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Mark E. Frisse - One of the best experts on this subject based on the ideXlab platform.
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Barriers to Pediatric Health Information Exchange.
Pediatrics, 2017Co-Authors: Christoph U. Lehmann, Susan J. Kressly, Winston W. “chip” Hart, Kevin B. Johnson, Mark E. FrisseAbstract:* Abbreviations: CMS — : Centers for Medicare & Medicaid Services DM — : direct messaging EHR — : electronic Health record HIE — : Health Information Exchange MU — : meaningful use ONC — : Office of the National Coordinator The Office of the National Coordinator (ONC) included in stage 2 meaningful use (MU) the requirement for eligible providers to transmit a summary of care record electronically for at least 10% of patients referred or transferred to another setting of care or provider of care.1 The transmission of summary of care records, particularly from ambulatory pediatricians to specialists in tertiary care centers or in hospitals caring for children, would be extremely helpful to children and pediatricians and would improve safety and quality of care. Such transmissions would also reduce costs through avoidance of unnecessary testing, duplicate procedures, and allergic reactions, as well as radiation exposure from unnecessary duplicate radiology tests. Regrettably, means to Exchange Health Information among Health care entities remain complex, inefficient, and grossly underutilized.2–5 Outpatient pediatricians have 3 ways to Exchange records: (1) participate in the Nationwide Health Information Network; (2) use Exchange capabilities available through regional delivery networks through electronic Health record (EHR) systems with some Health Information Exchange (HIE) capabilities; or (3) direct messaging (DM), a secure and relatively inexpensive method designed for Exchange of patient Health Information across different networks theoretically available to every provider or facility using a certified EHR. None of these options is widely pursued. Neither referring organizations nor outpatient pediatricians have made participating … Address correspondence to Christoph U. Lehmann, MD, Vanderbilt University Medical Center, Suite 1475, 2525 West End Ave, Nashville, TN 37203. E-mail: culehmann{at}gmail.com
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does Health Information Exchange reduce unnecessary neuroimaging and improve quality of headache care in the emergency department
Journal of General Internal Medicine, 2013Co-Authors: James E. Bailey, Rebecca A. Pope, Jim Y. Wan, Teresa M. Waters, Lisa M Mabry, Stephen H Landy, Mark E. FrisseAbstract:Background Health Information Exchange (HIE) is advocated as an approach to reduce unnecessary testing and improve quality of emergency department (ED) care, but little evidence supports its use. Headache is a specific condition for which HIE has theoretical benefits.
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Health Information Exchange Reduces Repeated Diagnostic Imaging for Back Pain
Annals of Emergency Medicine, 2013Co-Authors: James E. Bailey, Rebecca A. Pope, Elizabeth C. Elliott, Jim Y. Wan, Teresa M. Waters, Mark E. FrisseAbstract:Study objective This study seeks to determine whether Health Information Exchange reduces repeated diagnostic imaging and related costs in emergency back pain evaluation. Methods This was a longitudinal data analysis of Health Information Exchange patient-visit data. All repeated emergency department (ED) patient visits for back pain with previous ED diagnostic imaging to a Memphis metropolitan area ED between August 1, 2007, and July 31, 2009, were included. Use of a regional Health Information Exchange by ED personnel to access the patient's record during the emergency visit was the primary independent variable. Main outcomes included repeated lumbar or thoracic diagnostic imaging (radiograph, computed tomography [CT], or magnetic resonance imaging [MRI]) and total patient-visit estimated cost. Results One hundred seventy-nine (22.4%) of the 800 qualifying repeated back pain visits resulted in repeated diagnostic imaging (radiograph 84.9%, CT 6.1%, and MRI 9.5%). Health Information Exchange use in the study population was low, at 12.5%, and Health care providers as opposed to administrative/nursing staff accounted for 80% of the total Health Information Exchange use. Health Information Exchange use by any ED personnel was associated with reduced repeated diagnostic imaging (odds ratio 0.36; 95% confidence interval 0.18 to 0.71), as was physician or nurse practitioner Health Information Exchange use (odds ratio 0.47; 95% confidence interval 0.23 to 0.96). No cost savings were associated with Health Information Exchange use because of increased CT imaging when Health care providers used Health Information Exchange. Conclusion Health Information Exchange use is associated with 64% lower odds of repeated diagnostic imaging in the emergency evaluation of back pain. Health Information Exchange effect on estimated costs was negligible. More studies are needed to evaluate specific strategies to increase Health Information Exchange use and further decrease potentially unnecessary diagnostic imaging and associated costs of care.
