Organizing the U.S. Health Care Delivery System for High Performance

Analyzes the fragmentation of the healthcare delivery system and makes policy recommendations -- including payment reform, regulatory changes, and infrastructure -- for creating mechanisms to coordinate care across providers and settings

Geisinger Health System: Achieving the Potential of System Integration Through Innovation, Leadership, Measurement, and Incentives

Presents a case study of a physician-led nonprofit healthcare group exhibiting the attributes of an ideal healthcare delivery system as defined by the Fund. Describes how its ProvenCare model improved clinical outcomes with reduced resource utilization

Scott & White Healthcare: Opening Up and Embracing Change to Improve Performance

Offers a case study of a multispeciality system with the attributes of an ideal healthcare delivery system as defined by the Fund. Describes a culture of continuous improvement, collaboration and peer accountability, and a comprehensive approach to care

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

Baylor Health Care System: High-Performance Integrated Health Care

Describes the organization's implementation of a quality infrastructure and its strategies, interventions to improve clinical preventive services, training, and adoption of electronic health records and other quality innovations. Outlines lessons learned

HealthPartners: Consumer-Focused Mission and Collaborative Approach Support Ambitious Performance Improvement Agenda

Presents a case study of a nonprofit healthcare organization that exhibits the six attributes of an ideal healthcare delivery system as defined by the Fund, including information continuity, care coordination and transitions, and system accountability

Doctor of Philosophy

dissertationAlthough Electronic Health Record (EHR) systems have recently achieved widespread adoption in the U.S., our understanding of their impact on care outcomes is still limited. Current literature has produced mixed results due to the use of non-standardized measurements and weak research designs. In this dissertation, 4 studies are conducted to develop a systematic methodology for detecting near real-time performance changes during EHR implementations. It also explores factors that can affect outcomes during a commercial EHR implementation. The first study assesses the current state of the literature on health IT adoption to identify the most commonly reported outcome measures and proposes a taxonomy to classify these measurements. The second study expands the first study by identifying additional measures through semistructured interviews with experienced clinical and administrative leaders from a large care delivery system. We also collect input from national informatics experts who suggested additional relevant measures. The third study is a robust longitudinal analysis including several measures from our larger inventory that were used for monitoring a large-scale commercial EHR implementation and detected patterns of impact and mixed time-sensitive effects across geographically dispersed settings from an integrated care delivery system. The fourth study is a qualitative analysis guided by the quantitative results of the third study. We identified several factors that may have contributed to performance changes detected by our methodology. In summary, this dissertation will help the broader medical and informatics communities by informing what and how to continuously monitor future similar implementations. First, it contributes to the identification of relevant outcomes likely impacted by health IT interventions. Second, it combines these outcome measures with a robust interrupted time-series design, producing a systematic methodology that allows earlier and potentially more precise detection of unexpected effects, and implementation of effective response to mitigate negative impacts. Last, the identification of factors that may impact outcomes during and following an EHR implementation and covariates to measure them will empower researchers in charge of future evaluations, hopefully increasing the understanding of the full impact of health IT interventions

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

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

Health Information Technology in the United States: The Information Base for Progress

Health information technology (HIT) has the potential to advance health care quality by helping patients with acute and chronic conditions receive recommended care, diminishing disparities in treatment and reducing medical errors. Nevertheless, HIT dissemination has not occurred rapidly, due in part to the high costs of electronic health record (EHR) systems for providers of care—including the upfront capital investment, ongoing maintenance and short-term productivity loss. Also, many observers are concerned that, if HIT follows patterns observed with other new medical technologies, HIT and EHRs may diffuse in ways that systematically disadvantage vulnerable patient populations, thus increasing or maintaining existing disparities in access to and quality of care. These and other concerns have led to public and private efforts that aim to increase the pace of and reduce disparities in HIT diffusion by formulating national plans for dissemination, catalyzing the development of standards to encourage interoperability and promoting public-private partnerships to develop HIT infrastructures at the local and regional levels