Brian E. Dixon

A Framework for evaluating the costs, effort, and value of nationwide health information exchange

OBJECTIVEnThe nationwide health information network (NHIN) has been proposed to securely link community and state health information exchange (HIE) entities to create a national, interoperable network for sharing healthcare data in the USA. This paper describes a framework for evaluating the costs, effort, and value of nationwide data exchange as the NHIN moves toward a production state. The paper further presents the results of an initial assessment of the framework by those engaged in HIE activities.nnnDESIGNnUsing a literature review and knowledge gained from active NHIN technology and policy development, the authors constructed a framework for evaluating the costs, effort, and value of data exchange between an HIE entity and the NHIN.nnnMEASUREMENTnAn online survey was used to assess the perceived usefulness of the metrics in the framework among HIE professionals and researchers.nnnRESULTSnThe framework is organized into five broad categories: implementation; technology; policy; data; and value. Each category enumerates a variety of measures and measure types. Survey respondents generally indicated the framework contained useful measures for current and future use in HIE and NHIN evaluation. Answers varied slightly based on a respondents participation in active development of NHIN components.nnnCONCLUSIONnThe proposed framework supports efforts to measure the costs, effort, and value associated with nationwide data exchange. Collecting longitudinal data along the NHINs path to production should help with the development of an evidence base that will drive adoption, create value, and stimulate further investment in nationwide data exchange.

Linking health information technology to patient safety and quality outcomes: a bibliometric analysis and review

Objective. To assess the scholarly output of grants funded by the Agency for Healthcare Research and Quality (AHRQ) that published knowledge relevant to the impact of health information technologies on patient safety and quality of care outcomes. Study design We performed a bibliometric analysis of the identified scholarly articles, their journals, and citations. In addition, we performed a qualitative review of the full-text articles and grant documents. Data collection/extraction methods Papers published by AHRQ-funded investigators were retrieved from MEDLINE, journal impact factors were extracted from the 2010 Thompson Reuters Journal Citation Report, citations were retrieved from ISIs Web of Knowledge and Google Scholar. Principal findings. Seventy-two articles met the criteria for review. Most articles addressed one or more of AHRQs outcome goals and focus priorities. The average impact factor for the journals was 4.005 (range: 0.654–28.899). The articles, and their respective grants, represented a broad range of health information technologies. Conclusions. This set of AHRQ-funded research projects addressed the goals and priorities of AHRQ, indicating notable contributions to the scientific knowledge base on the impact of information system use in healthcare.

Measuring the impact of a health information exchange intervention on provider-based notifiable disease reporting using mixed methods: a study protocol

BackgroundHealth information exchange (HIE) is the electronic sharing of data and information between clinical care and public health entities. Previous research has shown that using HIE to electronically report laboratory results to public health can improve surveillance practice, yet there has been little utilization of HIE for improving provider-based disease reporting. This article describes a study protocol that uses mixed methods to evaluate an intervention to electronically pre-populate provider-based notifiable disease case reporting forms with clinical, laboratory and patient data available through an operational HIE. The evaluation seeks to: (1) identify barriers and facilitators to implementation, adoption and utilization of the intervention; (2) measure impacts on workflow, provider awareness, and end-user satisfaction; and (3) describe the contextual factors that impact the effectiveness of the intervention within heterogeneous clinical settings and the HIE.Methods/DesignThe intervention will be implemented over a staggered schedule in one of the largest and oldest HIE infrastructures in the U.S., the Indiana Network for Patient Care. Evaluation will be conducted utilizing a concurrent design mixed methods framework in which qualitative methods are embedded within the quantitative methods. Quantitative data will include reporting rates, timeliness and burden and report completeness and accuracy, analyzed using interrupted time-series and other pre-post comparisons. Qualitative data regarding pre-post provider perceptions of report completeness, accuracy, and timeliness, reporting burden, data quality, benefits, utility, adoption, utilization and impact on reporting workflow will be collected using semi-structured interviews and open-ended survey items. Data will be triangulated to find convergence or agreement by cross-validating results to produce a contextualized portrayal of the facilitators and barriers to implementation and use of the intervention.DiscussionBy applying mixed research methods and measuring context, facilitators and barriers, and individual, organizational and data quality factors that may impact adoption and utilization of the intervention, we will document whether and how the intervention streamlines provider-based manual reporting workflows, lowers barriers to reporting, increases data completeness, improves reporting timeliness and captures a greater portion of communicable disease burden in the community.

Why "What Data Are Necessary for This Project?" and Other Basic Questions are Important to Address in Public Health Informatics Practice and Research.

Despite the likelihood of poor quality data flowing from clinical information systems to public health information systems, current policies and practices are pushing for the adoption and use of even greater numbers of electronic data feeds. However, using poor data can lead to poor decision-making outcomes in public health. Therefore public health informatics professionals need to assess, and periodically re-evaluate, the quality of electronic data and their sources. Unfortunately there is currently a paucity of tools and strategies in use across public health agencies. Our Center of Excellence in Public Health Informatics is working to develop and disseminate tools and strategies for supporting on-going assessment of data quality and solutions for overcoming data quality challenges. In this article, we outline the need for better data quality assessment and our approach to the development of new tools and strategies. In other words, public health informatics professionals need to ask questions about the electronic data received by public health agencies, and we hope to create tools and strategies to help informaticians ask questions that will lead to improved population health outcomes.

