Development of a Regional Digital Health Record for Geriatric Health Care in Rural Areas: Community-Based Participatory Research Approach (Preprint)

2021 ◽  
Author(s):  
Nils Pfeuffer ◽  
Angelika Beyer ◽  
Peter Penndorf ◽  
Maren Leiz ◽  
Franziska Radicke ◽  
...  
Keyword(s):  
Health Information ◽  
Information Exchange ◽  
Healthcare Professionals ◽  
Health Information Exchange ◽  
Digital Health ◽  
Healthcare Providers ◽  
Community Based Participatory Research ◽  
Research Approach ◽  
Community Based

BACKGROUND Geriatric patients are often treated by several healthcare providers at the same time. The spatial, informational, and organizational separation of these healthcare providers can hinder an effective treatment of geriatric patients. OBJECTIVE The aim of this study was to develop a regional Digital Health Record (abbreviated in German as ReDiFa) in order to improve health information exchange in geriatric treatment. This study also evaluated the usability of ReDiFa and seeks to identify barriers and facilitators for its implementation. METHODS The development of ReDiFa followed the Community-Based Participatory Research Approach (CBPR) and involved various geriatric healthcare professionals in all stages of development: identification of suitable regions for later implementation, identification of regional stakeholders, identifying specific, regional needs, development of a content concept, programming and testing of ReDiFa. Primary outcomes were usability of ReDiFa, expected implementation barriers and facilitators and the quality of the developmental process. Data were collected and analyzed by using a mixed-method approach. RESULTS 3 focus regions were identified, 22 geriatric healthcare providers participated in the development of ReDiFa and 11 workshops were conducted between October 2019 and September 2020. 12 participants responded to a questionnaire. Main results were, that ReDiFa should support the exchange of assessments, diagnoses, medication, assistive device supply and social information. The ReDiFa was expected to be able to improve the quality and continuity of care. Main barriers expected for implementation were: lack of resources, interoperability issues, computer illiteracy, lack of trust, privacy concerns, and ease-of-use issues. CONCLUSIONS Participating healthcare professionals share similar motivations for developing ReDiFa including improved quality of care, reduction of unnecessary examinations, and more effective healthcare provision. An overly complicated registration process for healthcare professionals and the patients' free choice of their healthcare providers hinder the effectiveness of ReDiFa and result in incomplete patient health information. However, the web-based design of ReDiFa bridges interoperability problems which exists due to different technical and organizational structures of the involved healthcare facilities. ReDiFa is better accepted by healthcare professionals which are already engaged in an inter-disciplinary, geriatric-focused network. This might indicate that pre-existing cross-organisational structures and processes are prerequisites for using health information exchange systems. The participatory design supports the development of technologies adaptable to regional needs. Healthcare providers are interested in participating in the development of a health information exchange system, but they often lack the required time, knowledge and resources.

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 Exploring the role of the Care and Health Information Exchange (CHIE) in clinical decision-making: a realist evaluation

2020 ◽  
Author(s):  
Philip Scott ◽  
Elisavet Andrikopoulou ◽  
Haythem Nakkas ◽  
Paul Roderick
Keyword(s):  
Decision Making ◽  
Health Information ◽  
Information Exchange ◽  
Healthcare Professionals ◽  
Clinical Decision Making ◽  
Social Care ◽  
Health Information Exchange ◽  
Clinical Decision ◽  
Health And Social Care ◽  
The Impact

Background: The overall evidence for the impact of electronic information systems on cost, quality and safety of healthcare remains contested. Whilst it seems intuitively obvious that having more data about a patient will improve care, the mechanisms by which information availability is translated into better decision-making are not well understood. Furthermore, there is the risk of data overload creating a negative outcome. There are situations where a key information summary can be more useful than a rich record. The Care and Health Information Exchange (CHIE) is a shared electronic health record for Hampshire and the Isle of Wight that combines key information from hospital, general practice, community care and social services. Its purpose is to provide clinical and care professionals with complete, accurate and up-to-date information when caring for patients. CHIE is used by GP out-of-hours services, acute hospital doctors, ambulance service, GPs and others in caring for patients. Research questions: The fundamental question was How does awareness of CHIE or usage of CHIE affect clinical decision-making? The secondary questions were What are the latent benefits of CHIE in frontline NHS operations? and What is the potential of CHIE to have an impact on major NHS cost pressures? The NHS funders decided to focus on acute medical inpatient admissions as the initial scope, given the high costs associated with hospital stays and the patient complexities (and therefore information requirements) often associated with unscheduled admissions. Methods: Semi-structured interviews with healthcare professionals to explore their experience about the utility of CHIE in their clinical scenario, whether and how it has affected their decision-making practices and the barriers and facilitators for their use of CHIE. The Framework Method was used for qualitative analysis, supported by the software tool Atlas.ti. Results: 21 healthcare professionals were interviewed. Three main functions were identified as useful: extensive medication prescribing history, information sharing between primary, secondary and social care and access to laboratory test results. We inferred two positive cognitive mechanisms: knowledge confidence and collaboration assurance, and three negative ones: consent anxiety, search anxiety and data mistrust. Conclusions: CHIE gives clinicians the bigger picture to understand the patient's health and social care history and circumstances so as to make confident and informed decisions. CHIE is very beneficial for medicines reconciliation on admission, especially for patients that are unable to speak or act for themselves or who cannot remember their precise medication or allergies. We found no clear evidence that CHIE has a significant impact on admission or discharge decisions. We propose the use of recommender systems to help clinicians navigate such large volumes of patient data, which will only grow as additional data is collected.

scholarly journals Does Health Information Exchange Reduce Unnecessary Neuroimaging and Improve Quality of Headache Care in the Emergency Department?

2012 ◽  
Vol 28 (2) ◽  
pp. 176-183 ◽  
Author(s):  
James E. Bailey ◽  
Jim Y. Wan ◽  
Lisa M. Mabry ◽  
Stephen H. Landy ◽  
Rebecca A. Pope ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Improve Quality ◽  
Headache Care

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. 

scholarly journals What Affects Clinicians’ Usage of Health Information Exchange?

2011 ◽  
Vol 02 (03) ◽  
pp. 250-262 ◽  
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.

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.

Health Information Exchange for Improving the Efficiency and Quality of Healthcare Delivery

2011 ◽  
pp. 352-374 ◽  
Author(s):  
Jing Shi ◽  
Sudhindra Upadhyaya ◽  
Ergin Erdem
Keyword(s):  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Critical Role ◽  
Healthcare Delivery ◽  
Cost Effective ◽  
Quality Of Healthcare ◽  
Future Research ◽  
The Right

In healthcare industry, providers, patients, and all other stakeholders must have the right information at the right time for achieving efficient and cost effective services. Exchange of information between the heterogeneous system entities plays a critical role. Health information exchange (HIE) is not only a process of transmitting data, but also a platform for streamlining operations to improve healthcare delivery in a secure manner. In this chapter, we present a comprehensive view of electronic health record (EHR) systems and HIE by presenting their architecture, benefits, challenges, and other related issues. While providing information on the current state of EHR/HIE applications, we also discuss advanced issues and secondary uses of HIE implementations, and shed some light on the future research in this area by highlighting the challenges and potentials.

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