The Experts below are selected from a list of 110460 Experts worldwide ranked by ideXlab platform
David W Bates - One of the best experts on this subject based on the ideXlab platform.
-
a systematic review of the impact of Health Information Technology on nurses time
2020Co-Authors: Esther C Moore, David W Bates, Clare L Tolley, Sarah P SlightAbstract:OBJECTIVE Nursing time represents one of the highest costs for most Health services. We conducted a systematic review of the literature on the impact of Health Information Technology on nurses' time. MATERIALS AND METHODS We followed PRISMA guidelines and searched 6 large databases for relevant articles published between Jan 2004 and December 2019. Two authors reviewed the titles, abstracts, and full texts. We included articles that included a comparison group in the design, measured the time taken to carry out documentation or medication administration, documented the quantitative estimates of time differences between the 2, had nurses as subjects, and was conducted in either a care home, hospital, or community clinic. RESULTS We identified a total of 1647 articles, of which 33 met our inclusion criteria. Twenty-one studies reported the impact of 12 different Health Information Technology (HIT) implementations on nurses' documentation time. Weighted averages were calculated for studies that implemented barcode medication administration (BCMA) and 2 weighted averages for those that implemented EHRs, as these studies used different sampling units; both showed an increase in the time spent in documentation (+22% and +46%). However, the time spent carrying out medication administration following BCMA implementation fell by 33% (P < .05). HIT also caused a redistribution of nurses' time which, in some cases, was spent in more "value-adding" activities, such as delivering direct patient care as well as inter-professional communication. DISCUSSION AND CONCLUSIONS Most of the HIT systems increased nursing documentation time, although time fell for medication administration following BCMA. Many HIT systems also resulted in nurses spending more time in direct care and "value-adding" activities.
-
current challenges in Health Information Technology related patient safety
2020Co-Authors: Dean F Sittig, Adam Wright, Enrico Coiera, Farah Magrabi, Raj M Ratwani, David W Bates, Hardeep SinghAbstract:We identify and describe nine key, short-term, challenges to help Healthcare organizations, Health Information Technology developers, researchers, policymakers, and funders focus their efforts on Health Information Technology-related patient safety. Categorized according to the stage of the Health Information Technology lifecycle where they appear, these challenges relate to (1) developing models, methods, and tools to enable risk assessment; (2) developing standard user interface design features and functions; (3) ensuring the safety of software in an interfaced, network-enabled clinical environment; (4) implementing a method for unambiguous patient identification (1-4 Design and Development stage); (5) developing and implementing decision support which improves safety; (6) identifying practices to safely manage Information Technology system transitions (5 and 6 Implementation and Use stage); (7) developing real-time methods to enable automated surveillance and monitoring of system performance and safety; (8) establishing the cultural and legal framework/safe harbor to allow sharing Information about hazards and adverse events; and (9) developing models and methods for consumers/patients to improve Health Information Technology safety (7-9 Monitoring, Evaluation, and Optimization stage). These challenges represent key "to-do's" that must be completed before we can expect to have safe, reliable, and efficient Health Information Technology-based systems required to care for patients.
-
ten key considerations for the successful optimization of large scale Health Information Technology
2017Co-Authors: Kathrin Cresswell, David W Bates, Aziz SheikhAbstract:Implementation and adoption of complex Health Information Technology (HIT) is gaining momentum internationally. This is underpinned by the drive to improve the safety, quality, and efficiency of care. Although most of the benefits associated with HIT will only be realized through optimization of these systems, relatively few Health care organizations currently have the expertise or experience needed to undertake this. It is extremely important to have systems working before embarking on HIT optimization, which, much like implementation, is an ongoing, difficult, and often expensive process. We discuss some key organization-level activities that are important in optimizing large-scale HIT systems. These include considerations relating to leadership, strategy, vision, and continuous cycles of improvement. Although these alone are not sufficient to fully optimize complex HIT, they provide a starting point for conceptualizing this important area.
