scholarly journals Patient crossover and potentially avoidable repeat computed tomography exams across a health information exchange

2016 ◽  
Vol 24 (1) ◽  
pp. 30-38 ◽  
Author(s):  
Benjamin H Slovis ◽  
Tina Lowry ◽  
Bradley N Delman ◽  
Anton Oscar Beitia ◽  
Gilad Kuperman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
New York ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Cohort Analysis ◽  
Time Frame ◽  
Ct Scans ◽  
Number Of Patients ◽  
Alerting System

Objective: The purpose of this study was to measure the number of repeat computed tomography (CT) scans performed across an established health information exchange (HIE) in New York City. The long-term objective is to build an HIE-based duplicate CT alerting system to reduce potentially avoidable duplicate CTs. Methods: This retrospective cohort analysis was based on HIE CT study records performed between March 2009 and July 2012. The number of CTs performed, the total number of patients receiving CTs, and the hospital locations where CTs were performed for each unique patient were calculated. Using a previously described process established by one of the authors, hospital-specific proprietary CT codes were mapped to the Logical Observation Identifiers Names and Codes (LOINC®) standard terminology for inter-site comparison. The number of locations where there was a repeated CT performed with the same LOINC code was then calculated for each unique patient. Results: There were 717 231 CTs performed on 349 321 patients. Of these patients, 339 821 had all of their imaging studies performed at a single location, accounting for 668 938 CTs. Of these, 9500 patients had 48 293 CTs performed at more than one location. Of these, 6284 patients had 24 978 CTs with the same LOINC code performed at multiple locations. The median time between studies with the same LOINC code was 232 days (range of 0 to 1227); however, 1327 were performed within 7 days and 5000 within 30 days. Conclusions: A small proportion (3%) of our cohort had CTs performed at more than one location, however this represents a large number of scans (48 293). A noteworthy portion of these CTs (51.7%) shared the same LOINC code and may represent potentially avoidable studies, especially those done within a short time frame. This represents an addressable issue, and future HIE-based alerts could be utilized to reduce potentially avoidable CT scans.

scholarly journals Standard Anatomic Terminologies: Comparison for Use in a Health Information Exchange–Based Prior Computed Tomography (CT) Alerting System

2017 ◽  
Vol 5 (4) ◽  
pp. e49 ◽  
Author(s):  
Anton Oscar Beitia ◽  
Tina Lowry ◽  
Daniel J Vreeman ◽  
George T Loo ◽  
Bradley N Delman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Alerting System

scholarly journals Identifying homelessness using health information exchange data

2015 ◽  
Vol 22 (3) ◽  
pp. 682-687 ◽  
Author(s):  
John Zech ◽  
Gregg Husk ◽  
Thomas Moore ◽  
Gilad J Kuperman ◽  
Jason S Shapiro
Keyword(s):  
New York ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Housing Status ◽  
Number Of Patients ◽  
Address Data ◽  
Patients Experience ◽  
Exchange Data

Abstract Background Homeless patients experience poor health outcomes and consume a disproportionate amount of health care resources compared with domiciled patients. There is increasing interest in the federal government in providing care coordination for homeless patients, which will require a systematic way of identifying these individuals. Objective We analyzed address data from Healthix, a New York City–based health information exchange, to identify patterns that could indicate homelessness. Methods Patients were categorized as likely to be homeless if they registered with the address of a hospital, homeless shelter, place of worship, or an address containing a keyword synonymous with “homelessness.” Results We identified 78 460 out of 7 854 927 Healthix patients (1%) as likely to have been homeless over the study period of September 30, 2008 to July 19, 2013. We found that registration practices for these patients varied widely across sites. Conclusions The use of health information exchange data enabled us to identify a large number of patients likely to be homeless and to observe the wide variation in registration practices for homeless patients within and across sites. Consideration of these results may suggest a way to improve the quality of record matching for homeless patients. Validation of these results is necessary to confirm the homeless status of identified individuals. Ultimately, creating a standardized and structured field to record a patient’s housing status may be a preferable approach.

scholarly journals An empirical analysis of the financial benefits of health information exchange in emergency departments

2015 ◽  
Vol 22 (6) ◽  
pp. 1169-1172 ◽  
Author(s):  
Niam Yaraghi
Keyword(s):  
New York ◽  
Health Information ◽  
Information Exchange ◽  
Laboratory Tests ◽  
Negative Binomial ◽  
Health Information Exchange ◽  
Negative Binomial Regression ◽  
Control Group ◽  
History Of ◽  
The Impact

