scholarly journals Health systems’ use of enterprise health information exchange vs single electronic health record vendor environments and unplanned readmissions

2019 ◽  
Vol 26 (10) ◽  
pp. 989-998
Author(s):  
Joshua R Vest ◽  
Mark Aaron Unruh ◽  
Seth Freedman ◽  
Kosali Simon
Keyword(s):  
Electronic Health Record ◽  
Health System ◽  
Health Information ◽  
Health Systems ◽  
Information Exchange ◽  
Fixed Effects ◽  
Health Information Exchange ◽  
Health Record ◽  
Single Vendor ◽  
Electronic Health

Abstract Objective Enterprise health information exchange (HIE) and a single electronic health record (EHR) vendor solution are 2 information exchange approaches to improve performance and increase the quality of care. This study sought to determine the association between adoption of enterprise HIE vs a single vendor environment and changes in unplanned readmissions. Materials and Methods The association between unplanned 30-day readmissions among adult patients and adoption of enterprise HIE or a single vendor environment was measured in a panel of 211 system-member hospitals from 2010 through 2014 using fixed-effects regression models. Sample hospitals were members of health systems in 7 states. Enterprise HIE was defined as self-reported ability to exchange information with other members of the same health system who used different EHR vendors. A single EHR vendor environment reported exchanging information with other health system members, but all using the same EHR vendor. Results Enterprise HIE adoption was more common among the study sample than EHR (75% vs 24%). However, adoption of a single EHR vendor environment was associated with a 0.8% reduction in the probability of a readmission within 30 days of discharge. The estimated impact of adopting an enterprise HIE strategy on readmissions was smaller and not statically significant. Conclusion Reductions in the probability of an unplanned readmission after a hospital adopts a single vendor environment suggests that HIE technologies can better support the aim of higher quality care. Additionally, health systems may benefit more from a single vendor environment approach than attempting to foster exchange across multiple EHR vendors.

scholarly journals Search Functionality Within the Electronic Health Record and Health Information Exchange Databases

2020 ◽  
Vol 3 ◽  
Author(s):  
Brandon Gregory ◽  
Jordan Hill ◽  
Titus Schleyer
Keyword(s):  
Electronic Health Record ◽  
Health Information ◽  
Patient Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Health Record ◽  
Search Function ◽  
Electronic Health

Background and Hypothesis:  In the US today, over 95% of healthcare institutions operate using the electronic health record (EHR). While proven to be a substantial improvement to medical practice, the substantial amount of retained information within those records has made searching the EHR for relevant material difficult and too time consuming. We hypothesize that by providing a search function within the EHR with added capability of collaborative filtration, physicians will be better able to retrieve important patient information and thus provide more efficient care.     Project Methods:   Emergency Department physicians of Sidney & Lois Eskenazi Hospital and Indiana University Health Hospital were recruited to partake in this study based on their use and familiarity of the EHR Cerner and/or Health Information Exchange (HIE) CareWeb Search function. Participants filled out a pre-interview, Likert-scale questionnaire to determine their general impressions of search functions and the frequency with which they were used. Additional insight was obtained during an interview focusing on participants’ previous experiences searching within the EHR/HIE. Participants were then shown a mock-up of potential collaborative filtering integration into CareWeb in order to collect opinions regarding the feature’s usability/practicality, display/format, and a number of suggested terms.    Results:   From the pilot study, current challenges that limit clinician search function use include limited time in clinician workflow, information overload, and inaccurate results. Clinicians are more likely to conduct searches when treating patients who have limited medical history, complex histories, known recent visitations, and/or who have been seen at other institutions. Participants demonstrated interest in a collaborative filtration search feature; they expressed a preference to have the feature recommend five related search terms.    Potential Impact:   The data from this study aims to refine the way healthcare providers search within the EHR/HIE. This will allow healthcare providers to more efficiently extract relevant patient information for improved healthcare delivery and proficient clinician workflow. 