-
leveraging Health Information Technology to achieve the triple aim of Healthcare reform
2015Co-Authors: Harpreet S Sood, Aziz Sheikh, David W BatesAbstract:Objective To investigate experiences with leveraging Health Information Technology (HIT) to improve patient care and population Health, and reduce Healthcare expenditures. Materials and methods In-depth qualitative interviews with federal government employees, Health policy, HIT and medico-legal experts, Health providers, physicians, purchasers, payers, patient advocates, and vendors from across the United States. Results The authors undertook 47 interviews. There was a widely shared belief that Health Information Technology for Economic and Clinical Health (HITECH) had catalyzed the creation of a digital infrastructure, which was being used in innovative ways to improve quality of care and curtail costs. There were however major concerns about the poor usability of electronic Health records (EHRs), their limited ability to support multi-disciplinary care, and major difficulties with Health Information exchange, which undermined efforts to deliver integrated patient-centered care. Proposed strategies for enhancing the benefits of HIT included federal stimulation of competition by mandating vendors to open-up their application program interfaces, incenting development of low-cost consumer informatics tools, and promoting Congressional review of the The Health Insurance Portability and Accountability Act (HIPPA) to optimize the balance between data privacy and reuse. Many underscored the need to “kick the legs from underneath the fee-for-service model” and replace it with a data-driven reimbursement system that rewards high quality care. Conclusions The HITECH Act has stimulated unprecedented, multi-stakeholder interest in HIT. Early experiences indicate that the resulting digital infrastructure is being used to improve quality of care and curtail costs. Reform efforts are however severely limited by problems with usability, limited interoperability and the persistence of the fee-for-service paradigm—addressing these issues therefore needs to be the federal government’s main policy target.
-
Health Information Technology and care coordination the next big opportunity for informatics
2015Co-Authors: David W BatesAbstract:The costs of care in the U.S. are very high, in part because canre is relatively uncoordinated. To begin to address this and other issues, Health care reform was passed, including the notion of accountable care. Under acountable care arrangements, providers are at risk for the costs of the care they provide to groups of patients. Evaluation of costs has made it clear that a large proportion of these costs are in the post-acute setting, and also that many specific problems such as adverse events and unnecessary readmissions occur following transitions. However, the electronic Health records of today do not provide a great deal of assistance with the coordination of care, and even the best organizations have relatively primitive systems with respect to care coordination, even though communication is absolutely central to better coordination of care and Health Information Technology (HIT) is a powerful lever for improving communication. This paper identifies specific gaps in care coordination today, presents a framework for better coordinating care using HIT, then describes how specific technologies can be leveraged. Also discussed are the need to build and test specific interventions to improve HIT-related care coordination tools, and the key policy steps needed to accomplish this.
Aziz Sheikh - One of the best experts on this subject based on the ideXlab platform.
-
ten key considerations for the successful optimization of large scale Health Information Technology
2017Co-Authors: Kathrin Cresswell, David W Bates, Aziz SheikhAbstract:Implementation and adoption of complex Health Information Technology (HIT) is gaining momentum internationally. This is underpinned by the drive to improve the safety, quality, and efficiency of care. Although most of the benefits associated with HIT will only be realized through optimization of these systems, relatively few Health care organizations currently have the expertise or experience needed to undertake this. It is extremely important to have systems working before embarking on HIT optimization, which, much like implementation, is an ongoing, difficult, and often expensive process. We discuss some key organization-level activities that are important in optimizing large-scale HIT systems. These include considerations relating to leadership, strategy, vision, and continuous cycles of improvement. Although these alone are not sufficient to fully optimize complex HIT, they provide a starting point for conceptualizing this important area.
