Evaluating the Impact of Health Information Technology on Quality

There is an important need to understand how health information technology impacts healthcare quality. In this systematic review we analyze recent literature to understand the relationship between health information technology and healthcare quality. We report preliminary findings and offer recommendations for future study

Beyond Meaningful Use: A Model for Evaluating Electronic Health Record Success

This paper presents a conceptual model for the evaluation of electronic health records. The model is grounded in IS models for evaluating system success and task-technology fit, and integrates concepts of meaningful use and outcome research to arrive at a holistic conceptualization of evaluating the success of EHR. The paper presents numerous issues and challenges to the practice of health care outcomes research, and offers practical solutions for overcoming them

The implications and impact of 3 approaches to health information exchange: community, enterprise, and vendor‐mediated health information exchange

IntroductionElectronic health information exchange (HIE) is considered essential to establishing a learning health system, reducing medical errors, and improving efficiency, but establishment of widespread, high functioning HIE has been challenging. Healthcare organizations now have considerable flexibility in selecting among several HIE strategies, most prominently community HIE, enterprise HIE (led by a healthcare organization), and electronic health record vendor‐mediated HIE. Each of these strategies is characterized by different conveners, capabilities, and motivations and may have different abilities to facilitate improved patient care.MethodsI reviewed the available scholarly literature to draw conceptual distinctions between these types of HIE, to assess the current evidence on each type of HIE, and to indicate important areas of future research.ResultsWhile community HIE seems to offer the most open approach to HIE allowing for high levels of connectivity, both enterprise HIE and vendor‐mediated HIE face lower barriers to formation and sustainability. Most existing evidence is focused on community HIE and points towards low overall use, challenges to usability, and ambiguous impact. To better guide organizational leaders and policymakers in the expansion of beneficial HIE and anticipate future trends, future research should work to better capture the prevalence of other forms of HIE, and to adopt common methods to allow comparisons of rate of use, usability, and impact on patient care across studies and types of HIE.ConclusionsHealthcare organizations’ choice of HIE strategy influences the set of partners the organization is connected to and may influence the benefit that efforts supported by HIE can offer to patients. Current research is not fully capturing the diversity of approaches to HIE and their potentially varying impact on providers and patients.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/136725/1/lrh210021_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/136725/2/lrh210021.pd

Fatores dificultadores na utilização de um sistema de informação em unidades de terapia intensiva

Nas instituies de sade os Sistemas de informao (SI) podem estar sendo subutilizados, carecendo de investigaes sobre os fatores que podem estar contribuindo para este problema. Assim, foi realizado um estudo que teve como objetivo identificar os fatores dificultadores na utilizao de um Sistema de Informao em Unidades de Terapia Intensiva (UTIs). Pesquisa descritiva e exploratria com abordagem qualitativa, realizada por meio de entrevistas semi-estruturadas com usurios de um SI em trs UTIs de um hospital de Belo Horizonte/MG, entre Maro e Junho de 2009. A organizao e anlise dos dados teve como base a Anlise Temtica de Contedo. Emergiram trs categorias de anlise: a) Aspectos tcnicos relacionados ao prprio sistema; b) Infra-estrutura da instituio e c) Posturas e atitudes dos profissionais frente ao uso do SI e falta de capacitao. preciso envolver os profissionais na utilizao, implantao e avaliao dos SIS, capacit-los e adequar o sistema s necessidades dos setores. Ainda precisamos refletir sobre a insero da informtica em sade no contexto das universidades, nos cursos profissionalizantes e at mesmo em outros contextos da sociedade

Fatores dificultadores na utilização de um sistema de informação em unidades de terapia intensiva

Nas instituições de saúde os Sistemas de informação (SI) podem estar sendo subutilizados, carecendo de investigações sobre os fatores que podem estar contribuindo para este problema. Assim, foi realizado um estudo que teve como objetivo identificar os fatores dificultadores na utilização de um Sistema de Informação em Unidades de Terapia Intensiva (UTI’s). Pesquisa descritiva e exploratória com abordagem qualitativa, realizada por meio de entrevistas semi-estruturadas com usuários de um SI em três UTI´s de um hospital de Belo Horizonte/MG, entre Março e Junho de 2009. A organização e análise dos dados teve como base a “Análise Temática de Conteúdo”. Emergiram três categorias de análise: a) Aspectos técnicos relacionados ao próprio sistema; b) Infra-estrutura da instituição e c) Posturas e atitudes dos profissionais frente ao uso do SI e falta de capacitação. É preciso envolver os profissionais na utilização, implantação e avaliação dos SIS, capacitá-los e adequar o sistema às necessidades dos setores. Ainda precisamos refletir sobre a inserção da informática em saúde no contexto das universidades, nos cursos profissionalizantes e até mesmo em outros contextos da sociedade

