Is There an App for That? Electronic Health Records (EHRs) and a New Environment of Conflict Prevention and Resolution

Katsh discusses the new problems that are a consequence of a new technological environment in healthcare, one that has an array of elements that makes the emergence of disputes likely. Novel uses of technology have already addressed both the problem and its source in other contexts, such as e-commerce, where large numbers of transactions have generated large numbers of disputes. If technology-supported healthcare is to improve the field of medicine, a similar effort at dispute prevention and resolution will be necessary

HITECH Revisited

Assesses the 2009 Health Information Technology for Economic and Clinical Health Act, which offers incentives to adopt and meaningfully use electronic health records. Recommendations include revised criteria, incremental approaches, and targeted policies

Explanation-Based Auditing

To comply with emerging privacy laws and regulations, it has become common for applications like electronic health records systems (EHRs) to collect access logs, which record each time a user (e.g., a hospital employee) accesses a piece of sensitive data (e.g., a patient record). Using the access log, it is easy to answer simple queries (e.g., Who accessed Alice's medical record?), but this often does not provide enough information. In addition to learning who accessed their medical records, patients will likely want to understand why each access occurred. In this paper, we introduce the problem of generating explanations for individual records in an access log. The problem is motivated by user-centric auditing applications, and it also provides a novel approach to misuse detection. We develop a framework for modeling explanations which is based on a fundamental observation: For certain classes of databases, including EHRs, the reason for most data accesses can be inferred from data stored elsewhere in the database. For example, if Alice has an appointment with Dr. Dave, this information is stored in the database, and it explains why Dr. Dave looked at Alice's record. Large numbers of data accesses can be explained using general forms called explanation templates. Rather than requiring an administrator to manually specify explanation templates, we propose a set of algorithms for automatically discovering frequent templates from the database (i.e., those that explain a large number of accesses). We also propose techniques for inferring collaborative user groups, which can be used to enhance the quality of the discovered explanations. Finally, we have evaluated our proposed techniques using an access log and data from the University of Michigan Health System. Our results demonstrate that in practice we can provide explanations for over 94% of data accesses in the log.Comment: VLDB201

SecHealth: enhancing EHR security in digital health transformation.

In the contemporary wave of digital transformation, the implementation of electronic health records (EHRs) has become a pivotal undertaking for numerous nations. However, amidst this technological advancement, a critical facet deserving heightened attention is the security and privacy of these electronic health systems. Regrettably, this crucial concern often finds itself eclipsed by other aspects of digitalization. Consequently, these oversight lapses create vulnerabilities within the EHR framework, leaving them open and exposed to an array of malicious cyber intrusions. In response to this pressing issue, our study delves into a comprehensive evaluation of security measures within the ambit of African digital health strategies. Remarkably, among the number of approximately 42 nations that have embarked on digital health strategy formulation, a mere 2 countries have taken cognizance of the imperative to integrate robust security and privacy policies into their healthcare-oriented digital transformation initiatives. In light of this disconcerting revelation, we present an actionable roadmap that endeavours to fortify EHR security, aligning with the progressive "shift-left" paradigm. By advocating for the proactive integration of security measures from the inception of EHR development, we strive to curtail vulnerabilities and enhance the overall resilience of these systems. Our proposed roadmap stands as a clarion call for governments, healthcare authorities, and technology stakeholders to collectively prioritize security in tandem with digital health advancement, thereby fostering a safeguarded and privacy-respecting electronic healthcare landscape

Federal Research and Development Funding: FY2009

In February 2008, President Bush proposed total research and development (R&D) funding of $147.0 billion in his FY2009 budget request to Congress, a$3.9 billion (2.7%) increase over the estimated FY2008 level of $143.1 billion. President Bush’s request included$29.3 billion for basic research, up $847 million (3.0$27.1 billion for applied research, down $1.0 billion (-3.6$84.0 billion for development, up 1.6 billion (1.9%); and 6.5 billion for R&D facilities and equipment, up 2.5 billion (61.7%). In the absence of final action on the regular FY2009 appropriations bills, Congress passed H.R. 2638 (110th Congress), the Consolidated Security, Disaster Assistance, and Continuing Appropriations Act, 2009 (P.L. 110-329) which President Bush signed on September 30, 2008. This act provides FY2009 appropriations for the Department of Defense, Department of Homeland Security, and Military Construction and Veterans Affairs; continued funding for agencies not covered under these provisions at their FY2008 funding levels through March 6, 2009; and supplemental funding for disaster relief. The uncompleted regular appropriations bills considered by the 110th Congress expired with the beginning of the 111th Congress. On February 23, 2009, H.R. 1105, the Omnibus Appropriations Act, 2009 (P.L. 111-8), which provides specific FY2009 appropriations for the agencies covered under the continuing appropriations provisions of P.L. 110-329, was introduced in the House and passed two days later. With the Omnibus bill under consideration in the Senate, on March 6 Congress passed and President Obama signed H.J.Res. 38 (P.L. 111-6), extending the continuing appropriations provisions of P.L. 110-329 through March 11, 2009. On March 10, the Senate passed H.R. 1105 without amendment. President Obama signed the act on March 11. Additional funding for research and development was provided under the American Recovery and Reinvestment Act of 2009 (H.R. 1), often referred to informally as “the stimulus bill.” H.R. 1 was passed by the House and Senate on February 13, and signed into law (P.L. 111-5) by President Obama on February 17. The act includes approximately $22.7 billion for R&D, facilities, equipment and related activities. For the past two fiscal years, federal R&D funding and execution has been affected by mechanisms used to complete the annual appropriations process—the year-long continuing resolution for FY2007 (P.L. 110-5) and the combining of 11 appropriations bills into the Consolidated Appropriations Act, 2008 for FY2008 (P.L. 110-161). For example, FY2008 R&D funding for some agencies and programs was below the level requested by President Bush and passed by the House of Representatives and the Senate. Completion of appropriations after the beginning of each fiscal year also resulted in delays or cancellation of planned R&D and equipment acquisition. While the annual budget requests of incumbent Presidents are usually delivered to Congress in early February for the next fiscal year, the change of presidential administrations delayed the initial release of President Obama’s FY2010 budget until February 26, 2009. The director of the White House Office of Management and Budget, Peter R. Orzag, has testified that a more detailed version of the budget will be released in the spring