-
leveraging Health Information Technology to achieve the triple aim of Healthcare reform
2015Co-Authors: Harpreet S Sood, Aziz Sheikh, David W BatesAbstract:Objective To investigate experiences with leveraging Health Information Technology (HIT) to improve patient care and population Health, and reduce Healthcare expenditures. Materials and methods In-depth qualitative interviews with federal government employees, Health policy, HIT and medico-legal experts, Health providers, physicians, purchasers, payers, patient advocates, and vendors from across the United States. Results The authors undertook 47 interviews. There was a widely shared belief that Health Information Technology for Economic and Clinical Health (HITECH) had catalyzed the creation of a digital infrastructure, which was being used in innovative ways to improve quality of care and curtail costs. There were however major concerns about the poor usability of electronic Health records (EHRs), their limited ability to support multi-disciplinary care, and major difficulties with Health Information exchange, which undermined efforts to deliver integrated patient-centered care. Proposed strategies for enhancing the benefits of HIT included federal stimulation of competition by mandating vendors to open-up their application program interfaces, incenting development of low-cost consumer informatics tools, and promoting Congressional review of the The Health Insurance Portability and Accountability Act (HIPPA) to optimize the balance between data privacy and reuse. Many underscored the need to “kick the legs from underneath the fee-for-service model” and replace it with a data-driven reimbursement system that rewards high quality care. Conclusions The HITECH Act has stimulated unprecedented, multi-stakeholder interest in HIT. Early experiences indicate that the resulting digital infrastructure is being used to improve quality of care and curtail costs. Reform efforts are however severely limited by problems with usability, limited interoperability and the persistence of the fee-for-service paradigm—addressing these issues therefore needs to be the federal government’s main policy target.
-
Health Information Technology in hospitals current issues and future trends
2015Co-Authors: Kathrin Cresswell, Aziz SheikhAbstract:Healthcare is at an important crossroads in that current models of care are increasingly seen by politicians and policymakers as unsustainable. Furthermore, there is a need to move away from the reactive, doctor-centred model of care to one that is more patient-centred and that consistently delivers accessible, high-quality and safe care to all. Greater use of Health Information Technology (HIT) is seen by many key decision makers as crucial to this transformation process and, hence, substantial investments are made in this area. However, Healthcare, particularly in UK hospitals, remains a laggard in HIT adoption. To uncover the underlying reasons, we discuss current implementation and adoption challenges and explore potential ways to address these. We outline strategic, organisational, technical and social factors that can 'make or break' technological implementations. Most importantly, we suggest that efforts should be characterised by an underlying awareness of the complexity of the hospital environment and the need to develop tools that support provision of integrated multidisciplinary care. We conclude with a discussion of promising future developments, including increased patient involvement; access and contribution to shared records; the penetration of smart devices; greater Health Information exchange and interoperability; and innovative real-time secondary uses of data. We argue that there is considerable merit in evaluating the introduction of these interventions to help ensure that they are optimised for effectiveness, support efficient working and minimise the possibility of inadvertently introducing new risks into already complex Health systems. Our over-riding message is that HIT should be seen as, where appropriate, a potential enabler and an important source of data to support Healthcare redesign and that critical, ongoing evaluation is key to maximising benefits. However, it should not be seen as a silver bullet.
-
ten key considerations for the successful implementation and adoption of large scale Health Information Technology
2013Co-Authors: Kathrin Cresswell, David W Bates, Aziz SheikhAbstract:The implementation of Health Information Technology interventions is at the forefront of most policy agendas internationally. However, such undertakings are often far from straightforward as they require complex strategic planning accompanying the systemic organizational changes associated with such programs. Building on our experiences of designing and evaluating the implementation of large-scale Health Information Technology interventions in the USA and the UK, we highlight key lessons learned in the hope of informing the on-going international efforts of policymakers, Health directorates, Healthcare management, and senior clinicians.
Irene L Katzan - One of the best experts on this subject based on the ideXlab platform.
