Population Health Initiatives Among Hospitals: Associated Hospital Characteristics.

EXECUTIVE SUMMARY: This study explored how hospitals define population health and the factors associated with hospitals' population health initiatives. Data came from the 2015 American Hospital Association (AHA) Population Health Survey, the 2015 AHA Annual Survey, and the 2015 AHA Health Information Technology Supplement. Descriptive statistics described the sample of 1,386 nonfederal acute care hospitals and variables of interest. Multivariate logistic regression explored associations between population health commitment among hospitals and hospital characteristics. While hospitals defined population health in several ways, most (83%) responded that they were committed to population health activities. Multivariate regression results indicated that hospitals with lower levels of health information technology sophistication were less likely to commit to population health activities. For-profit hospitals were also less likely to commit to population health, compared to not-for-profit hospitals. System members were more likely to commit to population health initiatives, compared to independent hospitals. The variation in the definition of population health has implications for developing strategies to improve outcomes. These results present preliminary evidence on the relationship between hospital characteristics and hospital commitment to population health efforts.

Using Technology to Improve Access to Mental Health Services.

Mental ill-health is a public health threat that is prevalent throughout the United States. Tens of millions of Americans have been diagnosed along the continuum of mental ill-health, and many more millions of family members and friends are indirectly affected by the pervasiveness of mental ill-health. Issues such as access and the societal stigma related to mental health issues serve as deterrents to patients receiving their necessary care. However, technological advances have shown the potential to increase access to mental health services for many patients.

Use of electronic health record documentation by healthcare workers in an acute care hospital system.

Acute care clinicians spend significant time documenting patient care information in electronic health records (EHRs). The documentation is required for many reasons, the most important being to ensure continuity of care. This study examined what information is used by clinicians, how this information is used for patient care, and the amount of time clinicians perceive they review and document information in the EHR. A survey administered at a large, multisite healthcare system was used to gather this information. Findings show that diagnostic results and physician documents are viewed more often than documentation by nurses and ancillary caregivers. Most clinicians use the information in the EHR to understand the patient's overall condition, make clinical decisions, and communicate with other caregivers. The majority of respondents reported they spend 1 to 2 hours per day reviewing information and 2 to 4 hours documenting in the EHR. Bedside nurses spend 4 hours per day documenting, with much of this time spent completing detailed forms seldom viewed by others. Various flow sheets and forms within the EHR are rarely viewed. Organizations should provide ongoing education and awareness training for hospital clinical staff on available forms and best practices for effective and efficient documentation. New forms and input fields should be added sparingly and in collaboration with informatics staff and clinical team members to determine the most useful information when developing documentation systems.

Cloud computing and patient engagement: leveraging available technology.

Cloud computing technology has the potential to transform medical practices and improve patient engagement and quality of care. However, issues such as privacy and security and "fit" can make incorporation of the cloud an intimidating decision for many physicians. This article summarizes the four most common types of clouds and discusses their ideal uses, how they engage patients, and how they improve the quality of care offered. This technology also can be used to meet Meaningful Use requirements 1 and 2; and, if speculation is correct, the cloud will provide the necessary support needed for Meaningful Use 3 as well.

EHR implementation in a new clinic: a case study of clinician perceptions.

Driven by the Health Information Technology for Economic and Clinical Health (HITECH) Act large numbers of physicians and hospitals are now implementing electronic health records (EHR) with the general expectation that such systems will improve the quality, safety and efficiency of health care services. Studies of conversions from paper to electronic records paint a mixed picture with healthcare providers pleased with some aspects of their EHRs but dissatisfied with others. These prior studies focused on conversions from paper to electronic records. Many provider impressions, therefore, may have been influenced by reactions to the process of being required to change well established patterns. In order to help separate such reactions from true evaluations of the efficacy of the EHR, we decided to survey the providers in a new health center. To insure that the information gathered was not merely anecdotal, we used a well-established format starting with a semi-structured interview which facilitates analysis and recognition of major themes. We included questions around several important areas including workflow, communication, patient satisfaction, productivity, documentation, and quality of care. Ten main themes emerged: impeding patient flow, hindering communication in office, improving communication after the visit, improving tracking of patient care, spending less time with patients, requiring more training, wanting more features, diminishing productivity, appreciating benefits of templates, and enhancing internal communication. The need for better training appeared to be of especially high importance as it impacted several of the other themes. We believe that our study helps validate the similar concerns expressed in studies of transitions from paper to electronic record systems. Our method may be generally useful to other clinics because it facilitates timely recognition of themes, both positive and negative, that clinicians and clinic managers would want to know at an early stage. Prompt knowledge of such developing themes may help to accentuate the positive aspects of the EHR and to prevent negative themes from developing into serious problems that might be considered serious unintended consequences of EHR usage.

