Changing the research landscape: the New York City Clinical Data Research Network.

The New York City Clinical Data Research Network (NYC-CDRN), funded by the Patient-Centered Outcomes Research Institute (PCORI), brings together 22 organizations including seven independent health systems to enable patient-centered clinical research, support a national network, and facilitate learning healthcare systems. The NYC-CDRN includes a robust, collaborative governance and organizational infrastructure, which takes advantage of its participants' experience, expertise, and history of collaboration. The technical design will employ an information model to document and manage the collection and transformation of clinical data, local institutional staging areas to transform and validate data, a centralized data processing facility to aggregate and share data, and use of common standards and tools. We strive to ensure that our project is patient-centered; nurtures collaboration among all stakeholders; develops scalable solutions facilitating growth and connections; chooses simple, elegant solutions wherever possible; and explores ways to streamline the administrative and regulatory approval process across sites.

Health information seeking behaviors of ethnically diverse adolescents.

Research on health information has primarily focused on the needs of adults or parents of children with chronic illnesses or consumers. There is limited research on the health information needs of adolescents and in particular those from underserved communities. The primary objective of this qualitative study was to understand the health information needs of healthy, urban adolescents, and how they met those needs. Focus group methodology was used to gather information from a sample of ethnically diverse urban adolescents. Data was analyzed using Kriekelas' information seeking behavior framework to, examine the participants'' report of their immediate and deferred health information needs. Our sample of adolescents used several different sources to satisfy their health information needs depending on acuity and severity, which was congruent with Kriekelas' framework. Understanding how adolescents use technology to meet their health information needs, and in what order of preference, will be critical for the development of technology that adolescents find useful and has the potential to decrease health disparities.

Financial effects of health information technology: a systematic review.

BACKGROUND: Health information technology (HIT) is widely viewed as an important lever with which to improve the quality and efficiency of the healthcare system. However, there has long been debate about its financial effects. OBJECTIVES: To characterize the existing data on the financial effects of HIT and to consider the implications for the effect of HIT on healthcare spending. STUDY DESIGN: Systematic literature review. METHODS: We identified articles by (1) searching PubMed using the intersection of terms related to HIT applications and terms related to financial or economic effect; and (2) reviewing the reference lists of the included articles as well as additional policy articles and literature reviews. RESULTS: A total of 57 articles met our inclusion criteria, including 43 articles (75%) reporting financial benefits to a stakeholder associated with HIT. These included 26 articles (46%) reporting cost savings, 6 articles (11%) reporting revenue gains, and 11 articles (19%) reporting a mixture of cost savings and revenue gains. Among articles with experimental study designs, 22 of 34 (65%) reported financial benefits; and among articles explicitly measuring costs and benefits, 19 of 21 (90%) reported financial benefits. The most prevalent mechanisms were savings on administrative goods and/or personnel, savings on pharmaceuticals, and revenue gains through improved billing. Overall there is a dearth of articles on this topic, especially ones with strong study designs and financial analyses. CONCLUSIONS: HIT can have financial benefits, but more research is required, especially on HIT's effects under emerging delivery and payment reform efforts.

Developing data content specifications for the nationwide health information network trial implementations.

In 2007, the Department of Health and Human Services commissioned the Nationwide Health Information Network (NHIN) Trial Implementations project to demonstrate the secure exchange of data among health information exchange organizations around the country. The project's Core Services Content Work Group (CSCWG) developed the content specifications for the project. The CSCWG developed content specifications for a summary patient record and for eight use cases that were implemented in demonstration events in 2008. The CSCWG developed tools to represent the specifications and facilitate implementation. The experience revealed that, in general, the Health Information Technology Standards Panel (HITSP) constructs served as a suitable starting point for the development of content specifications for interoperability. The ability to adhere to specified terminologies still presents significant challenges. This paper describes the process of developing the content specifications and lessons learned.