Peter W. Crane

The impact of interoperability of electronic health records on ambulatory physician practices: a discrete-event simulation study

BACKGROUND The effect of health information technology (HIT) on efficiency and workload among clinical and nonclinical staff has been debated, with conflicting evidence about whether electronic health records (EHRs) increase or decrease effort. None of this paper to date, however, examines the effect of interoperability quantitatively using discrete event simulation techniques. OBJECTIVE To estimate the impact of EHR systems with various levels of interoperability on day-to-day tasks and operations of ambulatory physician offices. METHODS Interviews and observations were used to collect workflow data from 12 adult primary and specialty practices. A discrete event simulation model was constructed to represent patient flows and clinical and administrative tasks of physicians and staff members. RESULTS High levels of EHR interoperability were associated with reduced time spent by providers on four tasks: preparing lab reports, requesting lab orders, prescribing medications, and writing referrals. The implementation of an EHR was associated with less time spent by administrators but more time spent by physicians, compared with time spent at paper-based practices. In addition, the presence of EHRs and of interoperability did not significantly affect the time usage of registered nurses or the total visit time and waiting time of patients. CONCLUSION This paper suggests that the impact of using HIT on clinical and nonclinical staff work efficiency varies, however, overall it appears to improve time efficiency more for administrators than for physicians and nurses.

A Consensus-Driven Agenda for Emergency Medicine Firearm Injury Prevention Research

Study objective To identify critical emergency medicine–focused firearm injury research questions and develop an evidence‐based research agenda. Methods National content experts were recruited to a technical advisory group for the American College of Emergency Physicians Research Committee. Nominal group technique was used to identify research questions by consensus. The technical advisory group decided to focus on 5 widely accepted categorizations of firearm injury. Subgroups conducted literature reviews on each topic and developed preliminary lists of emergency medicine–relevant research questions. In‐person meetings and conference calls were held to iteratively refine the extensive list of research questions, following nominal group technique guidelines. Feedback from external stakeholders was reviewed and integrated. Results Fifty‐nine final emergency medicine–relevant research questions were identified, including questions that cut across all firearm injury topics and questions specific to self‐directed violence (suicide and attempted suicide), intimate partner violence, peer (nonpartner) violence, mass violence, and unintentional (“accidental”) injury. Some questions could be addressed through research conducted in emergency departments; others would require work in other settings. Conclusion The technical advisory group identified key emergency medicine–relevant firearm injury research questions. Emergency medicine–specific data are limited for most of these questions. Funders and researchers should consider increasing their attention to firearm injury prevention and control, particularly to the questions identified here and in other recently developed research agendas.

Characterising the effect of interoperability on healthcare work: a novel framework

Successful design and implementation of interoperable health IT requires an understanding of specific technological capabilities of systems, as well as how these systems impact clinical workflow. Several existing frameworks classify interoperability levels, but none focus on the impact on clinical work, particularly at the task level. A synthesis of existing interoperability frameworks from select interoperability frameworks in the literature about both medical and non-medical systems is presented and a new, 7-level framework in order to characterise the effect of varying levels of interoperability on the users’ work based upon qualitative data collected in a field study of the use of health information exchange in 12 ambulatory practices is proposed. The lowest level describes paper-based tasks completed with no access to electronic information from other institutions; the highest level describes interoperable systems in which data elements from other institutions are integrated into the patients record seamlessly and in a computable format.

Characterizing Levels of Health IT System Interoperability based on How it Affects the Work of the Users

After comparing existing interoperability frameworks that describe information exchange among health IT systems and other non-medical domains, we propose a new framework for classification based on work as experienced by frontline healthcare workers. Seven user-centric interoperability levels are proposed.