Public Health and Epidemiology Informatics: Recent Research and Trends in the United States

Objectives To survey advances in public health and epidemiology informatics over the past three years. Methods We conducted a review of English-language research works conducted in the domain of public health informatics (PHI), and published in MEDLINE between January 2012 and December 2014, where information and communication technology (ICT) was a primary subject, or a main component of the study methodology. Selected articles were synthesized using a thematic analysis using the Essential Services of Public Health as a typology. Results Based on themes that emerged, we organized the advances into a model where applications that support the Essential Services are, in turn, supported by a socio-technical infrastructure that relies on government policies and ethical principles. That infrastructure, in turn, depends upon education and training of the public health workforce, development that creates novel or adapts existing infrastructure, and research that evaluates the success of the infrastructure. Finally, the persistence and growth of infrastructure depends on financial sustainability. Conclusions Public health informatics is a field that is growing in breadth, depth, and complexity. Several Essential Services have benefited from informatics, notably, “Monitor Health,” “Diagnose & Investigate,” and “Evaluate.” Yet many Essential Services still have not yet benefited from advances such as maturing electronic health record systems, interoperability amongst health information systems, analytics for population health management, use of social media among consumers, and educational certification in clinical informatics. There is much work to be done to further advance the science of PHI as well as its impact on public health practice

Can Accreditation Work in Public Health? Lessons From Other Service Industries

Reviews the literature on the experiences and outcomes of existing accreditation programs in health and social service industries in order to derive implications about the potential benefits and costs of accreditation for public health agencies

Meaningful Use of Health Information Technology: Proving Its Worth?

Health policymakers in recent years have looked to the implementation of health information technology (IT)—electronic health records and the like—as a means to improve quality, reduce costs, and achieve better health outcomes across populations. But implementing health IT in a meaningful way must go beyond purchasing medical records software. The U.S. Department of Health and Human Services (HHS) devised a set of measures and incentives for hospitals and eligible medical professionals within Medicare or Medicaid to mark successive stages of effective IT implementation. This issue brief discusses the history of meaningful use, the measures used to evaluate effectiveness, and the policy implications of the HHS requirements

Antibiotic resistance information exchanges : interim guidance

Antibiotic resistance (AR) is a major clinical and public health threat with potential to unravel more than half a century of human health advances offered by modern medical care. Unfortunately, modern healthcare delivery is notably contributory to the spread of antibiotic-resistant organisms, as patients who have become colonized with resistant organisms often receive care across multiple healthcare settings (e.g., ambulatory care, acute care hospitals (ACHs), and various long-term care (LTC) settings, including long-term acute care hospitals (LTACHs) and skilled nursing facilities (SNFs)).Although the threat of antibiotic-resistant organism transmission from a colonized patient to physically proximate patients remains for the duration of colonization, the lack of information sharing between healthcare facilities often results in the colonized status of a patient being unknown to a receiving or admitting facility. When this occurs, the appropriate infection control precautions are less likely to be used from the start of patient care, which increases the likelihood that resistant organisms will spread to other patients.The need for improved AR situational awareness is a major challenge to the U.S. Centers for Disease Control and Prevention\u2019s (CDC\u2019s) strategy to contain the most threatening forms of resistance and the genes responsible for such phenotypes. To fulfill their central role in implementing the CDC\u2019s containment strategy, some state health departments have developed systems (Multidrug-Resistant Organism (MDRO) Registries or MDRO Alert Systems, referred to herein as AR Information Exchanges (ARIEs)) that track patients previously colonized or infected with specific MDROs and then alert healthcare providers when these patients are admitted to a facility. The term AR Information Exchange emphasizes the importance of multidirectional information flow amongst healthcare facilities and public health authorities, as opposed to unidirectional data collection and storage.This interim guidance is intended for operational use by individuals and organizations responsible for developing or enhancing an ARIE; however, it does not constitute legal advice. Public health agencies should follow applicable laws, statues, and/or regulations when developing ARIEs with questions about directed to the entity\u2019s legal counsel.CS 324851-AARIE-Interim-Guidance-508.pdf20211158

Four Health Care Organizations' Efforts to Improve Patient Care and Reduce Costs

Synthesizes findings from four case studies in the Brookings-Dartmouth ACO Pilot Program about forming integrated systems that can deliver accountable care under shared-savings agreements with private payers

The Promise of Information and Communication Technology In Health Care: Extracting Value from the Chaos

Healthcare is an information business with expanding use of information and communication technologies (ICTs). Current ICT tools are immature, but a brighter future looms. We examine 7 areas of ICT in healthcare: electronic health records (EHRs), health information exchange (HIE), patient portals, telemedicine, social media, mobile devices and wearable sensors and monitors, and privacy and security. In each of these areas, we examine the current status and future promise, highlighting how each might reach its promise. Steps to better EHRs include a universal programming interface, universal patient identifiers, improved documentation and improved data analysis. HIEs require federal subsidies for sustainability and support from EHR vendors, targeting seamless sharing of EHR data. Patient portals must bring patients into the EHR with better design and training, greater provider engagement and leveraging HIEs. Telemedicine needs sustainable payment models, clear rules of engagement, quality measures and monitoring. Social media needs consensus on rules of engagement for providers, better data mining tools and approaches to counter disinformation. Mobile and wearable devices benefit from a universal programming interface, improved infrastructure, more rigorous research and integration with EHRs and HIEs. Laws for privacy and security need updating to match current technologies, and data stewards should share information on breaches and standardize best practices. ICT tools are evolving quickly in healthcare and require a rational and well-funded national agenda for development, use and assessment

