Electronic Health Records and Health Information Exchange and Their Impact on International Healthcare System Efficiency

The 19th century epidemiological transition in healthcare caused a major shift in physician focus from curing one-time, deadly illness to managing chronic disease. Now, even the most advanced international healthcare systems must find a way to increase their efficiency in order to compensate for heightened strains on medical systems and swelling costs of healthcare delivery. Fortunately, recent technological innovation and, chiefly, the growth of Electronic Health Records (EHRs) provide a potential solution to this looming threat. EHRs are digital charts with the potential to store and share patient health data among providers to offer the most informed, streamlined care available. Yet, their effectiveness in increasing health system efficiency remains uncertain. Relying on the concept of technical efficiency in the healthcare sector, I explore the efficacy of long-term international EHR implementation. Using OECD data, I performed a Stochastic Frontier Analysis (SFA) and measured the change in hospital subsector efficiency over time for each of the 15 chosen countries within my analysis. Followed by this data is a comprehensive EHR index as well as 5 individual country case studies to better explain the histories, successes, and failures of EHR implementation throughout the world. These measures yielded somewhat inconclusive results pertaining to EHR’s effect on international healthcare efficiency. Nevertheless, the findings of this study strongly support the need for continued international healthcare efficiency analysis. Rather than submit to the difficulties of such nuanced and complex analytical processes, researchers must remain vigilant and steadfast in their pursuit of efficiency in order to provide effective, affordable healthcare to everyone in need

Database queries for hospitalizations for acute congestive heart failure: flexible methods and validation based on set theory

Background and objective Electronic health records databases are increasingly used for identifying cohort populations, covariates, or outcomes, but discerning such clinical ‘phenotypes’ accurately is an ongoing challenge. We developed a flexible method using overlapping (Venn diagram) queries. Here we describe this approach to find patients hospitalized with acute congestive heart failure (CHF), a sampling strategy for one-by-one ‘gold standard’ chart review, and calculation of positive predictive value (PPV) and sensitivities, with SEs, across different definitions. Materials and methods We used retrospective queries of hospitalizations (2002–2011) in the Indiana Network for Patient Care with any CHF ICD-9 diagnoses, a primary diagnosis, an echocardiogram performed, a B-natriuretic peptide (BNP) drawn, or BNP >500 pg/mL. We used a hybrid between proportional sampling by Venn zone and over-sampling non-overlapping zones. The acute CHF (presence/absence) outcome was based on expert chart review using a priori criteria. Results Among 79 091 hospitalizations, we reviewed 908. A query for any ICD-9 code for CHF had PPV 42.8% (SE 1.5%) for acute CHF and sensitivity 94.3% (1.3%). Primary diagnosis of 428 and BNP >500 pg/mL had PPV 90.4% (SE 2.4%) and sensitivity 28.8% (1.1%). PPV was <10% when there was no echocardiogram, no BNP, and no primary diagnosis. ‘False positive’ hospitalizations were for other heart disease, lung disease, or other reasons. Conclusions This novel method successfully allowed flexible application and validation of queries for patients hospitalized with acute CHF

IT ENABLED SERVICE INNOVATION: STRATEGIES FOR FIRM PERFORMANCE

This dissertation seeks to understand firm strategies and implications for sustainability and success in the context of IT-enabled service innovations. The first essay examines how business models evolve to influence the financial sustainability and maturity of health information exchanges (HIE), a new organizational form in the United States healthcare landscape to facilitate electronic health information sharing across multiple stakeholders such as hospitals, doctors, laboratories, and patients. The study focusses on two components of business models of HIEs: the customer value proposition that is manifested through three categories of service offerings (e.g., foundational, vendor driven and advanced), and two revenue model approaches to earn profits (e.g., subscription and transaction-based revenues models). Using an unique archival data set constructed from surveys of HIEs in the US from 2008 to 2010 for empirical analysis; we find that foundational IT enabled service offerings have higher positive influence on operational maturity and financial sustainability, compared to vendor driven or advanced service offerings. Further, findings show subscription-based revenue models are more advantageous for sustainability in early stages, while transaction-based revenue models lead to higher operational maturity in later stages. The second essay investigates how two dimensions of IT enabled service augmentation, i.e., value added service and customer care, interplay with core services to influence customer satisfaction with cell phone services in base-of-the-pyramid (BOP) markets. Arguing for price- and relational- evaluations, we develop hypotheses for a substitution effect of value added services, and a complementary effect of customer care, on the relationship between core service and customer satisfaction. Specific to the BOP market context, we further proposed a differentiated influence of service augmentation for different categories of providers based on their institutional contexts and investment strategies. We empirically examine and find support for the hypothesized relationships using an archival data set from surveys of over 3,400 cell phone customers across 34 providers in seven South Asian countries. The two studies contribute to existing literature in exploring the factors associated with firm performance, and derive managerial implications to effectively manage and profit from IT enabled service innovations. Overall, the dissertation has research and practice implications to gain an understanding of the appropriate strategies to increase firm performance in the context of IT enabled service innovations