Emergency department utilization at a large regional hospital: a strategy for survivability.

This research effort provides a brief picture of the operational, patient, and financial patterns of the multiple emergency departments of a large hospital system located in the southeastern United States. The results are presented anonymously as a descriptive case study. A multifaceted strategy is presented to assist hospital leaders as they strive to ensure the survivability of their emergency departments in this era of high uncompensated care.

Health literacy among visiting college students in the U.S.: A pilot study.

Objective This study examined the health literacy of international college students from Colombia visiting the United States. Participants: Thirty (30) students from a Colombian university completed the survey in October 2017. Methods: This pilot study surveyed international college students using the eHEALS and Newest Vital Signs (NVS) health literacy tools to determine the health literacy of this group. Although these students spoke English, a translator was provided. Results: The results show 63% of participants agreed they were confident with filling out health forms alone. In terms of finding helpful health resources on the Internet, 87% of participants felt they knew how to find health information, while 80% felt they knew where to find the resources. Conclusion: There was no association between the health literacy and the confidence of completing forms alone or the perception of using the Internet to answer health questions and knowing where to find helpful resources on the Internet.

Using monitoring and controlling in an electronic health record module upgrade: a case study.

Project management consists of the repetitive and cyclical interaction between the initiating, planning, executing, monitoring and controlling, and closing processes. This article seeks to apply the 2 of these processes, monitoring and controlling, to an electronic health record module upgrade. Recommendations such as flexibility, tracking changes, project teams, milestones, and testing changes before implantation are discussed and applied to a case study.

The use of governance tools in promotion of health care information technology adoption by physicians.

Electronic health records are important technology for health care with promises of streamlining and improving care. However, physicians have been slow to adopt the technology usually because of financial constraints. Third-party payers, including Medicare and Medicaid, are coming forward with solutions and funding. While payers have the most to gain in terms of cost savings, they have been slow to provide a solution to the financial dilemmas posed by the new technology. This article details some governance tools that are frequently used to alleviate the financial concerns. Grants, loans, and tax expenditures are some of the options available to physicians to purchase electronic health records and other types of health care information technology.

Electronic health record project initiation and early planning in a community health center.

Community health centers exist to help their constituents become proactive in addressing their own health care needs and to improve the overall well-being of the community. However, they pose a different set of challenges when implementing an electronic health record system. This article applies 2 project management principles, initiation and early planning, to the electronic health record implementation in a community health center. Issues such as planning, financial considerations, and quality improvement are discussed.

The laboratory workforce shortage: a managerial perspective.

Most clinical laboratories in the nation report severe difficulties in recruitment and retention of most types of personnel. Other important factors impacting this problem include work complexities, increased automation, and a graying workforce. As a further challenge, institutional needs for clinical laboratory personnel are expected to grow significantly in the next decade. This article examines the current situation of the clinical laboratory workforce. It analyzes the different types of personnel; the managerial, supervision, and line positions that are key for different types of laboratories; the job outlook and recent projections for different types of staff; and the current issues, trends, and challenges of the laboratory workforce. Laboratory managers need to take action with strategies suggested for overcoming these challenges. Most importantly, they need to become transformational leaders by developing effective staffing models, fostering healthy and productive work environments, and creating value with a strategic management culture and implementation of knowledge management.

Electronic health record implementations: applying the principles of monitoring and controlling to achieve success.

Electronic health record systems are being implemented in physicians' offices around the country at an outstanding rate. These implementations require great skill and collaboration. This article seeks to apply 2 fundamental principles of project management, monitoring and controlling, to electronic health record implementation. Issues such as project costs, project progress, schedule controls, quality management, and controlling risks are discussed.