Electronic health record adoption and health information exchange among hospitals in New York State

2011 ◽  
Vol 18 (6) ◽  
pp. 1156-1162 ◽  
Author(s):  
Erika L. Abramson ◽  
Sandra McGinnis ◽  
Alison Edwards ◽  
Dayna M. Maniccia ◽  
Jean Moore ◽  
...  
Keyword(s):  
New York ◽  
Electronic Health Record ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
New York State ◽  
Health Record ◽  
York State ◽  
Electronic Health

Implementation of Electronic Health Record (EHR) System in the Healthcare Industry

2016 ◽  
pp. 1001-1016
Author(s):  
Robert P Schumaker ◽  
Kavya P. Reganti
Keyword(s):  
Electronic Health Record ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Health Management ◽  
Healthcare Delivery ◽  
Healthcare Services ◽  
Health Record ◽  
Healthcare Industry ◽  
Efficient Delivery ◽  
Electronic Health

The purpose of this research is to demonstrate the efficiency of the Electronic Health Record (EHR) software that is adopted in the healthcare industry to provide better patient care. The authors examine the impact of EHRs on the efficient delivery of healthcare services. More specifically, they detail the origin of EHR, its significance in modern healthcare delivery along with the selection and implementation criteria for EHR software. They present a survey on the extent of adoption of EHR by clinicians. They also highlight the challenges and barriers faced by organizations in adopting EHR software such as cost, workflow impact and data security. Finally, the authors contemplate the future of EHR, its role in the implementation of health information exchange and its implementation in the cloud. They conclude that the implementation of EHR in the cloud is an important step towards better health management across the population with the end-goal of better health outcomes.

Implementation of Electronic Health Record (EHR) System in the Healthcare Industry

2014 ◽  
Vol 2 (2) ◽  
pp. 57-71 ◽  
Author(s):  
Robert P Schumaker ◽  
Kavya P. Reganti
Keyword(s):  
Electronic Health Record ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Health Management ◽  
Healthcare Delivery ◽  
Healthcare Services ◽  
Health Record ◽  
Healthcare Industry ◽  
Electronic Health ◽  
The Impact

The purpose of this research is to demonstrate the efficiency of the Electronic Health Record (EHR) software that is adopted in the healthcare industry to provide better patient care. The authors examine the impact of EHRs on the efficient delivery of healthcare services. More specifically, they detail the origin of EHR, its significance in modern healthcare delivery along with the selection and implementation criteria for EHR software. They present a survey on the extent of adoption of EHR by clinicians. They also highlight the challenges and barriers faced by organizations in adopting EHR software such as cost, workflow impact and data security. Finally, the authors contemplate the future of EHR, its role in the implementation of health information exchange and its implementation in the cloud. They conclude that the implementation of EHR in the cloud is an important step towards better health management across the population with the end-goal of better health outcomes.

scholarly journals Emergency physician use and perceptions of the Alberta Netcare Portal, a province-wide interoperable electronic health record (Preprint)

2018 ◽  
Author(s):  
Timothy AD Graham ◽  
Mark Ballerman ◽  
Eddy Lang ◽  
Michael J Bullard ◽  
Denise Parsons ◽  
...  
Keyword(s):  
Patient Safety ◽  
Electronic Health Record ◽  
Health Information ◽  
Continuity Of Care ◽  
Information Exchange ◽  
Clinical Information System ◽  
Positive Impact ◽  
Health Record ◽  
Structured Interviews ◽  
Electronic Health