The Process of Building Patient Trust in Health Information Exchange (HIE): The Impacts of Perceived Benefits, Perceived Transparency of Privacy Policy, and Familiarity

Exchange technologies such as health information exchanges (HIE) currently lack acceptance theories that consider not only cognitive beliefs that result in adoption behavior but also emotional factors that may influence adoption intention. Based on the theory of reasoned action (TRA), the technology-adoption literature, and the trust literature, I theoretically explain and empirically test the impact that perceived benefits, perceived transparency of privacy policy, and familiarity have on cognitive trust and emotional trust in HIE. Moreover, I analyze the effect that cognitive trust and emotional trust have on individuals’ intention to opt into HIE and their willingness to disclose health information. I conducted an online survey using data from individuals who knew about HIE through experiences with providers that participated in a regional consumer-mediated HIE network. In my SEM analysis, I found empirical support for the proposed model. My findings indicate that, when patients know more about HIE benefits, HIE sharing procedures, and privacy guidelines, they feel more in control, more assured, and less at risk. The results also show that patient trust in HIE may take the forms of intentions to opt in to HIE and patients’ willingness to disclose personal health information that providers exchange through the HIE. I discuss the implications my results have for both academics and practitioners

Diffusion of Electronic Health Records in Rural Primary Care Clinics

By the end of 2015, Medicare-eligible physicians at primary care practices (PCP) who do not use an electronic health record (EHR) system will incur stiff penalties if they fail to meet the deadline for using EHRs. Yet, less than 30% of rural primary clinics have fully functional EHR systems. The purpose of this phenomenology study was to explore rural primary care physicians and physician assistants\u27 experiences regarding overcoming barriers to implementing EHRs. Complex adaptive systems formed the conceptual framework for this study. Data were collected through face-to-face interviews with a purposeful sample of 21 physicians and physician assistants across 2 rural PCPs in the southeastern region of Missouri. Participant perceptions were elicited regarding overcoming barriers to implementing EHRs under the American Recovery and Reinvestment Act, Health Information Technology for Economic and Clinical Health, and the Patient Protection and Affordable Care Act legislation. Interview questions were transcribed and processed through qualitative software to discern themes of how rural PCP physicians and physician assistants might overcome barriers to implementing electronic health records. Through the exploration of the narrative segments, 4 emergent themes were common among the participants: (a) limited finances to support EHRs, (b) health information exchange issues, (c) lack of business education, and (d) lack of transformation at rural medical practices. The implications for positive social change include the potential implementation of EHRs particularly in physician practices in rural communities, which could provide cost-efficient health care services for those communities and a more sustainable future at primary care practices