Health Information Exchange Use in Primary Care

Indiana University-Purdue University Indianapolis (IUPUI)The United States has invested over $40 billion in digitizing the health care system, yet the anticipated gains in improved care coordination, quality, and cost savings remain largely unrealized. This is due in part to limited interoperability and low rates of health information exchange (HIE) use, which can support care coordination and improve provider decision-making. Primary care providers are central to the US health care delivery system and frequently function as care coordinators, yet capability and HIE use gaps among these providers limit the potential of these digital systems to achieve their intended goals. I study HIE use in the context of primary care to examine 1) factors associated with provider HIE use, 2) the extent and nature of team-based HIE use, and 3) differences in HIE system use patterns across discrete groups of system users. First, I use a national sample of primary care providers to analyze market and practice factors related to HIE use for patient referrals. Overall, I find that only 43% of primary care provider referrals used HIE. Furthermore, I find substantial variation in HIE use rates across electronic health record (EHR) vendors. Second, I use HIE system log data to understand the breadth and depth of HIE use among teams, a care model underpinning primary care delivery reform efforts. I find that although use of HIE systems remains low, in primary care settings it overwhelmingly takes place in a manner consistent with team-based care workflows. Furthermore, team-based use does not differ in breadth from single provider HIE use, but illustrates less depth before and after visits. Third, I apply cluster analysis to 16 HIE use measures representing 7 use attributes, and identify 5 discrete user groups. I then compare two of these user groups and find user-level variation in volume and efficiency of use, both of which have implications for HIE system design and usability improvements. Ultimately, these findings help to inform how HIE use can be increased and improved in primary care, moving the US health care system closer to realizing the coordination, quality, and cost savings made possible by a digitized delivery system

Hospital Networks of Shared Patients and Engagement in Health Information Exchange

Although the healthcare delivery system is composed of an array of organizations that are linked through important, enduring, and complex ties, the healthcare delivery system is rarely explicitly conceptualized or measured as a network. In consequence, we know little about how the enduring but often informal relationships between organizations shape their behavior in terms of the decisions that they make, the quality of care that they provide, and the efficiency of that care. Using techniques developed in the multidisciplinary field of network analysis, I sought to better understand two important facets of health care that are intrinsically linked to the network perspective: the fragmentation of patients’ treatments between multiple hospitals, and hospitals engagement in electronically sharing patient information. By analyzing networks of shared Medicare patients treated at multiple hospitals, I first identified dense networks of hospitals that are closely interlinked through many high volume shared patient connections and are therefore likely linked through complex collaborative and competitive relationships. I then characterized these networks to identify arrangements of patient sharing that allowed hospitals to better manage care fragmentation. I found that more concentrated networks, in which hospitals shared most of their patients with few important partners rather than a large number of other hospitals, and more centralized networks, in which the network is arranged in a hub-and-spoke model, were associated with more efficient, higher quality care. I next described three different approaches to health information exchange and the logic of participation in each approach with specific emphasis on the value of the enterprise approach for connecting a smaller number of providers and the community approach for facilitating broader connections between more partners. I then investigated whether the choice that hospitals made about how to electronically share patient information was shaped by their networks. I found that hospitals with and within more concentrated patient sharing networks were more likely to engage in enterprise exchange while hospitals with and within less concentrated networks engaged in community exchange more frequently. Together, these findings offer novel insights into the network features of hospitals and how they relate to important healthcare processes and outcomes. More concentrated, centralized networks appear to perform better and these features may be one reason for variation in the cost and quality of care across the nation. Similarly, policy changes designed to shape how healthcare organizations interact and who they interact with—like accountable care organizations, bundled payment initiatives and patient center medical homes—may be more successful if they reinforce beneficial network attributes. Further, as policy efforts designed to facilitate the sharing of information between healthcare providers continue, it will be crucial to allow flexible adoption of different approaches to health information exchange and to support hospitals that engage in an approach to information exchange that benefits communities.PHDHealth Services Organization & PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/137104/1/jeverson_1.pd