Sue S. Feldman

Collaboration in electronic medical evidence development: A case study of the Social Security Administration's MEGAHIT System

BACKGROUND In January 2009, the Social Security Administration (SSA) began a collaboration with MedVirginia to send authorized requests for and receipts of patient health information using the Medical Evidence Gathering and Analysis through Health IT (MEGAHIT) application. This request and receipt used the Nationwide Health Information Network (NwHIN) for secure and interoperable Health IT standards-based transport of patient information. METHODS This case study, conducted from June to November 2009, represents the first production exchange of health information across the NwHIN. Interviews with 43 participants from a variety of organizations are reported across technical, organizational, and governance dimensions in terms of challenges, successes, and considerations for moving forward. RESULTS This case study reports on the technical, organizational, and governance dimensions of collaboration. In terms of technical success, the authorized medical evidence request and receipt took approximately 2 min, including Continuity of Care Document (CCD) rendering. Overall, this resulted in mean case-processing time savings of 30%. Organizationally, the production effort required collaboration among multiple stakeholders: SSA sought claimant health information, MedVirginia provided patient health information, and other parties, such as the Office of the National Coordinator (ONC), facilitated transport of patient information across the NwHIN. According to those involved, this limited production effort tolerated and even benefited from an ad hoc multiparty governance structure. CONCLUSIONS Multi-party collaboration can result in technical success, but achieving that success is dependent on a variety of organizational factors. This case study highlights the significance of and potential for requesting and receiving patient health information across the NwHIN. It will inform interested collaborating stakeholders as SSA engages additional providers in using MEGAHIT to collect health information via the NwHIN.

Understanding the value proposition of health information exchange: the case of uncompensated care cost recovery

This case study examined the use of the Nationwide Health Information Network as a mechanism for secure and interoperable transport of existing clinical data from electronic health records. The context for this study was the secondary use of existing data from MedVirginia, a Virginia Health Information Exchange, for Social Security Administration disability determination. The study found that an estimated U.S.

The prospective role of personal health records in streamlining and accelerating the disability determination process

1.9 million in uncompensated care costs were recovered over a 12-month period from August 2009 to July 2010, and serves as an example demonstrating that uncompensated care cost recovery is a promising means by which a health information exchange can provide value to healthcare providers.

Cyberinfrastructure for Secondary Use of EHR Data: SSA's Use of the Nationwide Health Information Network

BACKGROUND The disability community could benefit significantly from the widespread adoption of health information technology, in particular from its ability to streamline and accelerate processing of the estimated 3 million disability benefits applications filed with the Social Security Administration each year. Disability determination is an inefficient, largely paper-based process requiring large volumes of clinical data compiled from multiple provider sources. That, coupled with a lack of transparency within the process, adds unnecessary delays and expense. OBJECTIVE The objective of this paper is to outline the case for how personal health records, particularly those populated with information from provider-held electronic health records and payer claims data, offer a means to achieve financial savings from shortened disability determination processes, as well as a tool for disability health self-management and care coordination. METHODS Drawing from research and policy forums and testimony before the American Health Information Community, the importance of including the disability community as the nation moves forward with health information technology initiatives is explored. RESULTS Our research suggests that systemwide improvements such as the Nationwide Health Information Network and other such health information technology initiatives could be used to bring benefits to the disability community. CONCLUSIONS The time has come to use health information technology initiatives so that federal policy makers can takes steps to reduce the inefficiencies in the Social Security Administration disability determination process while improving the programs value to those who need it the most.

Figure Correction: Health Information Technology in Healthcare Quality and Patient Safety: Literature Review (Preprint)

This study examined the use of the Nationwide Health Information Network (NHIN) as a cyberinfrastructure for secure and interoperable transport of existing clinical data from electronic health records. The context for this study was secondary use of existing data for Social Security Administration (SSA) disability determination. The medical records were requested and gathered using an SSA developed application called MEGAHIT. While challenges were expressed in terms of some technical standards such as gateway specifications, successes were articulated in terms of turnaround time for the release of information of under 2 minutes, a 30% time saving in overall medical information development.

An Early Model for Value and Sustainability in Health Information Exchanges: Qualitative Study

[This corrects the article DOI: 10.2196/10264.].

