud-based technology will minimize or at best prevent human’s errors, repetition or duplication of records, and reduce cost of operation and time

A Framework for Tracking the Impacts of the Affordable Care Act in California

Recommends measures for monitoring the impact of healthcare reform on insurance coverage, affordability and comprehensiveness of coverage, and access to care; the best data source for each measure; gaps in existing data; and issues for data presentation

The transformation of community hospitals through the transition to value-based care: Lessons from Massachusetts

Enabling community hospitals to provide efficient and effective care and maintain competition on par with their academic medical center (AMC) counterparts remain challenges for most states. Advancing accountable care readiness adds to the complexity of these challenges. Community hospitals experience narrower operating margins and more limited access to large populations than their AMC counterparts, making the shift to value-based care difficult. Massachusetts has taken legislative action to ensure a statewide focus on reducing healthcare costs, which includes a nearly $120-million grant program supporting community hospital and system transformation toward a value-based environment. The Massachusetts Health Policy Commission’s Community Hospital Acceleration, Revitalization and Transformation (CHART) investment program is the state’s largest effort to date aimed at readying community hospitals for value-based care. In doing so, Massachusetts has created the largest state-driven, all-payer (payer-blind) readmission reduction initiative in the country. n this paper, we examine the design and evolution of CHART Phases 1 and 2 and offer insights for other states contemplating innovative approaches to bolstering community hospital participation in value-based care models

Economic Environment and Applications of Telemedicine

Telemedicine is broadly defined as the transmission of electronic medical data across a distance among hospitals, clinicians, and/or patients. This definition is deliberately unlimited to what kind of information is transmitted, how the information is transmitted, or how the information is used once received (HCAB, 2003). Telemedicine has the potential of making a greater positive effect on the future of healthcare and medicine than any other modality. Fueled by advances in multiple technologies such as digital communications, full-motion/compressed video, and telecommunications, providers see an unprecedented opportunity to provide access to high-quality care, independent of distance or location

Exploring knowledge exchange: a useful framework for practice and policy

Knowledge translation is underpinned by a dynamic and social knowledge exchange process but there are few descriptions of how this unfolds in practice settings. This has hampered attempts to produce realistic and useful models to help policymakers and researchers understand how knowledge exchange works. This paper reports the results of research which investigated the nature of knowledge exchange. We aimed to understand whether dynamic and fluid definitions of knowledge exchange are valid and to produce a realistic, descriptive framework of knowledge exchange. Our research was informed by a realist approach. We embedded a knowledge broker within three service delivery teams across a large mental health organisation, each of whom was grappling with specific challenges. The knowledge broker participated in the team's problem-solving process and collected observational fieldnotes. We also interviewed the team members. Observational and interview data were analysed quantitatively and qualitatively in order to determine and describe the nature of the knowledge exchange process in more detail. This enabled us to refine our conceptual framework of knowledge exchange. We found that knowledge exchange can be understood as a dynamic and fluid process which incorporates distinct forms of knowledge from multiple sources. Quantitative analysis illustrated that five broadly-defined components of knowledge exchange (problem, context, knowledge, activities, use) can all be in play at any one time and do not occur in a set order. Qualitative analysis revealed a number of distinct themes which better described the nature of knowledge exchange. By shedding light on the nature of knowledge exchange, our findings problematise some of the linear, technicist approaches to knowledge translation. The revised model of knowledge exchange which we propose here could therefore help to reorient thinking about knowledge exchange and act as a starting point for further exploration and evaluation of the knowledge exchange process