Abstract Objective To examine the impact of health information exchange (HIE) on reducing laboratory tests and radiology examinations performed in an emergency department (ED). Materials and Methods The study was conducted in an ED setting in Western New York over a period of 2 months. The care of the patients in the treatment group included an HIE query for every encounter, while the care of other patients in the control group did not include such queries. A group of medical liaisons were hired to query the medical history of patients from an HIE and provide it to the ED clinicians. Negative binomial regression was used to analyze the effects of HIE queries on the number of performed laboratory tests and radiology examinations. The log files of the HIE system since 1 year before the ED admission were used to analyze the differences in outcome measures between the 2 groups of patients. Results Ceteris paribus, HIE usage is associated with, respectively, 52% and 36% reduction in the expected total number of laboratory tests and radiology examinations ordered per patient at the ED. Conclusions The results indicate that access to additional clinical data through the HIE will significantly reduce the number of laboratory tests and radiology examinations performed in the ED settings and thus support the ongoing HIE efforts.

scholarly journals Evaluation of a health information exchange system for microcephaly case-finding — New York City, 2013—2015

PLoS ONE ◽  
2020 ◽  
Vol 15 (8) ◽  
pp. e0237392
Author(s):  
Eugenie Poirot ◽  
Carrie W. Mills ◽  
Andrew D. Fair ◽  
Krishika A. Graham ◽  
Emily Martinez ◽  
...  
Keyword(s):  
New York ◽  
New York City ◽  
Health Information ◽  
York City ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Case Finding ◽  
Exchange System

scholarly journals Drivers of information disclosure on health information exchange platforms: insights from an exploratory empirical study

2015 ◽  
Vol 22 (6) ◽  
pp. 1183-1186 ◽  
Author(s):  
Niam Yaraghi ◽  
Raj Sharman ◽  
Ram Gopal ◽  
Ranjit Singh ◽  
R Ramesh
Keyword(s):  
Primary Care ◽  
New York ◽  
Health Information ◽  
Information Exchange ◽  
Information Disclosure ◽  
Primary Care Physicians ◽  
Medical Information ◽  
Health Information Exchange ◽  
Care Physician ◽  
Willingness To Disclose

Abstract Objective The objective of this research is to empirically explore the drivers of patients’ consent to sharing of their medical records on health information exchange (HIE) platforms. Materials and Methods The authors analyze a dataset consisting of consent choices of 20 076 patients in Western New York. A logistic regression is applied to empirically investigate the effects of patients’ age, gender, complexity of medical conditions, and the role of primary care physicians on patients’ willingness to disclose medical information on HIE platforms. Results The likelihood of providing consent increases by age (odds ratio (OR) = 1.055; P  < .0001). Female patients are more likely to provide consent (OR = 1.460; P  = .0003). As the number of different physicians involved in the care of the patient increases, the odds of providing consent slightly increases (OR = 1.024; P  = .0031). The odds of providing consent is significantly higher for the patients whom a primary care physician has been involved in their medical care (OR = 1.323; P  < .0001). Conclusion Individual-level characteristics are important predictors of patients’ willingness to disclose their medical information on HIE platforms.

scholarly journals The benefits of health information exchange: an updated systematic review

2018 ◽  
Vol 25 (9) ◽  
pp. 1259-1265 ◽  
Author(s):  
Nir Menachemi ◽  
Saurabh Rahurkar ◽  
Christopher A Harle ◽  
Joshua R Vest
Keyword(s):  
Systematic Review ◽  
New York ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Care Delivery ◽  
The United States ◽  
Current Systematic Review ◽  
Meta Analyses ◽  
The Impact

Abstract Objective Widespread health information exchange (HIE) is a national objective motivated by the promise of improved care and a reduction in costs. Previous reviews have found little rigorous evidence that HIE positively affects these anticipated benefits. However, early studies of HIE were methodologically limited. The purpose of the current study is to review the recent literature on the impact of HIE. Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct our systematic review. PubMed and Scopus databases were used to identify empirical articles that evaluated HIE in the context of a health care outcome. Results Our search strategy identified 24 articles that included 63 individual analyses. The majority of the studies were from the United States representing 9 states; and about 40% of the included analyses occurred in a handful of HIEs from the state of New York. Seven of the 24 studies used designs suitable for causal inference and all reported some beneficial effect from HIE; none reported adverse effects. Conclusions The current systematic review found that studies with more rigorous designs all reported benefits from HIE. Such benefits include fewer duplicated procedures, reduced imaging, lower costs, and improved patient safety. We also found that studies evaluating community HIEs were more likely to find benefits than studies that evaluated enterprise HIEs or vendor-mediated exchanges. Overall, these finding bode well for the HIEs ability to deliver on anticipated improvements in care delivery and reduction in costs.