Electronic Health Record Optimization for Cardiac Care

Electronic health record (EHR) systems have been studied for over 30 years, and despite the benefits of information technology in other knowledge domains, progress has been slow in healthcare. A growing body of evidence suggests that dissatisfaction with EHR systems was not simply due to resistance to adoption of new technology but also due to real concerns about the adverse impact of EHRs on the delivery of patient care. Solutions for EHR improvement require an approach that combines an understanding of technology adoption with the complexity of the social and technical elements of the US healthcare system. Several studies are presented to clarify and propose a new framework to study EHR-provider interaction. Four focus areas were defined - workflow, communication, medical decision-making and patient care. Using Human Computer Interaction best practices, an EHR usability framework was designed to include a realistic clinical scenario, a cognitive walkthrough, a standardized simulated patient actor, and a portable usability lab. Cardiologists, fellows and nurse practitioners were invited to participate in a simulation to use their institution’s EHR system for a routine cardiac visit. Using a mixed methods approach, differences in satisfaction and effectiveness were identified. Cardiologists were dissatisfied with EHR functionality, and were critical of the potential impact of the communication of incorrect information, while displaying the highest level of success in completing the tasks. Fellows were slightly less dissatisfied with their EHR interaction, and demonstrated a preference for tools to improve workflow and support decision-making, and showed less success in completing the tasks in the scenario. Nurse practitioners were also dissatisfied with their EHR interaction, and cited poor organization of data, yet demonstrated more success than fellows in successful completion of tasks. Study results indicate that requirements for EHR functionality differ by type of provider. Cardiologists, cardiology fellows, and nurse practitioners required different levels of granularity of patient data for use in medical decision-making, defined different targets for communication, sought different solutions to workflow which included distribution of data input, and requested technical solutions to ensure valid and relevant patient data. These findings provide a foundation for future work to optimize EHR functionality

Federally Qualified Health Centers in a Changing Health Care Environment: Are They Prepared for the Challenge?

In many communities access to primary care is absent, unaffordable, or otherwise inaccessible despite ever increasing demand. Since 1965, Federally Qualified Health Centers (FQHC) have acted as principle providers of primary care for those living in communities lacking adequate access. As of 2013, there were 1,202 FQHCs serving 21.7 million patients, of whom 93% were below 200% of the federal poverty line, 35% were uninsured, 62% were racial/ethnic minorities, 4% were migrants, and 23% were best served in a non-English language. Recently FQHCs received substantial financial support through the American Relief and Recovery Act of 2009 (ARRA), and the Patient Protection and Affordable Care Act of 2010 (ACA). ARRA provided more than $2 billion and ACA provides$11 billion directly to FQHCs for ongoing operations, new service sites, and expanded services. Several additional ACA provisions are expected to bolster the ability of FQHCs to accommodate new demand, while adding and expanding still needed services. Immediately playing the pivotal role expected of them in accommodating the anticipated increase in demand for primary healthcare will be challenging for FQHCs as they also adapt to new organizational structures and payment systems. This dissertation examines the ability of FQHCs to provide primary care services in a changing healthcare environment by evaluating the impact of the recession, ARRA, and ACA on: (1) the demographic and health composition of patients served by FQHCs; (2) the capacity of FQHCs to provide primary care services, and (3) the ability to accommodate the expected increase in demand. Lastly, this work examines the remaining challenges and the implications of those challenges for the future of the FQHC program.PHDHealth Services Organization & PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/135787/1/jwillem_1.pd

An Institutional Theory Perspective on EHR Engagement: Mandates, Penalties, and Enforcement

Electronic Health Record (EHR) systems are the predominant information system (IS) used by healthcare clinicians and have been the source of both great success and pain. User engagement with EHR systems is unique from traditional IS contexts in significant ways. Prior research explains EHR usage and success primarily on traditional technology acceptance research (i.e., TAM, UTAUT). However, these models assume that EHR engagement is no different from IS systems in general business domains. Yet, the healthcare context is far more regulated than most. Based on qualitative focus group sessions with a leading healthcare analytics firm (KLAS Research), we identify the role of mandates, penalties, and enforcements from government, organizations, associations, and insurance companies in explaining EHR engagement. We validate a measurement instrument for these factors and demonstrate that their inclusion can improve model fit five times over a traditional UTAUT-based model (R2 = 54.8% versus 10.2%)

High-tech diagnostic imaging clinical decision support tools adoption : study using a system dynamics approach

Tese de mestrado integrado. Engenharia Industrial e Gestão. Faculdade de Engenharia. Universidade do Porto, Massachusetts Institute of Technology. Engineering Systems Division. 201