Potential unintended consequences of health information exchange.

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.

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 ISI's Web of Knowledge and Google Scholar. PRINCIPAL FINDINGS: Seventy-two articles met the criteria for review. Most articles addressed one or more of AHRQ's 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.

Use of social network analysis tools to validate a resources infrastructure for interinstitutional translational research: a case study.

QUESTION: How can knowledge management and innovative technology, cornerstones of library practice, be leveraged to validate the progress of Clinical and Translational Science Awards? SETTING: The Indiana Clinical and Translational Sciences Institute (Indiana CTSI) promotes interdisciplinary research across academic institutions. METHODS: Using social networking tools and knowledge management skills enabled the department of knowledge informatics and translation to create a visualization of utilization of resources across different Indiana CTSI programs and coauthorship and citation patterns. RESULTS: Contacts with different resources per investigator increased; every targeted program was shown to be linked to another. Analysis of publications established a baseline to further analyze the scientific contribution of Indiana CTSI projects. CONCLUSION: Knowledge management and social networking utilities validated the efficacy of the Indiana CTSI resources infrastructure and demonstrated visualization of collaboration. The bibliometric analysis of publications provides a basis for assessing longer-term contributions of support to scientific discovery and transdisciplinary science.

Electronic laboratory data quality and the value of a health information exchange to support public health reporting processes.

There is increasing interest in leveraging electronic health data across disparate sources for a variety of uses. A fallacy often held by data consumers is that clinical data quality is homogeneous across sources. We examined one attribute of data quality, completeness, in the context of electronic laboratory reporting of notifiable disease information. We evaluated 7.5 million laboratory reports from clinical information systems for their completeness with respect to data needed for public health reporting processes. We also examined the impact of health information exchange (HIE) enhancement methods that attempt to improve completeness. The laboratory data were heterogeneous in their completeness. Fields identifying the patient and test results were usually complete. Fields containing patient demographics, patient contact information, and provider contact information were suboptimal. Data processed by the HIE were often more complete, suggesting that HIEs can support improvements to existing public health reporting processes.

Formative evaluation: a critical component in EHR implementation.

This Viewpoint paper has grown out of a presentation at the American College of Medical Informatics 2007 Winter Symposium, the resulting discussion, and several activities that have coalesced around an issue that most informaticians accept as true but is not commonly considered during the implementation of Electronic Health Records (EHR) outside of academia or research institutions. Successful EHR implementation is facilitated and sometimes determined by formative evaluation, usually focusing on process rather than outcomes. With greater federal funding for the implementation of electronic health record systems in health care organizations unfamiliar with research protocols, the need for formative evaluation assistance is growing. Such assistance, in the form of tools and protocols necessary to do formative evaluation and resulting in successful EHR implementations, should be provided by practicing medical informaticians.

Rural RHIOs: common issues in the development of two state-wide health information networks.

UNLABELLED: Over one hundred Regional Health Information Organizations (RHIOs) are under development in the United States. Many of these will fail but many will become a vital part of the Nationwide Health Information Network (NHIN). METHODS: Documentation was reviewed and summarized and a core group of Vermont Information Technology Leaders (VITL, Inc.) were interviewed to ascertained lessons learned in the development of Vermont's RHIO. RESULTS: Issues were grouped into five major categories: early planning, organization, education and marketing, technology, and financial sustainability. CONCLUSION: There are a number of commonalities about all RHIOs but also a number of differences predicated on location. RHIOs must remain dynamic and learn from others in order to survive.