The Number Of Health Information Exchange Efforts Is Declining, Leaving The Viability Of Broad Clinical Data Exchange Uncertain

Abstract Objective To identify factors that impede payer engagement in a health information exchange (HIE), along with organizational and policy strategies that might effectively address the impediments. Materials and Methods Qualitative analysis of semi-structured interviews with leaders from 17 varied payer organizations from across the country (e.g., large, national payers; state Blues plans; local Medicaid managed care plans). Results We found a large gap between payers’ vision of what optimal HIE should be and the current approach to HIE in the United States. Notably, payers sought to be active participants in HIE efforts – both providing claims data and accessing clinical data to support payer HIE use cases. Instead, payers were often asked by HIE efforts only to provide financial support without the option to participate in data exchange, or, when given the option, their data needs were secondary to those of providers. Discussion Efforts to engage payers in pursuit of more robust and sustainable HIE need to better align their value proposition with payer HIE use cases. This will require addressing provider concerns about payer access to clinical data. Policymakers should focus on creating the conditions for broader payer engagement by removing common obstacles, such as low provider engagement in HIE. Conclusion Despite variation in the extent to which payers engaged with current HIE efforts, there was agreement on the vision of optimal HIE and the facilitators of greater payer engagement. Specific actions by those leading HIE efforts, complemented by policy efforts nationally, could greatly increase payer engagement and enhance HIE sustainability.

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Maturity assessment of Kenya’s health information system interoperability readiness

BMJ Health & Care Informatics ◽

10.1136/bmjhci-2020-100241 ◽

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.

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hData - A Simple XML Framework for Health Data Exchange

Proceedings of Balisage: The Markup Conference 2009 ◽

10.4242/balisagevol3.beuchelt01 ◽

2009 ◽

Cited By ~ 1

Author(s):

Gerald Beuchelt ◽

Harry Sleeper ◽

Andrew Gregorowicz ◽

Robert Dingwell

Keyword(s):

Health Information ◽

Information Exchange ◽

Data Exchange ◽

Health Information Exchange ◽

Health Data ◽

Care Providers ◽

Future Health ◽

Data Interoperability ◽

History Of ◽

Electronic Health

Health data interoperability issues limit the expected benefits of Electronic Health Record (EHR) systems. Ideally, the medical history of a patient is recorded in a set of digital continuity of care documents which are securely available to the patient and their care providers on demand. The history of electronic health data standards includes multiple standards organizations, differing goals, and ongoing efforts to reconcile the various specifications. Existing standards define a format that is too complex for exchanging health data effectively. We propose hData, a simple XML-based framework to describe health information. hData addresses the complexities of the current HL7 Clinical Document Architecture (CDA). hData is an XML design that can be completely validated by modern XML editors and is explicitly designed for extensibility to address future health information exchange needs. hData applies established best practices for XML document architectures to the health domain, thereby facilitating interoperability, increasing software developer productivity, and thus reducing the cost for creating and maintaining EHR technologies.

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What Affects Clinicians’ Usage of Health Information Exchange?

Applied Clinical Informatics ◽

10.4338/aci-2011-03-ra-0021 ◽

2011 ◽

Vol 02 (03) ◽

pp. 250-262 ◽

Cited By ~ 38

Author(s):

L. Volk ◽

S. Simon ◽

D. Bates ◽

R. Rudin

Keyword(s):

Health Information ◽

Information Exchange ◽

Data Exchange ◽

Health Information Exchange ◽

Healthcare Providers ◽

Care Quality ◽

Time Savings ◽

And Training ◽

Exchange Health Information

SummaryBackground: The ability to electronically exchange health information among healthcare providers holds enormous promise to improve care coordination and reduce costs. Provider-to-provider data exchange is an explicit goal of the American Recovery and Reinvestment Act of 2009 and may be essential for the long-term success of the Affordable Care Act of 2010. However, little is known about what factors affect clinicians’ usage of health information exchange (HIE) functionality.Objective: To identify factors that affect clinicians’ HIE usage - in terms of frequency of contributing data to and accessing data from aggregate patient records - and suggest policies for fostering its usage.Methods: We performed a qualitative study using grounded theory by interviewing clinician-users and HIE staff of one operational HIE which supported aggregate patient record functionality. Fifteen clinicians were interviewed for one hour each about what factors affect their HIE usage. Five HIE staff were asked about technology and training issues to provide context. Interviews were recorded, transcribed and analyzed. Recruitment excluded clinicians with little or no familiarity with the HIE and was restricted to one community and a small number of specialties.Results: Clinicians were motivated to access the HIE by perceived improvements in care quality and time savings, but their motivation was moderated by an extensive list of factors including gaps in data, workflow issues and usability issues. HIE access intensities varied widely by clinician. Data contribution intensities to the HIE also varied widely and were affected by billing concerns and time constraints.Conclusions: Clinicians, EHR and HIE product vendors and trainers should work toward integrating HIE into clinical workflows. Policies should create incentives for HIE organizations to assist clinicians in using HIE, develop measures of HIE contributions and accesses, and create incentives for clinicians to contribute data to HIEs.