Short-Term Medical Costs of a VHA Health Information Exchange: A CHEERS-Compliant Article.

AbstractThe Virtual Lifetime Electronic Record (VLER) Health program provides the Veterans Health Administration (VHA) a framework whereby VHA providers can access the veterans’ electronic health record information to coordinate healthcare across multiple sites of care. As an early adopter of VLER, the Indianapolis VHA and Regenstrief Institute implemented a regional demonstration program involving bi-directional health information exchange (HIE) between VHA and non-VHA providers.The aim of the study is to determine whether implementation of VLER HIE reduces 1 year VHA medical costs.A cohort evaluation with a concurrent control group compared VHA healthcare costs using propensity score adjustment. A CHEERs compliant checklist was used to conduct the cost evaluation.Patients were enrolled in the VLER program onsite at the Indianapolis VHA in outpatient clinics or through the release-of-information office.VHA cost data (in 2014 dollars) were obtained for both enrolled and nonenrolled (control) patients for 1 year prior to, and 1 year after, the index date of patient enrollment.There were 6104 patients enrolled in VLER and 45,700 patients in the control group. The annual adjusted total cost difference per patient was associated with a higher cost for VLER enrollees

Chapter 5 – Regenstrief Medical Informatics: Experiences with Clinical Decision Support Systems

1152 (95% CI:

Improving Access to HIV and AIDS Information Resources for Patients, Caregivers, and Clinicians: Results from the SHINE Project

807–1433) (Pu200a<u200a0.01) (in 2014 dollars) than VLER nonenrollees.Short-term evaluation of this demonstration project did not show immediate reductions in healthcare cost as might be expected if HIE decreased redundant medical tests and treatments. Cost reductions from shared health information may be realized with longer time horizons.

A Case Study of a Semantically Enhanced Public Health Digital Collection

The discipline of clinical informatics endeavors to improve the process and outcomes of health care by enabling efficient access to information. Care providers can then use this information, both in the form of medical knowledge and in the form of patient data collected during clinical practice, to make decisions and comply with appropriate standards of care. The Regenstrief Institute began work on clinical information systems in 1972, when Dr. Clement McDonald and colleagues conceptualized and began construction of a computerized patient management system for outpatient diabetes care, developed to meet three primary goals: first, it was built to eliminate the problems inherent in paper records by making clinical data available to authorized users “just-in-time” as medical decisions are made; second, it was designed to aid in the recognition of diagnoses and adoption of pertinent care practices by assisting clinicians during their record-keeping activities; third, the system was designed to aggregate and analyze clinical information to be used in health care support systems, such as those for public health, health services research, and quality improvement. The first installation of the Regenstrief Medical Record System (RMRS) at Wishard Memorial Hospital occurred in 1974 and, over the next few years, the use of this system expanded outside of the diabetic clinic into a few of the hospital’s many general medicine clinics. From early in its history, the Regenstrief system has included mechanisms for tailoring rules based on the data, to generate reminders and alerts to care providers. This chapter provides a history of the development and growth of the RMRS into a region-wide source of clinical data, the Indiana Network for Patient Care (INPC), and a summary of the research on the decision support interventions themselves, made possible by this infrastructure. Additionally, lessons learned throughout the more than 30 years of experience in both building and maintaining this system are detailed, alongside some reflections that may be useful for future system builders.

Using Information Entropy to Monitor Chief Complaint Characteristics and Quality

Background Human immunodeficiency virus and acquired immunodeficiency syndrome (HIV/AIDS) remains a significant international public health challenge. The Statewide HIV/AIDS Information Network (SHINE) Project was created to improve HIV/AIDS health information use and access for health care professionals, patients, and affected communities in Indiana. Objective: Our objective was to assess the information-seeking behaviors of health care professionals and consumers who seek information on the testing, treatment, and management of HIV/AIDS and the usability of the SHINE Project’s resources in meeting end user needs. The feedback was designed to help SHINE Project members improve and expand the SHINE Project’s online resources. Methods: A convenience sample of health care professionals and consumers participated in a usability study. Participants were asked to complete typical HIV/AIDS information-seeking tasks using the SHINE Project website. Feedback was provided in the form of standardized questionnaire and usability “think-aloud” responses. Results: Thirteen participants took part in the usability study. Clinicians generally reported the site to be “very good,” while consumers generally found it to be “good.” Health care professionals commented that they lack access to comprehensive resources for treating patients with HIV/AIDS. They requested new electronic resources that could be integrated in clinical practice and existing information technology infrastructures. Consumers found the SHINE website and its collected information resources overwhelming and difficult to navigate. They requested simpler, multimedia-content rich resources to deliver information on HIV/AIDS testing, treatment, and disease management. Conclusions: Accessibility, usability, and user education remain important challenges that public health and information specialists must address when developing and deploying interventions intended to empower consumers and support coordinated, patient-centric care.

Inpatient Computerized Provider Order Entry (CPOE) - Findings from the AHRQ Health IT Portfolio

A historic public health digital collection, developed by the Ruth Lilly Medical Librarys Digital Initiatives Group, includes full-text public health bulletin issues; historic photos, drawings, and images; and a vital statistics database. Each content component resides in its own digital space and each has to be separately searched. This paper will discuss the development of a prototype system that integrates and relates digital content within a dispersed collection using Semantic Web technologies. The search result sets are presented as a collection of interrelated content on a scatter graph that spatially indicates the degree of contextual relevancy.