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

Characterization and Representation of Patient Use of Virtual Health Technology in Primary Care

Purpose. Advances in virtual care technology have made healthcare more convenient and accessible. The goal of this study was to elucidate current patient portal behaviors by examining the pattern of time and service type use of patients, via data provided by access logs within electronic health records, to increase communication and care coordination through online healthcare portals. Methods. We conducted a retrospective study of patients in an academic healthcare center over a 5-year period using access log records in electronic health records (EHR). Dimensionality reduction analysis was applied to group portal functionalities into more interpretable and meaningful feature domains, followed by negative binomial regression analysis to evaluate how patient and practice characteristics affected the use of each feature domain. Results. Patient portal usage was categorized into four feature domains: messaging, health information management, billing/insurance, and resource/education. Individuals having more chronic conditions, lab tests or prescriptions generally had greater patient portal usage. However, patients who were male, elderly, in minority groups, or living in rural areas persistently had lower portal usage. Individuals on public insurance were also less likely than those on commercial insurance to use patient portals, though Medicare patients showed greater portal usage on health information management features and uninsured patients had greater usage on viewing resource/education features. Having Internet access only affected the use of messaging features, but not other feature. Conclusions. Efforts in enrolling patients in online portals does not guarantee patients using the portals to manage their health. While promoting the use of virtual health tools as part of patient-center care delivery model, primary care clinicians need to be aware of technological, socioeconomic, and cultural challenges faced by their patients

Assessing the level of readiness in Tshwane and Dr Kenneth Kaunda Districts for implementing a national patient based information system

Research Report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the Degree of Master of Public Health. March 2017.PURPOSE: The National Health Insurance programme has been identified as a priority to achieve Universal Health Coverage in South Africa. The development and implementation of a health information system (HIS) that is underpinned by a master population index (ability to uniquely identify a person), and operates on the electronic health records (EHR) model is critical for the implementation of the NHI. This study assesses the level of readiness in Tshwane and Dr Kenneth Kaunda districts for implementing a national patient based health information system. METHODS: This study design was a descriptive cross-sectional design. The study used a structured questionnaire to measure the level of readiness in two NHI districts, namely, Tshwane and Dr Kenneth Kaunda, for implementing a patient based National Health Information System in South Africa. RESULTS: The assessment has revealed that PHC facilities are at varying levels of readiness for implementing a national patient based information system. Tshwane scored better than Dr Kenneth Kaunda district on all four readiness criteria, with non-significant differences between them for core readiness, engagement readiness, and societal readiness and significantly higher levels in Tshwane for technological readiness. The readiness results varied across all four domains, ranging from 13% and 16% for core readiness to 59% and 68% for engagement readiness for Dr Kenneth Kaunda and Tshwane districts respectively. CONCLUSION: PHC facilities in Tshwane and Dr Kenneth Kaunda districts were capacitated with respect to ICT infrastructure. There were weaknesses with respect to business processes and IT support. The business process for the filing system needs to be defined, optimised and implemented in PHC facilities. The turnaround time for IT support was unacceptably high in both districts and needs to be improved prior to implementation of a patient based information system.LG201

Assessing the Performance Differences Between Hospitals With and Without Meaningful Use of Electronic Health Records on Care Outcomes

Background and Purpose of the Study: The U.S. healthcare system at $3 trillion, is the sixth largest economy in the world. The federal government is the largest purchaser of healthcare in the country. In the past decade it has been on a quest to refocus its purchasing from volume to value. While spending nearly double per capita than every other industrialized nation, U.S. healthcare outcomes are consistently in the lowest quartile for every major indicator from life expectancy to ambulatory sensitive conditions. The Crossing the Quality Chasm Report (IOM) focused a lens on the dearth of electronic health record (EHR) systems nationally. Resultant legislation, the HITECH Act, funded a$50 billion investment to close this gap along with promulgation of standards known as Meaningful Use (MU) to achieve interoperability. This investment and related MU protocols for implementation warrant a careful examination to establish if the intended improved outcomes have been achieved. Methods: The study is a cross-sectional, retrospective design; it employs two cohorts, Meaningful Use (MU) vs Non-MU hospitals. Publicly reported data on clinical outcomes, cost and safety from 4221 or 95% of the nation’s hospitals were included in the analysis to identify if there is a difference in outcomes between the hospital cohorts. Results: 2315 of the 4221 or 55% hospitals who were included in the study met MU standards by 2013. The profile of an MU hospital was a non-teaching (70%), geographically southern (40%), not-for-profit hospital (61%). Non-Mu hospital had a similar profile, 78% non-teaching, 35% Southern and 60% not-for-profit. Those hospitals who met MU had statistically lower mortality (p Conclusion: The HITECH Act that committed over $50 billion in subsidy incentive funds has dramatically increased EHR adoption nationally from 8% in 2009 to over 50% by 2013. The results from this suggest hospitals that had implemented EHRs’ that meet MU standards demonstrate mortality and cost outcomes that result in statistically significant cost and clinical care benefit