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Resource Profile: The Regenstrief Institute COVID-19 Research Data Commons (CoRDaCo)

10.1101/2021.12.17.21267942 ◽

2021 ◽

Author(s):

Katie S. Allen ◽

Nader Zidan ◽

Vishal Dey ◽

Eneida Mendonca ◽

Shaun Grannis ◽

...

Keyword(s):

Health Information ◽

Clinical Data ◽

Information Exchange ◽

Health Information Exchange ◽

Primary Objective ◽

Research Data ◽

Early Warning Score ◽

Multiple Sources ◽

Data Repositories ◽

Data Commons

The primary objective of the COVID-19 Research Data Commons (CoRDaCo) is to provide broad and efficient access to a large corpus of clinical data related to COVID-19 in Indiana, facilitating research and discovery. This curated collection of data elements provides information on a significant portion of COVID-19 positive patients in the State from the beginning of the pandemic, as well as two years of health information prior its onset. CoRDaCo combines data from multiple sources, including clinical data from a large, regional health information exchange, clinical data repositories of two health systems, and state laboratory reporting and vital records, as well as geographic-based social variables. Clinical data cover information such as healthcare encounters, vital measurements, laboratory orders and results, medications, diagnoses, the Charlson Comorbidity Index and Pediatric Early Warning Score, COVID-19 vaccinations, mechanical ventilation, restraint use, intensive care unit and ICU and hospital lengths of stay, and mortality. Interested researchers can visit ridata.org or email [email protected] to discuss access to CoRDaCo.

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DITAS: An Integrated Gateway to E-health Communications

Studies in Health Technology and Informatics - Public Health and Informatics ◽

10.3233/shti210199 ◽

2021 ◽

Author(s):

Ehsan Bitaraf ◽

Fatemeh Sarani Rad ◽

Maryam Jafarpour ◽

Vajiheh Jami ◽

Ebrahim Keshavarz Safari ◽

...

Keyword(s):

Information Systems ◽

Health Information ◽

Information Exchange ◽

Data Exchange ◽

Health Information Exchange ◽

Improve Treatment ◽

Treatment Processes ◽

Communication Processes ◽

Health Related ◽

Demand For Health

Today, the demand for health-oriented systems to facilitate and improve treatment processes is growing. For different information systems with different structures and technologies to be able to communicate with each other, a single gateway is required. The gateway acts as an interface between information systems and unifies protocols, rules, and standards related to communication processes. Health-related systems need a unique regulator that explains data models, coding, and data exchange structures. Moreover, the gateway has control over information systems and the data transmitted between them. In this paper, we explain an integrated gateway of health information exchange named DITAS which is a bridging point between health-related systems.

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Health Information Exchange and Ambulatory Quality of Care

Applied Clinical Informatics ◽

10.4338/aci-2012-02-ra-0005 ◽

2012 ◽

Vol 03 (02) ◽

pp. 197-209 ◽

Cited By ~ 8

Author(s):

Y. Barrón ◽

R.V. Dhopeshwarkar ◽

R. Kaushal ◽

L.M. Kern

Keyword(s):

Quality Of Care ◽

Health Information ◽

Clinical Data ◽

Information Exchange ◽

Primary Care Physicians ◽

Health Information Exchange ◽

New York State ◽

Care Quality

SummaryBackground: Health information exchange is a national priority, but there is limited evidence of its effectiveness.Objective: We sought to determine the effect of health information exchange on ambulatory quality.Methods: We conducted a retrospective cohort study over two years of 138 primary care physicians in small group practices in the Hudson Valley region of New York State. All physicians had access to an electronic portal, through which they could view clinical data (such as laboratory and radiology test results) for their patients over time, regardless of the ordering physician. We considered 15 quality measures that were being used by the community for a pay-for-performance program, as well as the subset of 8 measures expected to be affected by the portal. We adjusted for 11 physician characteristics (including health care quality at baseline).Results: Nearly half (43%) of the physicians were portal users. Non-users performed at or above the regional benchmark on 48% of the measures at baseline and 49% of the measures at follow-up (p = 0.58). Users performed at or above the regional benchmark on 57% of the measures at baseline and 64% at follow-up (p<0.001). Use of the portal was independently associated with higher quality of care at follow-up for those measures expected to be affected by the portal (p = 0.01), but not for those not expected to be affected by the portal (p = 0.12).Conclusions: Use of an electronic portal for viewing clinical data was associated with modest improvements in ambulatory quality.

