Using structured and unstructured data to identify patients’ need for services that address the social determinants of health

Introduction Increasingly, health care providers are adopting population health management approaches that address the social determinants of health (SDH). However, effectively identifying patients needing services that address a SDH in primary care settings is challenging. The purpose of the current study is to explore how various data sources can identify adult primary care patients that are in need of services that address SDH. Methods A cross-sectional study described patients in need of SDH services offered by a safety-net hospital’s federally qualified health center clinics. SDH services of social work, behavioral health, nutrition counseling, respiratory therapy, financial planning, medical-legal partnership assistance, patient navigation, and pharmacist consultation were offered on a co-located basis and were identified using structured billing and scheduling data, and unstructured electronic health record data. We report the prevalence of the eight different SDH service needs and the patient characteristics associated with service need. Moreover, characteristics of patients with SDH services need documented in structured data sources were compared with those documented by unstructured data sources. Results More than half (53%) of patients needed SDH services. Those in need of such services tended to be female, older, more medically complex, and higher utilizers of services. Structured and unstructured data sources exhibited poor agreement on patient SDH services need. Patients with SDH services need documented by unstructured data tended to be more complex. Discussion The need for SDH services among a safety-net population is high. Identifying patients in need of such services requires multiple data sources with structured and unstructured data

Electronic health record portals in Portugal : a perspective from providers and patients

Dissertation presented as the partial requirement for obtaining a Master's degree in Information Management, specialization in Knowledge Management and Business IntelligenceHealthcare systems are becoming more patient centered, as today’s citizens are more active and more informed. In line with this trend, healthcare providers are promoting the use of online applications such as Electronic Health Record (EHR) portals. EHR portals can be defined as web based applications that combine an EHR system and a patient portal, with the potential of helping to achieve benefits for both patients and healthcare providers, which makes the adoption of EHR portals an important field to study and understand. The aim of this study is to characterize the view from providers and patients on EHR portals, having the Portuguese health system as scenario. The methodology was divided into a provider-centered and a patient-centered approach, being characterized as a mixed-methods research as qualitative and quantitative data collection procedures were followed. Results point out that EHR portals are considered by providers as crucial in the establishment of a digital relationship with patients, but efforts still need to be carried out for the users to adhere to these technologies. Also, the portals available in Portugal are heterogeneous in terms of functionalities offered, greatly differing in terms of number of functionalities. Patients view some functionalities of EHR portals more important than others and half of them are users of the portal developed by the public provider. The statistically determinants of adoption of EHR portals were verified. By having the perspective of providers and users, it was possible to provide insights that can be helpful to develop EHR portals that meet patient demands

Integrating Behavioral Health & Primary Care in New Hampshire: A Path Forward to Sustainable Practice & Payment Transformation