Privacy Officers: Who They are and Where They Work.

The study's objective is to examine the role of healthcare privacy officers, including their personal and organizational knowledge, and the facilities where they work. A survey was conducted of privacy officers that are members of the American Health Information Management Association (AHIMA). This resulted in 123 responses that were analyzed for this study. Descriptive statistics were used to characterize factors. The results showed the characteristics predominant among privacy officers are female, higher age, employed in healthcare for numerous years, mostly hold credentials, higher educated, with higher self-reported knowledge levels. Privacy officers are housed in several departments, with the majority within health information management (HIM). Their facilities are typically acute-care hospitals or healthcare systems located in states without additional privacy laws and are primarily non-profit.

The American Recovery and Reinvestment Act: lessons learned from physicians who have gone electronic.

The recently passed American Recovery and Reinvestment Act (the Act) is a landmark piece of legislation that will shape health care informatics in the United States for the foreseeable future. The Act provides financial incentives to hospitals and physicians who upgrade their medical record systems by implementing electronic versions. This article defines health care informatics, outlines the provisions of the Act and associated incentives that are available to hospitals and physicians, discusses the advantages and barriers related to upgrading to an electronic medical records system that have been identified in the literature, and details several case studies where small physician group practices put electronic medical records systems into operation. The analysis of these cases shows that the challenges faced by the physicians and practice administrators reinforce the key challenges identified in the literature. Given these seemingly common impediments, suggestions for overcoming such challenges are summarized. These key lessons should be of interest to any practice looking to upgrade their medical records system.

Hospital in-house laboratories: examining the external environment.

As hospitals fight for their portion of reimbursed health care expenditures, it will become increasingly necessary to investigate alternative funding mechanisms. In-house laboratories, which have likely been seen in the past as pure cost centers, can be repositioned to provide additional revenue to hospitals. This opportunity for in-house laboratories to be remade into profit centers is predicated upon a thorough understanding of the environmental factors affecting hospital laboratories. This article examines 4 distinct environmental factors: demographic and socioeconomic trends, reimbursement and financing, government policy, and clinical events. Each of these external environmental factors provides 2 broad sources of interest to hospitals and their in-house laboratory components: opportunities on which to capitalize and hazards against which to defend.

To report or not to report health care data breaches.

OBJECTIVES: The study's objectives were to explore the impact of personal/organizational knowledge, prior breach status of organizations, and framed scenarios on the choices made by privacy officers regarding the decision to report a breach. STUDY DESIGN: A survey was completed of 123 privacy officers who are members of the American Health Information Management Association (AHIMA). METHODS: The study used primary data collection through a survey. Individuals listed as privacy officers within the AHIMA were the target audience for the survey. Descriptive statistics, logistic regression, and predicted probabilities were used to analyze the data collected. RESULTS: The percentage of privacy officers who chose to report a breach to the Office for Civil Rights varied by scenario: scenario 1 (general with little information), 39%; scenario 2 (4-factor risk assessment, paper records), 73.2%; scenario 3 (4-factor risk assessment, ransomware case), 91.9%. Several factors affected the response to each scenario. In scenario 1, privacy officers with a Certified in Healthcare Privacy and Security (CHPS) credential were less likely to report; those who previously reported a prior breach were more likely to report. In scenario 2, privacy officers with a bachelor's degree or graduate education were less likely to report; those who held the CHPS or coding credential were less likely to report. CONCLUSIONS: Study findings show there are gray areas where privacy officers make their own decisions, and there is a difference in the types of decisions they are making on a day-to-day basis. Future guidance and policies need to address these gaps and can use the insight provided by the results of this study.

Navigating the Digital Divide: Barriers to Telehealth in Rural Areas.

Telehealth allows information-sharing and clinical care at a distance via telecommunication and information technologies. While telehealth promises to increase access for underserved populations (particularly those in rural areas), roadblocks are slowing widespread availability. These roadblocks have created disparities that are most acute in rural areas, and for racial minorities, the elderly, and those with low levels of educational attainment. The success of telehealth relies on having reliable, high-quality broadband access, facilitating interstate licensing for providers and parity in reimbursement for telehealth. However, due to various structural barriers, telehealth is not being adopted as quickly in rural areas, where it is most needed. We describe broadband access by state, state adoption of the Interstate Medical Licensure Compacts (IMLCs), which facilitates the practice of telehealth across states, and state adoption of telehealth parity laws. We discuss each of these in turn and provide policy recommendations.