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Health Information Exchange in Memphis: Impact on the Physician‐Patient Relationship
The Journal of Law Medicine & Ethics, 2010Co-Authors: Mark E. FrisseAbstract:Health Information Exchanges represent one way of making medical Information available to practitioners across institutional boundaries. One Health Information Exchange in Memphis Tennessee has been operational since May of 2006 and provides Information supporting care for over 1.2 million individuals. Creating such an Exchange challenged traditional institutional boundaries, roles, and perceptions. Approaching these challenges required leadership, trust, sound policy, new forms of dialogue, and an incremental approach to technology. Early evidence suggests a positive impact on patient care and a change in the way providers interact with their patients and on another. Personal Health records, consolidated EHR systems, and other alternative models promise to have similar impacts on the way in which providers and patients interact with one another.
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AMIA - A Regional Health Information Exchange: Architecture and Implementation
AMIA ... Annual Symposium proceedings. AMIA Symposium, 2008Co-Authors: Mark E. Frisse, Janet K. King, Will B. Rice, Lianhong Tang, Jameson P. Porter, Timothy A. Coffman, Michael Assink, Kevin Yang, Monroe Wesley, Rodney L. HolmesAbstract:The MidSouth eHealth Alliance’s Health Information Exchange in Memphis, Tennessee provides access to data on almost 1 million individuals. The effort is the product of a comprehensive, integrated approach to technology and policy that emphasizes patient-centered use, low-cost, flexibility, and rigorous privacy and confidentiality policies and practices. It is used in emergency departments and other clinical settings. This paper provides a high-level overview of the system and its use. The early anecdotal success of this effort and preliminary formal clinical and financial evaluation suggest that Health Information Exchanges can improve care at relatively low cost.
Rainu Kaushal - One of the best experts on this subject based on the ideXlab platform.
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Use of Health Information Exchange and Repeat Imaging Costs.
Journal of the American College of Radiology, 2015Co-Authors: Hye-young Jung, Lisa M. Kern, Joshua R. Vest, Mark Aaron Unruh, Rainu KaushalAbstract:Purpose The aim of this study was to quantify the association between Health Information Exchange (HIE) use and cost savings attributable to repeat imaging.
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a statewide assessment of electronic Health record adoption and Health Information Exchange among nursing homes
Health Services Research, 2014Co-Authors: Erika L Abramson, Jean Moore, Sandra Mcginnis, Rainu KaushalAbstract:Objective To determine rates of electronic Health record (EHR) adoption and Health Information Exchange (HIE) among New York State (NYS) nursing homes.
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AMIA - Potential value of Health Information Exchange for people with epilepsy: crossover patterns and missing clinical data.
AMIA ... Annual Symposium proceedings. AMIA Symposium, 2013Co-Authors: Zachary M. Grinspan, Erika L Abramson, Rainu Kaushal, Lisa M. Kern, Samprit Banerjee, Jason S. ShapiroAbstract:Context For people with epilepsy, the potential value of Health Information Exchange (HIE) is unknown.
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consumer perceptions of electronic Health Information Exchange
American Journal of Preventive Medicine, 2012Co-Authors: Alison M Edwards, Jessica S Ancker, Melissa C Miller, Rainu KaushalAbstract:Background Public support will be critical to the success and long-term sustainability of electronic Health Information Exchange (HIE) initiatives currently promoted by federal policy. Purpose The goal of this study was to assess consumer perceptions of HIE in a state (New York) with a 6-year history of successful HIE organizations. Methods The Empire State Poll is a random-digit-dial telephone survey of adult New York State residents conducted annually by the Survey Research Institute at Cornell University. In 2011, it contained 77 items. Results The survey was conducted and data were analyzed in 2011. Eight hundred respondents participated (71% response rate). Large majorities supported HIE among Healthcare providers (69%); thought it would improve quality of care (68%); and supported “break the glass” access to HIE data without need for consent in emergencies (90%). Support was lower among people who rated large corporations as less trustworthy. Privacy and security concerns were expressed by 68%. Respondents were supportive whether the architecture involved a physician sending data to another physician, a physician sending data to a patient who could send it to other physicians, or a physician accessing data from other institutions. Conclusions In New York, public support for HIE is strong. Policy and outreach pertaining to this type of Exchange may be most effective if it clarifies the roles and responsibilities of large businesses involved in different aspects of the Exchange, and privacy and security controls. Differing architectures received similar levels of support.