New Hampshire residents face challenges with behavioral and physical health conditions and the interplay between them. National studies show the costs and the burden of illness from behavioral health conditions and co-occurring chronic health conditions that are not adequately treated in either primary care or behavioral health settings. Bringing primary health and behavioral health care together in integrated care settings can improve outcomes for both behavioral and physical health conditions. Primary care integrated behavioral health works in conjunction with specialty behavioral health providers, expanding capacity, improving access, and jointly managing the care of patients with higher levels of acuity In its work to improve the health of NH residents and create effective and cost-effective systems of care, the NH Citizens Health Initiative (Initiative) created the NH Behavioral Health Integration Learning Collaborative (BHI Learning Collaborative) in November of 2015, as a project of its Accountable Care Learning Network (NHACLN). Bringing together more than 60 organizations, including providers of all types and sizes, all of the state’s community mental health centers, all of the major private and public insurers, and government and other stakeholders, the BHI Learning Collaborative built on earlier work of a NHACLN Workgroup focused on improving care for depression and co-occurring chronic illness. The BHI Learning Collaborative design is based on the core NHACLN philosophy of “shared data and shared learning” and the importance of transparency and open conversation across all stakeholder groups. The first year of the BHI Learning Collaborative programming included shared learning on evidence-based practice for integrated behavioral health in primary care, shared data from the NH Comprehensive Healthcare Information System (NHCHIS), and work to develop sustainable payment models to replace inadequate Fee-for-Service (FFS) revenues. Provider members joined either a Project Implementation Track working on quality improvement projects to improve their levels of integration or a Listen and Learn Track for those just learning about Behavioral Health Integration (BHI). Providers in the Project Implementation Track completed a self-assessment of levels of BHI in their practice settings and committed to submit EHR-based clinical process and outcomes data to track performance on specified measures. All providers received access to unblinded NHACLN Primary Care and Behavioral Health attributed claims data from the NHCHIS for provider organizations in the NH BHI Learning Collaborative. Following up on prior work focused on developing a sustainable model for integrating care for depression and co-occurring chronic illness in primary care settings, the BHI Learning Collaborative engaged consulting experts and participants in understanding challenges in Health Information Technology and Exchange (HIT/HIE), privacy and confidentiality, and workforce adequacy. The BHI Learning Collaborative identified a sustainable payment model for integrated care of depression in primary care. In the process of vetting the payment model, the BHI Learning Collaborative also identified and explored challenges in payment for Substance Use Disorder Screening, Brief Intervention and Referral to Treatment (SBIRT). New Hampshire’s residents will benefit from a health care system where primary care and behavioral health are integrated to support the care of the whole person. New Hampshire’s current opiate epidemic accentuates the need for better screening for behavioral health issues, prevention, and treatment referral integrated into primary care. New Hampshire providers and payers are poised to move towards greater integration of behavioral health and primary care and the Initiative looks forward to continuing to support progress in supporting a path to sustainable integrated behavioral and primary care

Centers for Disease Control and Prevention's National Center for Chronic Disease Prevention and Health Promotion : social determinants of health data exchange for chronic disease prevention initiative public health use case package. Version 1.2

DISCLAIMER: This Use Case document was developed solely for informational and decisional purposes in the identification of three public health use cases for documenting and sharing social determinants of health data. This document is not policy binding, does not recommend policy directions, nor provide policy guidance.The CDC\u2019s National Center for Chronic Disease Prevention and Health Promotion\u2019s (NCCDPHP or \u201cCenter\u201d) mission is to help people and communities prevent chronic diseases and promote health and wellness for all. Chronic diseases are defined broadly as conditions that last one year or more and require ongoing medical attention or limit activities of daily living or both. Presently, six in ten Americans live with at least one chronic disease such as heart disease and stroke, cancer, and diabetes, among others. These, and other chronic diseases, are the leading causes of death and disability in America as well as a leading driver of health care costs.CDC SDOH Public Health Use Case Package_FINAL_10-08-2022.pd

Electronic Information Sharing to Improve Post-Acute Care Transitions

Hospitals frequently transfer patients to skilled nursing facilities (SNFs) for post-acute care; information sharing between these settings is critical to ensure safe and effective transitions. Recent policy and payer initiatives have encouraged hospitals and SNFs to work together towards improving these care transitions, and associated patient outcomes such as avoidable re-hospitalizations. Exchanging information electronically, through health information exchange (HIE), can help facilitate information transfer, and has shown benefits to patient care in other contexts. But, it is unclear whether this evidence translates to the post-acute care context given the vulnerability of this patient population and complexities specific to coordination between acute and post-acute care settings. Chapter One estimates the national prevalence of hospital’s engagement in HIE with post-acute providers, and explores potential factors prompting this investment. 56% of hospitals report some level of HIE with post-acute care providers. This investment appears strategically to be more incidental than intentional; hospitals’ overall level of sophistication and investment in electronic health records and HIE strongly predicts whether HIE is occurring in the post-acute transition context. However, we see some evidence of association between participation in delivery and payment reforms and hospital use of HIE with post-acute providers. This suggests that HIE may increasingly be considered part of a comprehensive strategy to improve coordination between hospitals and post-acute care providers, though may lack the necessary customization to achieve meaningful value in this context. Chapter Two utilizes a difference-in-differences approach to assess HIE impact on patient outcomes in the post-acute context, exploiting one focal hospital’s selective implementation of HIE with just three partnering local SNFs. I find no measurable effect of HIE implementation on patient likelihood of re-hospitalization, relative to patients discharged to SNFs without HIE. However, log files that capture when and how these SNF providers use available HIE technology reveal significant variation in usage patterns. HIE was more often utilized following discharge situations where transitional care workflows may not be particularly robust, such as discharge from the ED or observation rather than an inpatient unit. However, the system was less likely to be used for more complex patients, and for patients discharged on the weekend – when SNFs operate at reduced staffing and may not have the bandwidth to leverage available technology. When we connect variation in usage patterns to likelihood of readmission, realizing patient care benefits depended on the timing (relative to patient transfer) and intensity (depth of information retrieved) of use. Chapter Three employs qualitative methods – semi-structured interviews with the focal hospital and five proximate SNFs – to better understand hospital-to-SNF transitions, and perceived opportunities and challenges in using HIE functionality to address information gaps. We capture five specific dimensions of information discontinuity; utilizing IT to address these issues is hindered by lack of process optimization from a sociotechnical perspective. Some SNFs lacked workflows to connect those with HIE access to the staff seeking information. Further, all facilities struggled with physician-centric transition processes that restricted availability of critical nursing and social work documentation, and promoted organizational changes that strengthened physician-to-physician handoff while unintentionally weakening inter-organizational transitional care processes. HIE has the potential to address information discontinuity that compromises post-acute transitions of care. These findings facilitate targeted efforts to help hospitals and SNFs pursue HIE in ways that are most likely to result in improved care quality and patient outcomes.PHDHealth Services Organization & PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/146031/1/dacross_1.pd