Data breach locations, types, and associated characteristics among US hospitals.

OBJECTIVES: The objectives of this study were to describe the locations in hospitals where data are breached, the types of breaches that occur most often at hospitals, and hospital characteristics, including health information technology (IT) sophistication and biometric security capabilities, that may be predicting factors of large data breaches that affect 500 or more patients. STUDY DESIGN: The Office of Civil Rights breach data from healthcare providers regarding breaches that affected 500 or more individuals from 2009 to 2016 were linked with hospital characteristics from the Health Information Management Systems Society and the American Hospital Association Health IT Supplement databases. METHODS: Descriptive statistics were used to characterize hospitals with and without breaches, data breach type, and location/mode of data breaches in hospitals. Multivariate logistic regression analysis explored hospital characteristics that were predicting factors of a data breach affecting at least 500 patients, including area characteristics, region, health system membership, size, type, biometric security use, health IT sophistication, and ownership. RESULTS: Of all types of healthcare providers, hospitals accounted for approximately one-third of all data breaches and hospital breaches affected the largest number of individuals. Paper and films were the most frequent location of breached data, occurring in 65 hospitals during the study period, whereas network servers were the least common location but their breaches affected the most patients overall. Adjusted multivariate results showed significant associations among data breach occurrences and some hospital characteristics, including type and size, but not others, including health IT sophistication or biometric use for security. CONCLUSIONS: Hospitals should conduct routine audits to allow them to see their vulnerabilities before a breach occurs. Additionally, information security systems should be implemented concurrently with health information technologies. Improving access control and prioritizing patient privacy will be important steps in minimizing future breaches.

Exploring physical therapists' perceptions of mobile application usage utilizing the FITT framework.

PRIMARY OBJECTIVE: The use of mobile apps in clinical settings is becoming a widely accepted tool for many healthcare professionals. Physical therapists (PTs) have been underresearched in this area, leaving little information regarding the challenges in using mobile apps in the PT environment. The FITT framework provides a theoretical underpinning for this investigation. RESEARCH DESIGN AND METHODS: A survey was developed based on the FITT framework and research questions. Licensed PTs in attendance at the FPTA conference were asked to complete the survey. A descriptive analysis was conducted for the study and demographic variables. A factor analysis was performed to determine the appropriateness of the FITT framework. MAIN OUTCOME AND RESULTS: The individual-technology dimension showed the best fit to the framework, with the weakest fit being the individual-task dimension. The majority of PTs surveyed do not currently use apps in their professional practice nor do they feel that their organizational leadership endorses app usage. CONCLUSIONS: The integration of mobile apps into physical therapy practice can improve the standard of care. Additional apps and marketing of these apps could elevate use of this technology. However, leadership support with the necessary resources for app usage will be key to improved overall FITT.

Mitigating error vulnerability at the transition of care through the use of health IT applications.

Adverse drug events are largely considered to be errors in which the severity of effects could be lessened or even prevented through more effective medication reconciliation practices. Transitions of care, particularly at the time of discharge from the hospital, represent a time of heightened error vulnerability that contributes to medication discrepancy occurrences. The observed vulnerability can be attributed to communication and care continuity gaps across health care settings and can often lead to preventable errors. Health IT tools developed through research can identify factors which increase the risk of medication discrepancies. Additionally, the implementations of optimized clinical workflow processes to form effective transitions of care are approaches to decreasing medication discrepancies which may lead to adverse drug events. While federal policies and certifying organizations have implemented quality initiatives to increase focus on medication reconciliation practices in the hospital and primary care settings, the same practices must be implemented after a patient is discharged to their homes or another health care facility in order to mitigate error vulnerabilities that occur at the transition of care. This paper provides an overview of health IT system capabilities and their applications within and across health care delivery settings to facilitate care coordination to ensure continuity of care.