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

The Second International Conference on Health Information Technology Advancement

TABLE OF CONTENTS I. Message from the Conference Co-Chairs B. Han and S. Falan …………………………....….……………. 5 II. Message from the Transactions Editor H. Lee …...………..………….......………….……….………….... 7 III. Referred Papers A. Emerging Health Information Technology and Applications The Role of Mobile Technology in Enhancing the Use of Personal Health Records Mohamed Abouzahra and Joseph Tan………………….……………. 9 Mobile Health Information Technology and Patient Care: Methods, Themes, and Research Gaps Bahae Samhan, Majid Dadgar, and K. D. Joshi…………..…. 18 A Balanced Perspective to Perioperative Process Management Jim Ryan, Barbara Doster, Sandra Daily, and Carmen Lewis…..….…………… 30 The Impact of Big Data on the Healthcare Information Systems Kuo Lane Chen and Huei Lee………….…………… 43 B. Health Care Communication, Literacy, and Patient Care Quality Digital Illness Narratives: A New Form of Health Communication Jofen Han and Jo Wiley…..….……..…. 47 Relationships, Caring, and Near Misses: Michael’s Story Sharie Falan and Bernard Han……………….…..…. 53 What is Your Informatics Skills Level? -- The Reliability of an Informatics Competency Measurement Tool Xiaomeng Sun and Sharie Falan.….….….….….….…. 61 C. Health Information Standardization and Interoperability Standardization Needs for Effective Interoperability Marilyn Skrocki…………………….…….………….… 76 Data Interoperability and Information Security in Healthcare Reid Berryman, Nathan Yost, Nicholas Dunn, and Christopher Edwards.…. 84 Michigan Health Information Network (MiHIN) Shared Services vs. the HIE Shared Services in Other States Devon O’Toole, Sean O’Toole, and Logan Steely…..……….…… 94 D. Health information Security and Regulation A Threat Table Based Approach to Telemedicine Security John C. Pendergrass, Karen Heart, C. Ranganathan, and V.N. Venkatakrishnan …. 104 Managing Government Regulatory Requirements for Security and Privacy Using Existing Standard Models Gregory Schymik and Dan Shoemaker…….…….….….… 112 Challenges of Mobile Healthcare Application Security Alan Rea………………………….……………. 118 E. Healthcare Management and Administration Analytical Methods for Planning and Scheduling Daily Work in Inpatient Care Settings: Opportunities for Research and Practice Laila Cure….….……………..….….….….… 121 Predictive Modeling in Post-reform Marketplace Wu-Chyuan Gau, Andrew France, Maria E. Moutinho, Carl D. Smith, and Morgan C. Wang…………...…. 131 A Study on Generic Prescription Substitution Policy as a Cost Containment Approach for Michigan’s Medicaid System Khandaker Nayeemul Islam…….…...……...………………….… 140 F. Health Information Technology Quality Assessment and Medical Service Delivery Theoretical, Methodological and Practical Challenges in Designing Formative Evaluations of Personal eHealth Tools Michael S. Dohan and Joseph Tan……………….……. 150 The Principles of Good Health Care in the U.S. in the 2010s Andrew Targowski…………………….……. 161 Health Information Technology in American Medicine: A Historical Perspective Kenneth A. Fisher………………….……. 171 G. Health Information Technology and Medical Practice Monitoring and Assisting Maternity-Infant Care in Rural Areas (MAMICare) Juan C. Lavariega, Gustavo Córdova, Lorena G Gómez, Alfonso Avila….… 175 An Empirical Study of Home Healthcare Robots Adoption Using the UTUAT Model Ahmad Alaiad, Lina Zhou, and Gunes Koru.…………………….….………. 185 HDQM2: Healthcare Data Quality Maturity Model Javier Mauricio Pinto-Valverde, Miguel Ángel Pérez-Guardado, Lorena Gomez-Martinez, Martha Corrales-Estrada, and Juan Carlos Lavariega-Jarquín.… 199 IV. A List of Reviewers …………………………..…….………………………208 V. WMU – IT Forum 2014 Call for Papers …..…….…………………20

Strategies to Mitigate Information Technology Discrepancies in Health Care Organizations

Medication errors increased 64.4% from 2015 to 2018 in the United States due to the use of computerized physician order entry (CPOE) systems and the inability to exchange information among health care facilities. Healthcare information exchange (HIE) and subsequent discrepancies resulted in significant medical errors due to the lack of exchangeable health care information using technology software. The purpose of this qualitative multiple case study was to explore the strategies health care business managers used to manage computerized physician order entry systems within health care facilities to reduce medication errors and increase profitability. The population of the study was 8 clinical business managers in 2 successful small health care clinics located in the mid-Atlantic region of the United States. Data were collected from semistructured interviews with health care leaders and documents from the health care organization as a resource. Inductive analysis was guided by the Donabedian theory and sociotechnical system theory, and trustworthiness of interpretations was confirmed through member checking. Three themes emerged: standardizing data formats reduced medication errors and increased profits, adopting user-friendly HIE reduced medication errors and increase profits, and efficient communication reduced medication errors and increased profits. The findings of this study contribute to positive change through improved health care delivery to patients resulting in healthier communities

Transactions of the First International Conference on Health Information Technology Advancement vol. 1, no. 1

Full proceedings of The First International Conference on Health Information Technology Advancement held at Western Michigan University in Kalamazoo, Michigan on October 28, 2011. Conference Co-Chairs: Dr. Bernard Han, Director of the Center for HIT Advancement (CHITA) at Western Michigan University Dr. Sharie Falan, Associate Director of the Center for HIT Advancement (CHITA) at Western Michigan University Transactions Editor: Dr. Huei Lee, Professor in the Department of Computer Information Systems at Eastern Michigan Universit

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