Usage of query-based health information exchange after event notifications

ABSTRACT Objectives: This study sought to quantify the association between event notifications and subsequent querybased health information exchange (HIE) use among end users of three different community health information organizations. Materials and Methods: Using system-log data merged with user characteristics, regression-adjusted estimates were used to describe the association between event notifications and subsequent query-based HIE usage. Results: Approximately 5% of event notifications were associated with query-based HIE usage within 30 days. In adjusted models, odds of query-based HIE usage following an event notification were higher for older patients and for alerts triggered by a discharge event. Query-based HIE usage was more common among specialty clinics and Federally Qualified Health Centers than primary care organizations. Discussion and Conclusion: In this novel combination of data, 1 in 20 event notifications resulted in subsequent query-based HIE usage. Results from this study suggest that event notifications and query-based HIE can be applied together to address clinical and population health use cases

Organizational characteristics and perceptions of clinical event notification services in healthcare settings: a study of health information exchange

Objective: Event notification systems are an approach to health information exchange (HIE) that notifies end-users of patient interactions with the healthcare system through real-time automated alerts. We examined associations between organizational capabilities and perceptions of event notification system use. Materials and methods: We surveyed representatives (n = 196) from healthcare organizations (n = 96) that subscribed to 1 of 3 Health Information Organizations' event notification services in New York City (response rate = 27%). The survey was conducted in Fall 2017 and Winter 2018. Surveys measured respondent characteristics, perceived organizational capabilities, event notification use, care coordination, and care quality. Exploratory factor analysis was used to identify relevant independent and dependent variables. We examined the relationship between organizational capabilities, care coordination, and care quality using multilevel linear regression models with random effects. Results: Respondents indicated that the majority of their organizations provided follow-up care for emergency department visits (66%) and hospital admissions (73%). Perceptions of care coordination were an estimated 57.5% (β = 0.575; P < 0.001) higher among respondents who reported event notifications fit within their organization's existing workflows. Perceptions of care quality were 46.5% (β = 0.465; P < 0.001) higher among respondents who indicated event notifications fit within existing workflows and 23.8% (β = 0.238; P < 0.01) higher where respondents reported having supportive policies and procedures for timely response and coordination of event notifications. Discussion and conclusion: Healthcare organizations with specific workflow processes and positive perceptions of fit are more likely to use event notification services to improve care coordination and care quality. In addition, event notification capacity and patient consent procedures influence how end-users perceive event notification services

The impact of interoperability of electronic health records on ambulatory physician practices: a discrete-event simulation study

Background The effect of health information technology (HIT) on efficiency and workload among clinical and nonclinical staff has been debated, with conflicting evidence about whether electronic health records (EHRs) increase or decrease effort. None of this paper to date, however, examines the effect of interoperability quantitatively using discrete event simulation techniques.Objective To estimate the impact of EHR systems with various levels of interoperability on day-to-day tasks and operations of ambulatory physician offices.Methods Interviews and observations were used to collect workflow data from 12 adult primary and specialty practices. A discrete event simulation model was constructed to represent patient flows and clinical and administrative tasks of physicians and staff members.Results High levels of EHR interoperability were associated with reduced time spent by providers on four tasks: preparing lab reports, requesting lab orders, prescribing medications, and writing referrals. The implementation of an EHR was associated with less time spent by administrators but more time spent by physicians, compared with time spent at paper-based practices. In addition, the presence of EHRs and of interoperability did not significantly affect the time usage of registered nurses or the total visit time and waiting time of patients.Conclusion This paper suggests that the impact of using HIT on clinical and nonclinical staff work efficiency varies, however, overall it appears to improve time efficiency more for administrators than for physicians and nurses

Interactive graphics for communicating health risks

Materials for consumer informatics, patient decision support, and health promotion frequently incorporate quantitative risks such as percentages, rates, or proportions. These risks are frequently illustrated with stick figures, bar charts, or other graphics. However, risk communication models (such as the extended parallel process model) and decision models (such as prospect theory) generally focus on features of the verbal message, while failing to explore the effects of number format and illustration design. That these factors are important is shown by growing literatures that describe consumers' difficulty comprehending numbers, as well as strong effects of numeracy and risk graphic design on perceived risk and choices. This dissertation proposes an integrated model of risk communication that draws from cognitive psychology and health behavior models to consider contributions of the verbal message, features of the graphic illustration, and the audience's numeracy. Next, the dissertation presents an ontology of features of risk graphics (including animation and interactivity) and their cognitive/perceptual effects, developed through a systematic literature review. Third, a qualitative formative study was conducted that resulted in the design of several animated and interactive risk graphics with applications in Web-based communication. Finally, a questionnaire study was conducted to assess the effect of the interactive graphics on risk estimates, risk feelings, and decisions, and interactions with numeracy. Numeracy strongly affected risk estimates, risk feelings, and decisions, with lower numeracy correlated with higher perceived risks. Interaction with one of the interactive graphics affected risk perceptions and narrowed differences between high- and low-numeracy respondents. Computer-based graphical displays such as the ones developed in this project have the potential to be applied in informatics interventions for health education, tailored health and risk communication, shared medical decision-making, and patient decision support. The methods used are also promising for assessing effects of other scientific data graphics

Health information exchange in the wild: the association between organizational capability and perceived utility of clinical event notifications in ambulatory and community care

Objective: Event notifications are real-time, electronic, automatic alerts to providers of their patients' health care encounters at other facilities. Our objective was to examine the effects of organizational capability and related social/organizational issues upon users' perceptions of the impact of event notifications on quality, efficiency, and satisfaction. Materials and methods: We surveyed representatives (n = 49) of 10 organizations subscribing to the Bronx Regional Health Information Organization's event notification services about organizational capabilities, notification information quality, perceived usage, perceived impact, and organizational and respondent characteristics. The response rate was 89%. Average item scores were used to create an individual domain summary score. The association between the impact of event notifications and organizational characteristics was modeled using random-intercept logistic regression models. Results: Respondents estimated that organizations followed up on the majority (83%) of event notifications. Supportive organizational policies were associated with the perception that event notifications improved quality of care (odds ratio [OR] = 2.12; 95% CI, = 1.05, 4.45), efficiency (OR = 2.06; 95% CI = 1.00, 4.21), and patient satisfaction (OR = 2.56; 95% CI = 1.13, 5.81). Higher quality of event notification information was also associated with a perceived positive impact on quality of care (OR = 2.84; 95% CI = 1.31, 6.12), efficiency (OR = 3.04; 95% CI = 1.38, 6.69), and patient satisfaction (OR = 2.96; 95% CI = 1.25, 7.03). Conclusions: Health care organizations with appropriate processes, workflows, and staff may be better positioned to use event notifications. Additionally, information quality remains critical in users' assessments and perceptions

Using Visual Analogies To Teach Introductory Statistical Concepts

Introductory statistical concepts are some of the most challenging to convey in quantitative literacy courses. Analogies supplemented by visual illustrations can be highly effective teaching tools. This literature review shows that to exploit the power of analogies, teachers must select analogies familiar to the audience, explicitly link the analog with the target concept, and avert misconceptions by explaining where the analogy fails. We provide guidance for instructors and a series of visual analogies for use in teaching medical and health statistics