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Health Information Exchange in Practice

Essentials of Clinical Informatics ◽

10.1093/med/9780190855574.003.0025 ◽

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.

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One country's journey to interoperability: Tanzania's experience developing and implementing a national health information exchange

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-021-01499-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Alpha Nsaghurwe ◽

Vikas Dwivedi ◽

Walter Ndesanjo ◽

Haji Bamsi ◽

Moses Busiga ◽

...

Keyword(s):

Supply Chain ◽

Health Information ◽

Information Exchange ◽

Data Exchange ◽

Health Information Exchange ◽

Data Availability ◽

Health Management Information System ◽

Significant Time ◽

Time Investment ◽

Step Procedure

Abstract Background Robust, flexible, and integrated health information (HIS) systems are essential to achieving national and international goals in health and development. Such systems are still uncommon in most low and middle income countries. This article describes a first-phase activity in Tanzania to integrate the country’s vertical health management information system with the help of an interoperability layer that enables cross-program data exchange. Methods From 2014 to 2019, the Tanzanian government and partners implemented a five-step procedure based on the “Mind the GAPS” (governance, architecture, program management, and standards) framework and using both proprietary and open-source tools. In collaboration with multiple stakeholders, the team developed the system to address major data challenges via four fully documented “use case scenarios” addressing data exchange among hospitals, between services and the supply chain, across digital data systems, and within the supply chain reporting system. This work included developing the architecture for health system data exchange, putting a middleware interoperability layer in place to facilitate the exchange, and training to support use of the system and the data it generates. Results Tanzania successfully completed the five-step procedure for all four use cases. Data exchange is currently enabled among 15 separate information systems, and has resulted in improved data availability and significant time savings. The government has adopted the health information exchange within the national strategy for health care information, and the system is being operated and managed by Tanzanian officials. Conclusion Developing an integrated HIS requires a significant time investment; but ultimately benefit both programs and patients. Tanzania’s experience may interest countries that are developing their HIS programs.

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One country's journey to interoperability: Tanzania's experience developing a national health information exchange

10.21203/rs.3.rs-33033/v1 ◽

2020 ◽

Author(s):

Alpha Nsaghurwe ◽

Vikas Dwivedi ◽

Walter Ndesanjo ◽

Haji Bams ◽

Moses Busiga ◽

...

Keyword(s):

Supply Chain ◽

Health Information ◽

Information Exchange ◽

Data Exchange ◽

Health Information Exchange ◽

Data Availability ◽

Health Management Information System ◽

Significant Time ◽

Time Investment ◽

Step Procedure

Abstract Background and purpose: Robust, flexible, and integrated health information (HIS) systems are essential to achieving national and international goals in health and development. Such systems are still uncommon in most low and middle income countries. This article describes a first-phase activity in Tanzania to integrate the country’s vertical health management information system with the help of an interoperability layer that enables cross-program data exchange. Methods: From 2014 to 2019, the Tanzanian government and partners implemented a five-step procedure based on the “Mind the GAPS” (governance, architecture, program management, and standards) framework and using both proprietary and open-source tools. In collaboration with multiple stakeholders, the team developed the system to address major data challenges via four fully documented “use case scenarios” addressing data exchange among hospitals, between services and the supply chain, across digital data systems, and within the supply chain reporting system. This work included developing the architecture for health system data exchange, putting a middleware interoperability layer in place to facilitate the exchange, and training to support use of the system and the data it generates. Results: Tanzania successfully completed the five-step procedure for all four use cases. Data exchange is currently enabled among 15 separate information systems, and has resulted in improved data availability and significant time savings. The government has adopted the health information exchange within the national strategy for health care information, and the system is being operated and managed by Tanzanian officials. Conclusion: Developing an integrated HIS requires a significant time investment; but ultimately benefit both programs and patients. Tanzania’s experience may interest countries that are developing their HIS programs.

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