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

Medical Records and Privacy Rights: The Unintended Consequences of Aggregated Data in Electronic Health Records

In an era of rapid-pace technological innovation and political focus on healthcare, the federal government is pushing for nationwide interoperability of electronic health records. While there are many benefits from such a program, the lack of federal or state privacy regulations for patients\u27 personal data opens up the possibility of widespread dissemination of private and sensitive information. This inattention to privacy will cause major problems if exploited. Currently, there are no federal or Colorado laws that protect against potential privacy violations and provide recourse for a patient if a medical professional decides to insert nonmedical information, such as information about the patient\u27s housing status, into a patient\u27s electronic health record without the patient\u27s prior consent. Although innocuous enough when only the doctor has access to this record, with the increased use of health information exchanges, this information can be disseminated to thousands of healthcare providers around the country. This Comment argues that a comprehensive privacy protection act is critical and long past due for patient protection in the quickly evolving intersection of health care and technology

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

A population ecology perspective on the functioning and future of health information organizations

Background: Increasingly, health care providers need to exchange information to meet policy expectations and business needs. A variety of health information organizations (HIOs) provide services to facilitate health information exchange (HIE). However, the future of these organizations is unclear. Purpose: The aim of this study was to explore the environmental context, potential futures, and survivability of community HIOs, enterprise HIEs, and electronic health record vendor-mediated exchange using the population ecology theory. Approach: Qualitative interviews with 33 key informants representing each type of HIE organization were analyzed using template analysis. Results: Community HIOs, enterprise HIEs, and electronic health record vendors exhibited a high degree of competition for resources, especially in the area of exchange infrastructure services. Competition resulted in closures in some areas. In response to environmental pressures, each organizational type was endeavoring to differentiate its services and unique use case, as well as pursing symbiotic relationships or attempting resource partitioning. Conclusion: HIOs compete for similar resources and are reacting to environmental pressures to better position themselves for continued survival and success. Our ecological research perspective helps move the discourse away from situation of a single exchange organization type toward a view of the broader dynamics and relationships of all organizations involved in facilitating HIE activities

Barriers and Facilitators of Electronic Health Records in Rural Communities

Electronic health records (EHRs) offer digitally stored healthcare information during an individual’s lifetime with the purpose of evidence-based research, continuity of care, prior health care, and educational resources. EHR’s contain diagnostic test, such as laboratory values and radiological images, treatments, therapies, medication administration, patient identifying information, and legal forms. The barriers and facilitators of electronic medical or health records (EMR or EHRs) are designated to offer data for providers and caregivers working in the local mobile health units in South Georgia. The project determined the readiness, barriers, needs assessment, and facilitators for electronic health records within the rural communities with the intent to obtain patient information, delivering quality care