BACKGROUND The adoption and use of an Electronic Health Record can facilitate real-time access to key health information and support improved outcomes. Many Canadian provinces use interoperable Electronic Health Records (iEHRs) to facilitate Health Information Exchange (HIE), but, to date, the clinical use and utility of iEHRs has not been well-described. OBJECTIVE Our study's primary objective was to describe the use and reported utility of a provincial iEHR known as the Alberta Netcare Portal (ANP) in four urban Alberta emergency departments (EDs). The secondary objectives were to characterize the time spent using the respective electronic tools, and which aspects were perceived as most useful by ED physicians. METHODS Four EDs were included in the study, two using paper-based ordering (University of Alberta Hospital [UAH] and Grey Nuns Community Hospital [GNCH]) and two using a commercial vendor Clinical Information System (Peter Lougheed Centre [PLC] and Foothills Medical Centre [FMC]). Structured clinical observations of ANP use, semi-structured interviews, and system audit logs analysis were compared at the four sites from October 2014 to March 2016. RESULTS Observers followed 142 physicians for a total of 566 hours over 376 occasions. The median percentage of observed time spent using ANP was 8.5% at UAH (interquartile range IQR: 3.7% - 13.3%), 4.4% at GNCH (2.4%-4.4%), 4.6% at FMC (2.4%-7.6%), and 5.1% at PLC (3.0%-7.7%). By combining administrative and access audit data, the median number of ANP screens (i.e., results and reports displayed on a screen) accessed per patient visit were 20 at UAH (IQR: 6-67), 9 at GNCH (4-29), 7 at FMC (2-18) and 5 at PLC (2-14) indicating that clinicians found significant value in using ANP while providing ED care. To explore this hypothesis, semi-structured interviews were analyzed using an inductive approach. The themes that emerged from the interviews were that the ANP improved the quality and continuity of care and patient safety. Further enhancements related to medication management would support better outcomes for patients. CONCLUSIONS This study shows that the iEHR is well utilized at the four sites studied and physicians participating in the study perceived ANP had a positive impact on knowledge of their patients, patient safety, and quality and continuity of care. Physicians described high utility and usability of ANP. More study about the clinical impacts of using iEHRs in the Canadian context, including longer term impacts on quality of practice and safety are required.

scholarly journals The Cosmos Collaborative: A Vendor-Facilitated Electronic Health Record Data Aggregation Platform

ACI Open ◽  
2021 ◽  
Vol 05 (01) ◽  
pp. e36-e46
Author(s):  
Yasir Tarabichi ◽  
Adam Frees ◽  
Steven Honeywell ◽  
Courtney Huang ◽  
Andrew M. Naidech ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Data Aggregation ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Healthcare Systems ◽  
Varicella Vaccination ◽  
Health Record ◽  
Services Research ◽  
Electronic Health Record Data ◽  
Electronic Health

Abstract Objective Learning healthcare systems use routinely collected data to generate new evidence that informs future practice. While implementing an electronic health record (EHR) system can facilitate this goal for individual institutions, meaningfully aggregating data from multiple institutions can be more empowering. Cosmos is a cross-institution, single EHR vendor-facilitated data aggregation tool. This work aims to describe the initiative and illustrate its potential utility through several use cases. Methods Cosmos is designed to scale rapidly by leveraging preexisting agreements, clinical health information exchange networks, and data standards. Data are stored centrally as a limited dataset, but the customer facing query tool limits results to prevent patient reidentification. Results In 2 years, Cosmos grew to contain EHR data of more than 60 million patients. We present practical examples illustrating how Cosmos could further efforts in chronic disease surveillance (asthma and obesity), syndromic surveillance (seasonal influenza and the 2019 novel coronavirus), immunization adherence and adverse event reporting (human papilloma virus and measles, mumps, rubella, and varicella vaccination), and health services research (antibiotic usage for upper respiratory infection). Discussion A low barrier of entry for Cosmos allows for the rapid accumulation of multi-institutional and mostly de-duplicated EHR data to power research and quality improvement queries characteristic of learning healthcare systems. Limitations are being vendor-specific, an “all or none” contribution model, and the lack of control over queries run on an institution's healthcare data. Conclusion Cosmos provides a model for within-vendor data standardization and aggregation and a steppingstone for broader intervendor interoperability.

