Exploring Health Information Exchange Through a System of Systems Framework

2020 ◽  
Vol 5 (2) ◽  
pp. 1-12
Author(s):  
Chaojie Wang
Keyword(s):  
Health Information ◽  
Systems Engineering ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Collaborative Governance ◽  
System Of Systems ◽  
Care Quality ◽  
Patient Centered ◽  
Sos Model ◽  
Patient Health

Clinical decisions require timely availability of holistic patient health information including clinical, demographic, behavioral, and socioeconomic risk factors. Health information exchanges (HIEs) help bridge the technical and organizational divides between disparate Electronic health records (EHR) systems and facilitate the sharing of health information between providers and between patients and providers through collaborative governance, secure protocols, and interoperable standards. HIEs come in many varieties and can be highly complex, both technically and organizationally. This conceptual paper adopts a system of systems (SoS) framework from the systems engineering discipline to analyze and break down the complexity of HIEs. The mnemonic nature of the five characteristics of the Boardman and Sauser SoS Model (A for Autonomy, B for Belonging, C for Connectivity, D for Diversity, and E for Emergence) makes it easier to understand the intricacy of HIEs and helps remove the barriers to effective use of HIEs for care coordination, patient safety, and patient-centered care quality.

Approaches to Patient Health Information Exchange and Their Impact on Emergency Medicine

2006 ◽  
Vol 48 (4) ◽  
pp. 426-432 ◽  
Author(s):  
Jason S. Shapiro ◽  
Joseph Kannry ◽  
Mark Lipton ◽  
Eric Goldberg ◽  
Paul Conocenti ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Patient Health ◽  
Patient Health Information

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 Health information exchange policies of 11 diverse health systems and the associated impact on volume of exchange

2016 ◽  
Vol 24 (1) ◽  
pp. 113-122 ◽  
Author(s):  
N Lance Downing ◽  
Julia Adler-Milstein ◽  
Jonathan P Palma ◽  
Steven Lane ◽  
Matthew Eisenberg ◽  
...  
Keyword(s):  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
External Information ◽  
Policy Decisions ◽  
Optimal Care ◽  
Specific Patient ◽  
Patient Consent ◽  
Patient Health ◽  
Patient Health Information

Background: Provider organizations increasingly have the ability to exchange patient health information electronically. Organizational health information exchange (HIE) policy decisions can impact the extent to which external information is readily available to providers, but this relationship has not been well studied. Objective: Our objective was to examine the relationship between electronic exchange of patient health information across organizations and organizational HIE policy decisions. We focused on 2 key decisions: whether to automatically search for information from other organizations and whether to require HIE-specific patient consent. Methods: We conducted a retrospective time series analysis of the effect of automatic querying and the patient consent requirement on the monthly volume of clinical summaries exchanged. We could not assess degree of use or usefulness of summaries, organizational decision-making processes, or generalizability to other vendors. Results: Between 2013 and 2015, clinical summary exchange volume increased by 1349% across 11 organizations. Nine of the 11 systems were set up to enable auto-querying, and auto-querying was associated with a significant increase in the monthly rate of exchange (P = .006 for change in trend). Seven of the 11 organizations did not require patient consent specifically for HIE, and these organizations experienced a greater increase in volume of exchange over time compared to organizations that required consent. Conclusions: Automatic querying and limited consent requirements are organizational HIE policy decisions that impact the volume of exchange, and ultimately the information available to providers to support optimal care. Future efforts to ensure effective HIE may need to explicitly address these factors.

scholarly journals Improving Access to Longitudinal Patient Health Information within an Emergency Department

2012 ◽  
Vol 03 (03) ◽  
pp. 290-300 ◽  
Author(s):  
S. Shen ◽  
D.A. Dorr ◽  
G. Hripcsak ◽  
L. Heermann ◽  
S.P. Narus ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Information ◽  
Information Exchange ◽  
Health Information Exchange ◽  
User Authentication ◽  
Tracking System ◽  
Clinical Information ◽  
Before And After ◽  
Patient Health ◽  
The Impact

