scholarly journals Balancing health privacy, health information exchange, and research in the context of the COVID-19 pandemic

2020 ◽  
Vol 27 (6) ◽  
pp. 963-966 ◽  
Author(s):  
Leslie Lenert ◽  
Brooke Yeager McSwain
Keyword(s):  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Systems Of Care ◽  
Clinical Care ◽  
The Novel ◽  
Remote Testing ◽  
Specimen Collection ◽  
Care Processes ◽  
Novel Coronavirus

Abstract The novel coronavirus disease 2019 infection poses serious challenges to the healthcare system that are being addressed through the creation of new unique and advanced systems of care with disjointed care processes (eg, telehealth screening, drive-through specimen collection, remote testing, telehealth management). However, our current regulations on the flows of information for clinical care and research are antiquated and often conflict at the state and federal levels. We discuss proposed changes to privacy regulations such as the Health Insurance Portability and Accountability Act designed to let health information seamlessly and frictionlessly flow among the health entities that need to collaborate on treatment of patients and, also, allow it to flow to researchers trying to understand how to limit its impacts.

scholarly journals Identification of patients at risk of new onset heart failure: Utilizing a large statewide health information exchange to train and validate a risk prediction model

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260885
Author(s):  
Son Q. Duong ◽  
Le Zheng ◽  
Minjie Xia ◽  
Bo Jin ◽  
Modi Liu ◽  
...  
Keyword(s):  
Machine Learning ◽  
Heart Failure ◽  
Health Information ◽  
Information Exchange ◽  
Validation Cohort ◽  
Health Information Exchange ◽  
Clinical Care ◽  
Preventative Care ◽  
Increased Risk ◽  
New Onset

Background New-onset heart failure (HF) is associated with poor prognosis and high healthcare utilization. Early identification of patients at increased risk incident-HF may allow for focused allocation of preventative care resources. Health information exchange (HIE) data span the entire spectrum of clinical care, but there are no HIE-based clinical decision support tools for diagnosis of incident-HF. We applied machine-learning methods to model the one-year risk of incident-HF from the Maine statewide-HIE. Methods and results We included subjects aged ≥ 40 years without prior HF ICD9/10 codes during a three-year period from 2015 to 2018, and incident-HF defined as assignment of two outpatient or one inpatient code in a year. A tree-boosting algorithm was used to model the probability of incident-HF in year two from data collected in year one, and then validated in year three. 5,668 of 521,347 patients (1.09%) developed incident-HF in the validation cohort. In the validation cohort, the model c-statistic was 0.824 and at a clinically predetermined risk threshold, 10% of patients identified by the model developed incident-HF and 29% of all incident-HF cases in the state of Maine were identified. Conclusions Utilizing machine learning modeling techniques on passively collected clinical HIE data, we developed and validated an incident-HF prediction tool that performs on par with other models that require proactively collected clinical data. Our algorithm could be integrated into other HIEs to leverage the EMR resources to provide individuals, systems, and payors with a risk stratification tool to allow for targeted resource allocation to reduce incident-HF disease burden on individuals and health care systems.

scholarly journals Beyond Interoperability with The Single Patient Viewer: A Clinical Portal to Access Integrated Patient Records

2020 ◽  
Vol 5 (5) ◽  
Author(s):  
Rosemary Foster ◽  
Alexa Heekes ◽  
Hannah Hussey ◽  
Mariette Smith ◽  
Themba Mutemaringa ◽  
...  
Keyword(s):  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Clinical Care ◽  
Data Access ◽  
Global Public Good ◽  
Single Patient ◽  
Patient Level Data ◽  
Patient Level ◽  
Level Data

IntroductionIn the Western Cape Province of South Africa, a wealth of patient-level data is collected through many separate electronic systems, which share a unique health identifier. However, clinicians primarily access paper folders, which can be unreliable, difficult to locate and are at risk of loss. Patients frequently attend multiple facilities and their information may not be accessible across facilities, hampering continuity of care. Objectives and ApproachFacilitated by the unique health identifier, a provincial Health Information Exchange (HIE), harmonises patient level data from routine systems into a health information exchange daily. The Single Patient Viewer (SPV) has been developed as a prototype web-based electronic health record and data access portal. SPV integrates clinical data for a single patient both longitudinally and cross-sectionally, in tabular and graphical views, to assist clinicians in rapid information discovery. The application is designed as a web application that calls a multi-purpose API that facilitates interoperability with the HIE. ResultSPV is in an extended pilot phase with over 200 clinicians using the portal, either for clinical care provision, or for clinical audit activities. The application has evolved to include referral, follow-up (voice call and messaging) and reporting functionality. In the past 6 months, over 17,000 patients have been viewed with an average daily search of 150 patients. An anonymised user survey with 52 participants showed that users felt that SPV was enjoyable to use, easy to learn, innovative, and supportive and valuable to their work. Conclusion / ImplicationsSPV has been developed as a global public good project and will be made freely available once matured. A unique feature of the development of SPV is that clinicians were using it while it was being built, enabling constant clinical user feedback. SPV demonstrates the value of integrating health data for clinical viewing while interoperable systems mature.

scholarly journals Health information exchange associated with improved emergency department care through faster accessing of patient information from outside organizations

2016 ◽  
Vol 24 (e1) ◽  
pp. e103-e110 ◽  
Author(s):  
Jordan Everson ◽  
Keith E Kocher ◽  
Julia Adler-Milstein
Keyword(s):  
Emergency Department ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Access Time ◽  
Emergency Department Care ◽  
Percentage Points ◽  
Care Processes ◽  
Electronic Health ◽  
The Relationship