-
characterization of patient interest in provider based consumer Health Information Technology survey study
2018Co-Authors: Joseph Featherall, Brittany Lapin, Alexander Chaitoff, Sonia A Havele, Nicolas R Thompson, Irene L KatzanAbstract:Background: Consumer Health Information Technology can improve patient engagement in their Health care and assist in navigating the complexities of Health care delivery. However, the consumer Health Information Technology offerings of Health systems are often driven by provider rather than patient perspectives and inadequately address patient needs, thus limiting their adoption by patients. Consideration given to patients as stakeholders in the development of such technologies may improve adoption, efficacy, and consumer Health Information Technology resource allocation. Objective: The aims of this paper were to measure patient interest in different Health system consumer Health Information Technology apps and determine the influence of patient characteristics on consumer Health Information Technology interest. Methods: Patients seen at the Cleveland Clinic Neurological Institute were electronically surveyed on their interest in using different consumer Health Information Technology apps. A self-efficacy scale, Patient Health Questionnaire-9 depression screen, and EuroQol 5 dimensions Health-related quality of life scale were also completed by patients. Logistic regression was used to determine the influence of patient characteristics on interest in consumer Health Information Technology in the categories of self-management, education, and communication. Results: The majority of 3852 patient respondents had an interest in all Technology categories assessed in the survey. The highest interest was in apps that allow patients to ask questions of providers (3476/3852, 90.24%) and to schedule appointments (3211/3839, 83.64%). Patient interest in consumer Health Information Technology was significantly associated with greater depression symptoms, worse quality of life, greater Health self-efficacy, and smartphone ownership (P<.001 for all listed). Conclusions: Patients should be viewed as active stakeholders in consumer Health Information Technology development and their perspectives should consistently guide development efforts. Health systems should consider focusing on consumer Health Information technologies that assist patients in scheduling appointments and asking questions of providers. Patients with depression should also be considered for targeted consumer Health Information Technology implementation. Health self-efficacy is a valid predictor of consumer Health Information Technology interest and may play a role in the utilization of consumer Health Information technologies. Health systems, broadly, should put forth greater effort to understand the needs and interests of patients in the consumer Health Information Technology development process. Consumer Health Information Technology design and implementation may be improved by understanding which technologies patients want. [J Med Internet Res 2018;20(4):e128]
Rainu Kaushal - One of the best experts on this subject based on the ideXlab platform.
-
effects of Health Information Technology on patient outcomes a systematic review
2016Co-Authors: Samantha K Brenner, Rainu Kaushal, Zachary M Grinspan, Christine Joyce, Inho Kim, Rhonda J Allard, Diana Delgado, Erika L AbramsonAbstract:Objective To systematically review studies assessing the effects of Health Information Technology (Health IT) on patient safety outcomes. Materials and Methods The authors employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement methods. MEDLINE, Cumulative Index to Nursing Allied Health (CINAHL), EMBASE, and Cochrane Library databases, from 2001 to June 2012, were searched. Descriptive and comparative studies were included that involved use of Health IT in a clinical setting and measured effects on patient safety outcomes. Results Data on setting, subjects, Information Technology implemented, and type of patient safety outcomes were all abstracted. The quality of the studies was evaluated by 2 independent reviewers (scored from 0 to 10). A total of 69 studies met inclusion criteria. Quality scores ranged from 1 to 9. There were 25 (36%) studies that found benefit of Health IT on direct patient safety outcomes for the primary outcome measured, 43 (62%) studies that either had non-significant or mixed findings, and 1 (1%) study for which Health IT had a detrimental effect. Neither the quality of the studies nor the rate of randomized control trials performed changed over time. Most studies that demonstrated a positive benefit of Health IT on direct patient safety outcomes were inpatient, single-center, and either cohort or observational trials studying clinical decision support or computerized provider order entry. Discussion and Conclusion Many areas of Health IT application remain understudied and the majority of studies have non-significant or mixed findings. Our study suggests that larger, higher quality studies need to be conducted, particularly in the long-term care and ambulatory care settings.
-
community based Health Information Technology alliances potential predictors of early sustainability
2011Co-Authors: Lisa M Kern, Adam B Wilcox, Jason S Shapiro, Kahyun Yoonflannery, Erika L Abramson, Yolanda Barron, Rainu KaushalAbstract:OBJECTIVE: To determine potential predictors of sustainability among community-based organizations that are implementing Health Information Technology (HIT) with Health Information exchange, in a state with significant funding of such organizations. STUDY DESIGN: A longitudinal cohort study of community-based organizations funded through the first phase of the $440 million Healthcare Efficiency and Affordability Law for New Yorkers program. METHODS: We administered a baseline telephone survey in January and February 2007, using a novel instrument with open-ended questions, and collected follow-up data from the New York State Department of Health regarding subsequent funding awarded in March 2008. We used logistic regression to determine associations between 18 organizational characteristics and subsequent funding. RESULTS: All 26 organizations (100%) responded. Having the alliance led by a Health Information organization (odds ratio [OR] 11.4, P = .01) and having performed a community-based needs assessment (OR 5.1, P = .08) increased the unadjusted odds of subsequent funding. Having the intervention target the long-term care setting (OR 0.14, P = .03) decreased the unadjusted odds of subsequent funding. In the multivariate model, having the alliance led by a Health Information organization, rather than a Healthcare organization, increased the odds of subsequent funding (adjusted OR 6.4; 95% confidence interval 0.8, 52.6; P = .08). CONCLUSION: Results from this longitudinal study suggest that both Health Information organizations and Healthcare organizations are needed for sustainable HIT transformation.