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Health Information Exchange and ambulatory quality of care.
Applied Clinical Informatics, 2012Co-Authors: Lisa M. Kern, Yolanda Barrón, Rina V. Dhopeshwarkar, Rainu KaushalAbstract:Background: 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
Gilad J. Kuperman - One of the best experts on this subject based on the ideXlab platform.
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Expanding Health Information Exchange Improves Identification of Frequent Emergency Department Users.
Annals of Emergency Medicine, 2019Co-Authors: Xiao Han, Gilad J. Kuperman, Tina Lowry, George T. Loo, Elaine Rabin, Zachary M. Grinspan, Lisa M. Kern, Jason S. ShapiroAbstract:Study objective Frequent emergency department (ED) users are of interest to policymakers and hospitals. The objective of this study is to examine the effect of Health Information Exchange size on the identification of frequent ED users. Methods We retrospectively analyzed data from Healthix, a Health Information Exchange in New York that previously included 10 hospitals and then grew to 31 hospitals. We divided patients into 3 cohorts: high-frequency ED users with 4 or more visits in any 30-day period, medium-frequency ED users with 4 or more visits in any year, and infrequent ED users with fewer than 4 visits in any year. For both the smaller (10-hospital) and larger (31-hospital) Health Information Exchanges, we compared the identification rate of frequent ED users that was based on hospital-specific data with the corresponding rates that were based on Health Information Exchange data. Results The smaller Health Information Exchange (n=1,696,279 unique ED patients) identified 11.4% more high-frequency users (33,467 versus 30,057) and 9.5% more medium-frequency users (109,497 versus 100,014) than the hospital-specific data. The larger Health Information Exchange (n=3,684,999) identified 19.6% more high-frequency patients (52,727 versus 44,079) and 18.2% more medium-frequency patients (222,574 versus 192,541) than the hospital-specific data. Expanding from the smaller Health Information Exchange to the larger one, we found an absolute increase of 8.2% and 8.7% identified high- and medium-frequency users, respectively. Conclusion Increasing Health Information Exchange size more accurately reflects how patients access EDs and ultimately improves not only the total number of identified frequent ED users but also their identification rate.
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Identifying homelessness using Health Information Exchange data
Journal of the American Medical Informatics Association, 2015Co-Authors: John Zech, Gilad J. Kuperman, Gregg Husk, Thomas Moore, Jason S. ShapiroAbstract: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.
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Potential unintended consequences of Health Information Exchange.
Journal of General Internal Medicine, 2013Co-Authors: Gilad J. Kuperman, Julie J. McgowanAbstract:Accountable models of care delivery demand that Health care provider organizations be able to Exchange clinical data about the patient. The “Meaningful Use” program is helping to advance Health Information Exchange by requiring physicians and hospitals to Exchange clinical data about patients in order to qualify for incentive payments for electronic Health records. Early studies demonstrate that the ability to Exchange clinical data among provider organizations has the potential to improve clinical care. However, as with any technology, there is a risk of unintended consequences from Health Information Exchange. This manuscript outlines seven aspects of Health Information Exchange that, if not managed properly, may lead to unintended consequences. These categories are: (1) the desire for complete, accurate and timely data for decision making, (2) data management and presentation, (3) assuring routine use of Health Information Exchange, (4) consideration of patient perceptions and concerns, (5) reputational and financial concerns, (6) technical issues and (7) administrative aspects of Health Information Exchange. Education about the capabilities and limitations of Health Information Exchange, along with checklists to support proper implementation and assure that systems are being used as planned, can mitigate risks and help to realize the promise of this powerful technology.