scholarly journals Adoption of Health Information Exchange by Emergency Physicians at Three Urban Academic Medical Centers

2011 ◽  
Vol 02 (03) ◽  
pp. 263-269 ◽  
Author(s):  
J. Shapiro ◽  
S. Vaidya ◽  
G. Kuperman ◽  
N. Genes
Keyword(s):  
New York ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Clinical Information ◽  
Data Availability ◽  
Emergency Physicians ◽  
Structured Interviews ◽  
Successful Retrieval ◽  
Data Elements

Summary Objectives: Emergency physicians are trained to make decisions quickly and with limited patient information. Health Information Exchange (HIE) has the potential to improve emergency care by bringing relevant patient data from non-affiliated organizations to the bedside. NYCLIX (New York CLinical Information eXchange) offers HIE functionality among multiple New York metropolitan area provider organizations and has pilot users in several member emergency departments (EDs). Methods: We conducted semi-structured interviews at three participating EDs with emergency physicians trained to use NYCLIX. Among “users” with > 1 login, responses to questions regarding typical usage scenarios, successful retrieval of data, and areas for improving the interface were recorded. Among “non-users” with ≤1 login, questions about NYCLIX accessibility and utility were asked. Both groups were asked to recall items from prior training regarding data sources and availability. Results: Eighteen NYCLIX pilot users, all board certified emergency physicians, were interviewed. Of the 14 physicians with more than one login, half estimated successful retrieval of HIE data affecting patient care. Four non-users (one login or less) cited forgotten login information as a major reason for non-use. Though both groups made errors, users were more likely to recall true NYCLIX member sites and data elements than non-users. Improvements suggested as likely to facilitate usage included a single automated login to both the ED information system (EDIS) and HIE, and automatic notification of HIE data availability in the EDIS All respondents reported satisfaction with their training. Conclusions: Integrating HIE into existing ED workflows remains a challenge, though a substantial fraction of users report changes in management based on HIE data. Though interviewees believed their training was adequate, significant errors in their understanding of available NYCLIX data elements and participating sites persist.

scholarly journals How could health information exchange better meet the needs of care practitioners?

2014 ◽  
Vol 05 (04) ◽  
pp. 861-877 ◽  
Author(s):  
R. Kaushal ◽  
J.R. Vest ◽  
P. Kierkegaard
Keyword(s):  
New York ◽  
Health Information ◽  
Patient Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Point Of Care ◽  
New York State ◽  
Multiple Sources ◽  
Healthcare Organizations ◽  
York State

SummaryBackground: Health information exchange (HIE) has the potential to improve the quality of health-care by enabling providers with better access to patient information from multiple sources at the point of care. However, HIE efforts have historically been difficult to establish in the US and the failure rates of organizations created to foster HIE have been high.Objectives: We sought to better understand how RHIO-based HIE systems were used in practice and the challenges care practitioners face using them. The objective of our study were to so investigate how HIE can better meet the needs of care practitioners.Methods: We performed a multiple-case study using qualitative methods in three communities in New York State. We conducted interviews onsite and by telephone with HIE users and non-users and observed the workflows of healthcare professionals at multiple healthcare organizations participating in a local HIE effort in New York State.Results: The empirical data analysis suggests that challenges still remain in increasing provider usage, optimizing HIE implementations and connecting HIE systems across geographic regions. Important determinants of system usage and perceived value includes users experienced level of available information and the fit of use for physician workflows.Conclusions: Challenges still remain in increasing provider adoption, optimizing HIE implementations, and demonstrating value. The inability to find information reduced usage of HIE. Healthcare organizations, HIE facilitating organizations, and states can help support HIE adoption by ensuring patient information is accessible to providers through increasing patient consents, fostering broader participation, and by ensuring systems are usable.Citation: Kierkegaard P, Kaushal R, Vest JR. How could health information exchange better meet the needs of care practitioners? Appl Clin Inf 2014; 5: 861–877http://dx.doi.org/10.4338/ACI-2014-06-RA-0055

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