Organizational Challenges in Developing One of the Nationwide Health Information Network Trial Implementation Awardees

Health care in the United States is rarely delivered in a coordinated manner. Current methods to share patient information are inefficient and may lead to medical errors, higher readmission rates, and delays in the delivery of needed health services. This qualitative study describes lessons learned concerning the early implementation of one Nationwide Health Information Network (NHIN) site in Long Beach, CA during its first year of operation. The Long Beach Network for Health (LBNH) focused on an incremental effort to exchange health information. Despite a limited concentration on emergency department care, virtually all respondents noted concerns regarding the sustainability, or business case, for the exchange of health information. Nevertheless, respondents were encouraged by progress on technological challenges and user requirements during this first year. The early gains in this process may, in turn, have laid the groundwork for future efforts to expand beyond the emergency department

Provider Stakeholders’ Perceived Benefit from a Nascent Health Information Exchange: A Qualitative Analysis

We sought to better understand the perceived costs and benefits of joining a nascent health information exchange (HIE) from the perspective of potential provider organization participants. We therefore conducted semi-structured interviews with organizational representatives. Interview transcriptions were thematically coded, and coded text was subsequently aggregated to summarize the breadth and depth of responses. Although no respondents expected HIE to result in net financial benefit to their organization, all respondents recognized some potential benefits, and some respondents expected HIE to result in overall organizational benefit. Disproportionate benefit was expected for the poorest, sickest patients. Many respondents had concerns about HIE increasing the risk of data security breaches, and these concerns were most pronounced at larger organizations. We found little evidence of organizational concern regarding loss of patients to other organizations or publication of unfavorable quality data. If HIE’s greatest benefactors are indeed the poorest, sickest patients, our current health care financing environment will make it difficult to align HIE costs with benefits. To sustain HIE, state and federal governments may need to consider ongoing subsidies. Furthermore, these governments will need to ensure that policies regulating data exchange have sufficient nationwide coordination and liability limitations that the perceived organizational risks of joining HIEs do not outweigh perceived benefits. HIE founders can address organizational concerns by attempting to coordinate HIE policies with those of their largest founding organizations, particularly for data security policies. Early HIE development and promotional efforts should not only focus on potential benefits, but should also address organizational concerns

Spatial and temporal variations in thesediment fluxes and metal contaminationin nickel mining-impacted catchments

Understanding of the entire sediment routing system and the links between sources and storage at the catchment scale remains limited in nickel mining-affected regions. This research aims to address the knowledge gap by examining the spatial and temporal variability in the sediment delivery and the extent of siltation and metal contamination in nickel mining-impacted catchments in the Philippines. Discharge and suspended sediment concentrations and fluxes were monitored across 13 sub-catchments with contrasting degrees of mining influence from June 2018 to July 2019 in the Santa Cruz and Pamalabawan catchments. The findings highlight the importance of the size of the area that has been physically disturbed within the sub-catchments (i.e., 10-22% of relative disturbance area generating fourfold to eightfold increase in the sediment yield) and the strong control of floodplain sediment recycling on sediment delivery at both reach and catchment scales (i.e., the relative contribution of floodplain sources to the sediment budget progressively increased over the wet season). Two-dimensional unsteady flow modelling of flood inundation during storms identified the extent of intermediate sediment stores and the zone of preferential silt deposition. Integrating the hydraulic models with the sediment budgets provided additional insight on how erosional and depositional processes vary in between events. Composite geochemical fingerprinting of overbank deposits pointed to mine effluents as the dominant sediment source (77.0 ± 8.7 %), with lower contribution from natural (16.9 ± 5.4 %) and agricultural sources (5.4 ± 1.1 %). Minimal contamination was assessed with respect to background sources due to inherently elevated background metal concentrations in the catchment that are orders of magnitude higher than the threshold values set by international sediment quality guidelines. Element partitioning data indicate that metals are dominantly associated with and transported to the floodplain and coastal areas via suspended particulate matter. Overall, this study underscores the importance of the entire sediment routing system in controlling sediment transport, and that focussing on managing sediment from mining structures and intermediate stores in the catchment is the key to minimising siltation and potential ecological impacts downstream of mining areas. The novel dataset and interpretations provided by this study could optimise environmental management in this ecologically important yet data-scarce region that is threatened by enhanced erosion from mining

Measurement of depression treatment among patients receiving HIV primary care: Whither the truth?

Background: Prescription records, manual chart review, and patient self-report are each imperfect measures of depression treatment in HIV-infected adults. Methods: We compared antidepressant prescription records in an electronic data warehouse with antidepressant treatment and psychotherapy identified via manual chart review and self-report for patients at 6 academic HIV treatment centers. We examined concordance among these three sources, and used latent class analysis (LCA) to estimate sensitivity and specificity of each measure. Results: In our charts sample (n = 586), 59% had chart indication of “any depression treatment” and 46% had a warehouse prescription record. Antidepressant use was concordant between charts and data warehouse for 77% of the sample. In our self-report sample (n = 677), 52% reported any depression treatment and 43% had a warehouse prescription record. Self-report of antidepressant treatment was consistent with prescription records for 71% of the sample. LCA estimates of sensitivity and specificity for “any depression treatment” were 67% and 90% (warehouse), 87% and 75% (self-report), and 96% and 77% (chart). Limitations: There is no gold standard to measure depression treatment. Antidepressants may be prescribed to patients for conditions other than depression. The results may not be generalizable to patient populations in non-academic HIV clinics. Regarding LCA, dependence of errors may have led to overestimation of sensitivity and specificity. Conclusions: Prescription records were largely concordant with self-report and chart review, but there were discrepancies. Studies of depression in HIV-infected patients would benefit from using multiple measures of depression treatment or correcting for exposure misclassification