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using Health Information Exchange to improve public Health
American Journal of Public Health, 2011Co-Authors: Jason S. Shapiro, Farzad Mostashari, George Hripcsak, Nicholas D Soulakis, Gilad J. KupermanAbstract:Public Health relies on data reported by Health care partners, and Information technology makes such reporting easier than ever. However, data are often structured according to a variety of different terminologies and formats, making data interfaces complex and costly. As one strategy to address these challenges, Health Information organizations (HIOs) have been established to allow secure, integrated sharing of clinical Information among numerous stakeholders, including clinical partners and public Health, through Health Information Exchange (HIE). We give detailed descriptions of 11 typical cases in which HIOs can be used for public Health purposes. We believe that HIOs, and HIE in general, can improve the efficiency and quality of public Health reporting, facilitate public Health investigation, improve emergency response, and enable public Health to communicate Information to the clinical community.
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Health-Information Exchange: why are we doing it, and what are we doing?
Journal of the American Medical Informatics Association, 2011Co-Authors: Gilad J. KupermanAbstract:Health-Information Exchange, that is, enabling the interoperability of automated Health data, can facilitate important improvements in Healthcare quality and efficiency. A vision of interoperability and its benefits was articulated more than a decade ago. Since then, important advances toward the goal have been made. The advent of the Health Information Technology for Economic and Clinical Health Act and the meaningful use program is already having a significant impact on the direction that Health-Information Exchange will take. This paper describes how interoperability activities have unfolded over the last decade and explores how recent initiatives are likely to affect the directions and benefits of Health-Information Exchange.
Jason S. Shapiro - One of the best experts on this subject based on the ideXlab platform.
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Expanding Health Information Exchange Improves Identification of Frequent Emergency Department Users.
Annals of Emergency Medicine, 2019Co-Authors: Xiao Han, Gilad J. Kuperman, Tina Lowry, George T. Loo, Elaine Rabin, Zachary M. Grinspan, Lisa M. Kern, Jason S. ShapiroAbstract:Study objective Frequent emergency department (ED) users are of interest to policymakers and hospitals. The objective of this study is to examine the effect of Health Information Exchange size on the identification of frequent ED users. Methods We retrospectively analyzed data from Healthix, a Health Information Exchange in New York that previously included 10 hospitals and then grew to 31 hospitals. We divided patients into 3 cohorts: high-frequency ED users with 4 or more visits in any 30-day period, medium-frequency ED users with 4 or more visits in any year, and infrequent ED users with fewer than 4 visits in any year. For both the smaller (10-hospital) and larger (31-hospital) Health Information Exchanges, we compared the identification rate of frequent ED users that was based on hospital-specific data with the corresponding rates that were based on Health Information Exchange data. Results The smaller Health Information Exchange (n=1,696,279 unique ED patients) identified 11.4% more high-frequency users (33,467 versus 30,057) and 9.5% more medium-frequency users (109,497 versus 100,014) than the hospital-specific data. The larger Health Information Exchange (n=3,684,999) identified 19.6% more high-frequency patients (52,727 versus 44,079) and 18.2% more medium-frequency patients (222,574 versus 192,541) than the hospital-specific data. Expanding from the smaller Health Information Exchange to the larger one, we found an absolute increase of 8.2% and 8.7% identified high- and medium-frequency users, respectively. Conclusion Increasing Health Information Exchange size more accurately reflects how patients access EDs and ultimately improves not only the total number of identified frequent ED users but also their identification rate.
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Health Information Exchange in Emergency Medicine
Annals of Emergency Medicine, 2016Co-Authors: Jason S. Shapiro, Diana Crowley, Shkelzen Hoxhaj, James R. Langabeer, Brian Panik, Todd B. Taylor, Arlo F. Weltge, Jeffrey A. NielsonAbstract:Emergency physicians often must make critical, time-sensitive decisions with a paucity of Information with the realization that additional unavailable Health Information may exist. Health Information Exchange enables clinician access to patient Health Information from multiple sources across the spectrum of care. This can provide a more complete longitudinal record, which more accurately reflects the way most patients obtain care: across multiple providers and provider organizations. This Information article explores various aspects of Health Information Exchange that are relevant to emergency medicine and offers guidance to emergency physicians and to organized medicine for the use and promotion of this emerging technology. This article makes 5 primary emergency medicine–focused recommendations, as well as 7 additional secondary generalized recommendations, to Health Information Exchanges, policymakers, and professional groups, which are crafted to facilitate Health Information Exchange's purpose and demonstrate its value.