Health Information Exchange in Practice

2019 ◽  
pp. 264-280
Author(s):  
Mark E. Frisse ◽  
Karl E. Misulis
Keyword(s):  
Health Information ◽  
Information Exchange ◽  
Data Exchange ◽  
Health Information Exchange ◽  
Healthcare Delivery ◽  
Health Record ◽  
Healthcare Data ◽  
Electronic Health ◽  
Alternative Settings ◽  
Collaborative Efforts

Even when restricting the focus of care to hospitals and ambulatory clinics, most individuals seek care from many practitioners operating in different locations and often employing different electronic health records. Early efforts at creating interoperable data exchange among these systems have often disappointed users and administrators. Effective collaboration is a prerequisite for effective healthcare delivery. Even if using different EHRs, every clinician and caregiver should share a common clinical record set and means of communicating to other providers. Recent collaborative efforts among major electronic health record vendors are simplifying exchange of information among hospitals and large clinics, but they have not yet sufficiently addressed the necessary broader exchange of healthcare data among the caregivers in alternative settings and in the home.

scholarly journals Utilizing a health information exchange to facilitate COVID-19 VA primary care follow-up for Veterans diagnosed in the community

JAMIA Open ◽  
2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Rachel L Sherman ◽  
Kimberly M Judon ◽  
Nicholas S Koufacos ◽  
Vivian M Guerrero Aquino ◽  
Shaniqua M Raphael ◽  
...  
Keyword(s):  
Primary Care ◽  
Electronic Health Record ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Clinical Pathways ◽  
Health Record ◽  
Primary Care Teams ◽  
Follow Up Care

Abstract The use of alerts from the Bronx RHIO, a health information exchange (HIE) to identify James J. Peters VAMC patients diagnosed with COVID-19 in the community was described to facilitate COVID-19 VA primary care follow-up. COVID-19 hospitalization and testing alerts were delivered on a Bronx RHIO facility report. VA COVID-19 follow-up care by telephone and video was guided by local COVID-19 clinical pathways, electronic health record (EHR) templates, and tracking through a database. VA received 180 RHIO alerts for 111 unique patients, and 88 had positive non-VA testing from March to June 2020. 41% of the 88 had non-VA admissions and 23% died. 63% received VA primary care follow-up of COVID-19 symptoms documented by custom EHR templates. The HIE identified 11% of the facility COVID-19 patients. HIE alerts can be used to identify facility COVID-19 patients diagnosed in the community and facilitate follow-up by their VA primary care teams.

An HL7 FHIR and GraphQL approach for interoperability between heterogeneous Electronic Health Record systems

2021 ◽  
Vol 27 (3) ◽  
pp. 146045822110439
Author(s):  
Suresh Kumar Mukhiya ◽  
Yngve Lamo
Keyword(s):  
Electronic Health Record ◽  
Information Exchange ◽  
Secure Communication ◽  
Health Information Exchange ◽  
Heterogeneous Systems ◽  
Data Representation ◽  
Health Record ◽  
Data Interoperability ◽  
Hl7 Fhir ◽  
Electronic Health

Heterogeneities in data representation and care processes create interoperability complexity among Electronic Health Record systems (EHRs). We can resolve such data and process level heterogeneities by following consistent healthcare standards like Clinical Document Architecture (CDA), OpenEHR, and HL7 FHIR. However, these standards also differ at the structural and implementation level, making interoperability more complex. Hence, there is a need to investigate mechanisms that can resolve data level heterogeneity to achieve semantic data interoperability between heterogeneous systems. As a solution to this, we offer an architecture that utilizes a resource server based on GraphQL and HL7 FHIR that establishes communication between two heterogeneous EHRs. This paper describes how the proposed architecture is implemented to achieve interoperability between two heterogeneous EHRs, HL7 FHIR and OpenMRS. The presented approach establishes secure communication between the EHRs and provides accurate mappings that enable timely health information exchange between EHRs.

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