-
Health Information Technology and Health Information exchange in new york state new initiatives in implementation and evaluation
2007Co-Authors: Lisa M Kern, Rainu KaushalAbstract:More research is needed to understand the effects of Health Information Technology (HIT) and Health Information exchange (HIE) on quality, safety, efficiency, finances, consumers and providers in community-based settings. New York State is investing heavily in HIT and HIE adoption through the HEAL NY program. It has already provided $53 million in seed money and requires that grantee organizations match the funds. HITEC (The Health Information Technology Evaluation Collaborative) was established to measure systematically the effects of HIT and HIE on consumers, providers, Health care quality, patient safety, public Health, and financial return on investment in New York State, as no individual grantee is able to conduct cross-cutting evaluations. The results of these evaluations should inform decisions made by leaders in HIT and HIE in New York State and across the nation.
Kathrin Cresswell - One of the best experts on this subject based on the ideXlab platform.
-
ten key considerations for the successful optimization of large scale Health Information Technology
2017Co-Authors: Kathrin Cresswell, David W Bates, Aziz SheikhAbstract:Implementation and adoption of complex Health Information Technology (HIT) is gaining momentum internationally. This is underpinned by the drive to improve the safety, quality, and efficiency of care. Although most of the benefits associated with HIT will only be realized through optimization of these systems, relatively few Health care organizations currently have the expertise or experience needed to undertake this. It is extremely important to have systems working before embarking on HIT optimization, which, much like implementation, is an ongoing, difficult, and often expensive process. We discuss some key organization-level activities that are important in optimizing large-scale HIT systems. These include considerations relating to leadership, strategy, vision, and continuous cycles of improvement. Although these alone are not sufficient to fully optimize complex HIT, they provide a starting point for conceptualizing this important area.
-
Health Information Technology in hospitals current issues and future trends
2015Co-Authors: Kathrin Cresswell, Aziz SheikhAbstract:Healthcare is at an important crossroads in that current models of care are increasingly seen by politicians and policymakers as unsustainable. Furthermore, there is a need to move away from the reactive, doctor-centred model of care to one that is more patient-centred and that consistently delivers accessible, high-quality and safe care to all. Greater use of Health Information Technology (HIT) is seen by many key decision makers as crucial to this transformation process and, hence, substantial investments are made in this area. However, Healthcare, particularly in UK hospitals, remains a laggard in HIT adoption. To uncover the underlying reasons, we discuss current implementation and adoption challenges and explore potential ways to address these. We outline strategic, organisational, technical and social factors that can 'make or break' technological implementations. Most importantly, we suggest that efforts should be characterised by an underlying awareness of the complexity of the hospital environment and the need to develop tools that support provision of integrated multidisciplinary care. We conclude with a discussion of promising future developments, including increased patient involvement; access and contribution to shared records; the penetration of smart devices; greater Health Information exchange and interoperability; and innovative real-time secondary uses of data. We argue that there is considerable merit in evaluating the introduction of these interventions to help ensure that they are optimised for effectiveness, support efficient working and minimise the possibility of inadvertently introducing new risks into already complex Health systems. Our over-riding message is that HIT should be seen as, where appropriate, a potential enabler and an important source of data to support Healthcare redesign and that critical, ongoing evaluation is key to maximising benefits. However, it should not be seen as a silver bullet.
-
ten key considerations for the successful implementation and adoption of large scale Health Information Technology
2013Co-Authors: Kathrin Cresswell, David W Bates, Aziz SheikhAbstract:The implementation of Health Information Technology interventions is at the forefront of most policy agendas internationally. However, such undertakings are often far from straightforward as they require complex strategic planning accompanying the systemic organizational changes associated with such programs. Building on our experiences of designing and evaluating the implementation of large-scale Health Information Technology interventions in the USA and the UK, we highlight key lessons learned in the hope of informing the on-going international efforts of policymakers, Health directorates, Healthcare management, and senior clinicians.