Objective: To assess whether electronic health information exchange (HIE) is associated with improved emergency department (ED) care processes and utilization through more timely clinician viewing of information from outside organizations. Materials and Methods: Our data included 2163 patients seen in the ED of a large academic medical center for whom clinicians requested and viewed outside information from February 14, 2014, to February 13, 2015. Outside information requests w.ere fulfilled via HIE (Epic’s Care Everywhere) or fax/scan to the electronic health record (EHR). We used EHR audit data to capture the time between the information request and when a clinician accessed the data. We assessed whether the relationship between method of information return and ED outcomes (length of visit, odds of imaging [computed tomography (CT), magnetic resonance imaging (MRI), radiographs] and hospitalization, and total charges) was mediated by request-to-access time, controlling for patient demographics, case mix, and acuity. Results: In multivariate analysis, there was no direct association between return of information via HIE vs fax/scan and ED outcomes. HIE was associated with faster outside information access (58.5 minutes on average), and faster access was associated with changes in ED care. For each 1-hour reduction in access time, visit length was 52.9 minutes shorter, the likelihood of imaging was lower (by 2.5, 1.6, and 2.4 percentage points for CT, MRI, and radiographs, respectively), the likelihood of admission was 2.4 percentage points lower, and average charges were $1187 lower (P ≤ .001 for all). Conclusion: The relationship between HIE and improved care processes and reduced utilization in the ED is mediated by faster accessing of information from outside organizations.

scholarly journals Maturity assessment of Kenya’s health information system interoperability readiness

2021 ◽  
Vol 28 (1) ◽  
pp. e100241
Author(s):  
Job Nyangena ◽  
Rohini Rajgopal ◽  
Elizabeth Adhiambo Ombech ◽  
Enock Oloo ◽  
Humphrey Luchetu ◽  
...  
Keyword(s):  
Health Information ◽  
Information Exchange ◽  
Working Group ◽  
Data Exchange ◽  
Enterprise Architecture ◽  
Health Information Exchange ◽  
Digital Health ◽  
Health Information System ◽  
Maturity Level ◽  
Technical Standards

BackgroundThe use of digital technology in healthcare promises to improve quality of care and reduce costs over time. This promise will be difficult to attain without interoperability: facilitating seamless health information exchange between the deployed digital health information systems (HIS).ObjectiveTo determine the maturity readiness of the interoperability capacity of Kenya’s HIS.MethodsWe used the HIS Interoperability Maturity Toolkit, developed by MEASURE Evaluation and the Health Data Collaborative’s Digital Health and Interoperability Working Group. The assessment was undertaken by eHealth stakeholder representatives primarily from the Ministry of Health’s Digital Health Technical Working Group. The toolkit focused on three major domains: leadership and governance, human resources and technology.ResultsMost domains are at the lowest two levels of maturity: nascent or emerging. At the nascent level, HIS activities happen by chance or represent isolated, ad hoc efforts. An emerging maturity level characterises a system with defined HIS processes and structures. However, such processes are not systematically documented and lack ongoing monitoring mechanisms.ConclusionNone of the domains had a maturity level greater than level 2 (emerging). The subdomains of governance structures for HIS, defined national enterprise architecture for HIS, defined technical standards for data exchange, nationwide communication network infrastructure, and capacity for operations and maintenance of hardware attained higher maturity levels. These findings are similar to those from interoperability maturity assessments done in Ghana and Uganda.

scholarly journals Despite Substantial Progress In EHR Adoption, Health Information Exchange And Patient Engagement Remain Low In Office Settings

2014 ◽  
Vol 33 (9) ◽  
pp. 1672-1679 ◽  
Author(s):  
Michael F. Furukawa ◽  
Jennifer King ◽  
Vaishali Patel ◽  
Chun-Ju Hsiao ◽  
Julia Adler-Milstein ◽  
...  
Keyword(s):  
Health Information ◽  
Patient Engagement ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Substantial Progress ◽  
Ehr Adoption

scholarly journals Interest in Health Information Exchange in Ambulatory Care: A Statewide Survey

2010 ◽  
Vol 01 (01) ◽  
pp. 1-10 ◽  
Author(s):  
S. E. Ross ◽  
B. K. Mellis ◽  
B. L. Beaty ◽  
L. M. Schilling ◽  
A. J. Davidson ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Value Proposition ◽  
Data Types ◽  
Clinical Notes ◽  
Childhood Immunizations ◽  
Problem Lists ◽  
Discharge Summaries

SummaryObjective: Assess the interest in and preferences of ambulatory practitioners in HIE.Background: Health information exchange (HIE) may improve the quality and efficiency of care. Identifying the value proposition for smaller ambulatory practices may help those practices engage in HIE.Methods: Survey of primary care and specialist practitioners in the State of Colorado.Results: Clinical data were commonly (always [2%], often [29%] or sometimes [49%]) missing during clinic visits. Of 12 data types proposed as available through HIE, ten were considered “extremely useful” by most practitioners. “Clinical notes/consultation reports,” “diagnosis or problem lists,” and “hospital discharge summaries” were considered the three most useful data types. Interest in EKG reports, diagnosis/problem lists, childhood immunizations, and discharge summaries differed among ambulatory practitioner groups (primary care, obstetrics-gynecology, and internal medicine subspecialties).Conclusion: Practitioners express strong interest in most of the data types, but opinions differed by specialties on what types were most important. All providers felt that a system that provided all data types would be useful. These results support the potential benefit of HIE in ambulatory practices.

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