SummaryWe designed and implemented an electronic patient tracking system with improved user authentication and patient selection. We then measured access to clinical information from previous clinical encounters before and after implementation of the system. Clinicians accessed longitudinal information for 16% of patient encounters before, and 40% of patient encounters after the intervention, indicating such a system can improve clinician access to information. We also attempted to evaluate the impact of providing this access on inpatient admissions from the emergency department, by comparing the odds of inpatient admission from an emergency department before and after the improved access was made available. Patients were 24% less likely to be admitted after the implementation of improved access. However, there were many potential confounders, based on the inherent pre-post design of the evaluation. Our experience has strong implications for current health information exchange initiatives.

scholarly journals Health Information Exchange and Ambulatory Quality of Care

2012 ◽  
Vol 03 (02) ◽  
pp. 197-209 ◽  
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.

scholarly journals Organizational characteristics and perceptions of clinical event notification services in healthcare settings: a study of health information exchange

JAMIA Open ◽  
2020 ◽  
Author(s):  
Kevin K Wiley ◽  
Katy Ellis Hilts ◽  
Jessica S Ancker ◽  
Mark A Unruh ◽  
Hye-Young Jung ◽  
...  
Keyword(s):  
Health Information ◽  
Care Coordination ◽  
Information Exchange ◽  
Health Information Exchange ◽  
End Users ◽  
Care Quality ◽  
Organizational Capabilities ◽  
Healthcare Organizations ◽  
Event Notification ◽  
Perceptions Of Care

Abstract Objective Event notification systems are an approach to health information exchange (HIE) that notifies end-users of patient interactions with the healthcare system through real-time automated alerts. We examined associations between organizational capabilities and perceptions of event notification system use. Materials and Methods We surveyed representatives (n = 196) from healthcare organizations (n = 96) that subscribed to 1 of 3 Health Information Organizations’ event notification services in New York City (response rate = 27%). The survey was conducted in Fall 2017 and Winter 2018. Surveys measured respondent characteristics, perceived organizational capabilities, event notification use, care coordination, and care quality. Exploratory factor analysis was used to identify relevant independent and dependent variables. We examined the relationship between organizational capabilities, care coordination, and care quality using multilevel linear regression models with random effects. Results Respondents indicated that the majority of their organizations provided follow-up care for emergency department visits (66%) and hospital admissions (73%). Perceptions of care coordination were an estimated 57.5% (β = 0.575; P &lt; 0.001) higher among respondents who reported event notifications fit within their organization’s existing workflows. Perceptions of care quality were 46.5% (β = 0.465; P &lt; 0.001) higher among respondents who indicated event notifications fit within existing workflows and 23.8% (β = 0.238; P &lt; 0.01) higher where respondents reported having supportive policies and procedures for timely response and coordination of event notifications. Discussion and Conclusion Healthcare organizations with specific workflow processes and positive perceptions of fit are more likely to use event notification services to improve care coordination and care quality. In addition, event notification capacity and patient consent procedures influence how end-users perceive event notification services.

Health Information Exchange in Memphis: Impact on the Physician-Patient Relationship

2010 ◽  
Vol 38 (1) ◽  
pp. 50-57 ◽  
Author(s):  
Mark E. Frisse
Keyword(s):  
Health Care ◽  
Health Information ◽  
Support Groups ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Care Delivery ◽  
Information Access ◽  
Physician Patient Relationship ◽  
Patient Centered ◽  
Financing System

Patients and their physicians frequently make important health care decisions with incomplete information. Memory fails; records are incomplete; the onset of significant events is confused with other life stories; and even the most basic information about medications, laboratory tests, allergies, and problems is often the result of guesswork. As providers and as patients, we suffer because information vital to health care is not available when and where it is needed. Data required for care are dispersed across various settings and represented in a range of formats; incentives to bring these data together do not exist.In recent years, four specific approaches have emerged to address patient-centered information access. The first model attempts to consolidate all care into a single care delivery and financing system. This model — prevalent in many European countries — is to some degree extant at Kaiser-Permanente and other integrated care and financing systems. This model is ideal if and when one organization is responsible for all care delivery and financing. Such models present “one-stop shopping” for managing health information, coordinating care, communicating with providers and support groups, and ensuring both payment and accountability.

Sign in / Sign up

Export Citation Format

Share Document