Health Information Technology in Healthcare Quality and Patient Safety: Literature Review

Background The primary value relative to health information exchange has been seen in terms of cost savings relative to laboratory and radiology testing, emergency department expenditures, and admissions. However, models are needed to statistically quantify value and sustainability and better understand the dependent and mediating factors that contribute to value and sustainability. Objective The purpose of this study was to provide a basis for early model development for health information exchange value and sustainability. Methods A qualitative study was conducted with 21 interviews of eHealth Exchange participants across 10 organizations. Using a grounded theory approach and 3.0 as a relative frequency threshold, 5 main categories and 16 subcategories emerged. Results This study identifies 3 core current perceived value factors and 5 potential perceived value factors—how interviewees predict health information exchanges may evolve as there are more participants. These value factors were used as the foundation for early model development for sustainability of health information exchange. Conclusions Using the value factors from the interviews, the study provides the basis for early model development for health information exchange value and sustainability. This basis includes factors from the research: fostering consumer engagement; establishing a provider directory; quantifying use, cost, and clinical outcomes; ensuring data integrity through patient matching; and increasing awareness, usefulness, interoperability, and sustainability of eHealth Exchange.

Introduction to IT Innovation for Change in Healthcare Minitrack

Background The area of healthcare quality and patient safety is starting to use health information technology to prevent reportable events, identify them before they become issues, and act on events that are thought to be unavoidable. As healthcare organizations begin to explore the use of health information technology in this realm, it is often unclear where fiscal and human efforts should be focused. Objective The purpose of this study was to provide a foundation for understanding where to focus health information technology fiscal and human resources as well as expectations for the use of health information technology in healthcare quality and patient safety. Methods A literature review was conducted to identify peer-reviewed publications reporting on the actual use of health information technology in healthcare quality and patient safety. Inductive thematic analysis with open coding was used to categorize a total of 41 studies. Three pre-set categories were used: prevention, identification, and action. Three additional categories were formed through coding: challenges, outcomes, and location. Results This study identifies five main categories across seven study settings. A majority of the studies used health IT for identification and prevention of healthcare quality and patient safety issues. In this realm, alerts, clinical decision support, and customized health IT solutions were most often implemented. Implementation, interface design, and culture were most often noted as challenges. Conclusions This study provides valuable information as organizations determine where they stand to get the most “bang for their buck” relative to health IT for quality and patient safety. Knowing what implementations are being effectivity used by other organizations helps with fiscal and human resource planning as well as managing expectations relative to cost, scope, and outcomes. The findings from this scan of the literature suggest that having organizational champion leaders that can shepherd implementation, impact culture, and bridge knowledge with developers would be a valuable resource allocation to consider.

Investigation of a Consumer Focused Health IT System: The Role of Claimant Information in the Social Security Determination Process

The innovative application of information technologies (IT) in the consumer, clinical, and public health spheres offers the potential for transformational improvements to the healthcare system. Addressing the significant challenge of developing, evaluating, and integrating such innovations requires a systems approach that encompasses the technical and social dimensions, as well as interrelationships across the personal, clinical and public health levels. Vital to the innovative process are electronic information platforms, or cyber infrastructure, that use grid and cloud-based systems for storage, harmonization, access, analysis, and utilization of data. IT innovation in healthcare includes infrastructures to support large data sets/sources as well as emerging data platforms such as the National Health Information Network (NwHIN), Public Health Information Network (PHIN), Cancer Research Network (CRN), and Health Data.gov. IT innovations are also important in health prevention and promotion. health surveillance data, such as the Health Information National Trends Survey (HINTS), are helpful for assessing population trends and informing health-related policy and practice. Such policy and practice applications can be accelerated through applied research, demonstrations, and open innovation developer challenges. Recent developer challenges have provided a key mechanism for applying disparate data sets to advance health promotion and disease prevention, improve health communication and coordination, and expand the use of applications targeting specific populations and health outcomes. This conference mini-track highlights some of the IT innovations in healthcare for population health and health services. It will feature the following papers: A Hybrid Case Based Recommender in mHealth for Smoking Cessation Lessons from an Online Stop-Smoking Intervention: Adaptations for Mobile Implementation Stage-Based mHealth Communication Interventions for HPV Education Towards Next Generation Health Data Exploration: A Data Cube-based Investigation into Population Statistics for Tobacco Towards Systematically-Enabled Next Generation Community Health Information Portals: The PopSciGrid Pilot These research papers address technical, behavioral, social and health issues, with topics ranging from high performance computing topics concerning the extraction of knowledge from various data collections, data acquisition and analysis in a data intensive health science world, and open technological advancements. A particular emphasis in several of the papers relates to the use of large data sets, mhealth, and cyber infrastructure to prevent, monitor, and manage cancer.

Introduction to Health Cyberinfrastructure: Applications and Technologies for Population Health and Health Services Minitrack

This paper examines a system driven government process and articulates how this system can be transformed into a consumer driven process through the use of Health Information Technology (Health IT). In order to achieve this, expert interviews were conducted with stakeholders familiar with the process, followed by a convening meeting to review status and directions. The findings identified a range of Health IT uses that would facilitate enhanced consumer access and active benefit and health management.