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Identifying homelessness using Health Information Exchange data
Journal of the American Medical Informatics Association, 2015Co-Authors: John Zech, Gilad J. Kuperman, Gregg Husk, Thomas Moore, Jason S. ShapiroAbstract: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.
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AMIA - Potential value of Health Information Exchange for people with epilepsy: crossover patterns and missing clinical data.
AMIA ... Annual Symposium proceedings. AMIA Symposium, 2013Co-Authors: Zachary M. Grinspan, Erika L Abramson, Rainu Kaushal, Lisa M. Kern, Samprit Banerjee, Jason S. ShapiroAbstract:Context For people with epilepsy, the potential value of Health Information Exchange (HIE) is unknown.
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Perceptions of Health Information Exchange in home Healthcare.
CIN: Computers Informatics Nursing, 2012Co-Authors: Sandip R Vaidya, Jason S. Shapiro, Andrea V. Papa, Gil Kuperman, Nadia Ali, Thomas Check, Mark LiptonAbstract:The aim of this study was to understand home Healthcare nurses' current experiences in obtaining outside clinical Information at the point of care and the type of clinical Information they most desire in their patients' Health Information Exchange profile. A Web-based survey was deployed to home Health workers in New York to learn about their experiences retrieving outside clinical data prior to having access to Health Information Exchange, preferred data elements and sources in their patients' Health Information Exchange profiles, and how availability of outside clinical data may affect emergency department referrals. Of the 2383 participants, 566 responded for a 23.8% overall response rate, and 469 of these respondents were RNs. Most RNs, 96.7%, agreed that easier and quicker access to outside Information would benefit delivery of care, and 72.6% said the number of emergency department referrals would decrease. When asked about pre-Health Information Exchange access to patient data, 96.3% said it was problematic. Inpatient discharge summaries were chosen most often by the RNs as a top five desired data element 81.5% of the time. Obtaining outside clinical Information has been a challenge without Health Information Exchange, but improved access to this Information may lead to improved care. Further study is required to assess experiences with the use of Health Information Exchange.
Paul G. Shekelle - One of the best experts on this subject based on the ideXlab platform.
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Usage and Effect of Health Information Exchange
Annals of Internal Medicine, 2014Co-Authors: Robert S. Rudin, Aneesa Motala, Caroline Goldzweig, Paul G. ShekelleAbstract:The use of Health Information Exchange (HIE) is increasing in the United States. This systematic review evaluated the use of HIE and its effect on clinical care. Authors found that HIE use can redu...
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usage and effect of Health Information Exchange a systematic review
Annals of Internal Medicine, 2014Co-Authors: Robert S. Rudin, Aneesa Motala, Caroline Goldzweig, Paul G. ShekelleAbstract:Background Health Information Exchange (HIE) is increasing in the United States, and it is incentivized by government policies. Purpose To systematically review and evaluate evidence of the use and effect of HIE on clinical care. Data sources Selected databases from 1 January 2003 to 31 May 2014. Study selection English-language hypothesis-testing or quantitative studies of several types of data Exchange among unaffiliated organizations for use in clinical care that addressed Health outcomes, efficiency, utilization, costs, satisfaction, HIE usage, sustainability, and attitudes or barriers. Data extraction Data extraction was done in duplicate. Data synthesis Low-quality evidence from 12 hypothesis-testing studies supports an effect of HIE use on reduced use or costs in the emergency department. Direct evidence that HIEs were used by providers was reported in 21 studies involving 13 distinct HIE organizations, 6 of which were located in New York, and generally showed usage in less than 10% of patient encounters. Findings from 17 studies of sustainability suggest that approximately one quarter of existing HIE organizations consider themselves financially stable. Findings from 38 studies about attitudes and barriers showed that providers, patients, and other stakeholders consider HIE to be valuable, but barriers include technical and workflow issues, costs, and privacy concerns. Limitation Publication bias, possible selective reporting of outcomes, and a dearth of reporting on context and implementation processes. Conclusion Health Information Exchange use probably reduces emergency department usage and costs in some cases. Effects on other outcomes are unknown. All stakeholders claim to value HIE, but many barriers to acceptance and sustainability exist. A small portion of operational HIEs have been evaluated, and more research is needed to identify and understand success factors. Primary funding source U.S. Department of Veterans Affairs. (PROSPERO registration number: CRD42014007469).
