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1.
N Z Med J ; 132(1488): 28-37, 2019 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-31851659

RESUMO

AIM: Incomplete and incorrect documentation of adverse drug reactions (ADRs) can restrict prescribing choices resulting in suboptimal pharmaceutical care. This study aimed to examine the quality of information held within electronic systems in a hospital setting, to determine the preciseness of ADR documentation, and identify discrepancies where multiple electronic systems are utilised. METHOD: Over a four-week period, consecutive patients admitted to the general medical ward at the study hospital had their electronic profiles reviewed. Patient demographic information (de-identified), ADR history and discrepancies between information sources (as recorded in all electronic systems utilised at initial prescribing) were recorded and analysed. RESULTS: Over the four-week period, 332 patient profiles were reviewed, and over 1,200 alerts were identified and analysed (including duplicates of ADR reactions). Of these patients, 151 (45.5%) had at least one documented allergy or intolerance which generated 585 reactions, relating to 526 unique events. A further 151 (45.5%) were classified as having no known (drug) allergies or intolerances; however, 20 (15%) of these patients did have at least one allergy documented in at least one other electronic system. The remaining 30 (9%) patients were classified as having an unknown allergy status and of those nine had allergies documented in at least one other electronic system. Further, most systems contained information duplication, which had not been addressed during the admission process. CONCLUSION: ADR information was both imprecise and inaccurate, as multiple discrepancies between ADR information recorded in different electronic patient management systems were found to exist. Information sharing between systems needs to be prioritised in order to allow full, accurate and complete ADR information to be collected, stored and utilised; both to reduce current inadequacies and to allow optimal pharmaceutical care.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/normas , Documentação/normas , Troca de Informação em Saúde/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Centros de Atenção Terciária , Adulto Jovem
2.
J Glob Health ; 9(2): 0204279, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31673351

RESUMO

Background: Health information exchange (HIE) is frequently cited as an important objective of health information technology investment because of its potential to improve quality, reduce cost, and increase patient satisfaction. In this paper we examine the status and practices of HIE in six countries, drawn from a range of higher and lower income regions. Methods: For each of the countries represented - China, England, India, Scotland, Switzerland, and the United States - we describe the state of current practice of HIE with reference to two scenarios: transfer of care and referral. For each country we discuss national objectives, barriers and plans for further advancing clinical information exchange. Results: The countries vary widely in levels of adoption of EHRs, availability of health information in electronic form suitable for HIE, and in the information technology infrastructure to be used for transmission. Common themes emerged, however, including an expectation that information will be exchanged rather than gathered anew, the need for incentives to promote information exchange, and concerns about data security and patient confidentiality. Conclusions: Although the ability to transfer health information to where it is most needed is nearly always mentioned as an advantage of HIE adoption, there are wide differences in the degree to which this has been achieved to support the scenarios used in this study. Nevertheless, these differences indicate varying stages of progress along a comparable pathway, with similar barriers being identified in the countries described. In some cases, these have been partially surmounted while elsewhere work is needed. We reflect on contextual factors influencing the status and direction of HIE efforts in different global regions and their implications for progress.


Assuntos
Troca de Informação em Saúde/estatística & dados numéricos , China , Inglaterra , Humanos , Índia , Escócia , Suíça , Estados Unidos
3.
Health Serv Res ; 54(6): 1335-1345, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31602639

RESUMO

OBJECTIVE: To assess whether an electronic health record (EHR) portal to enable health information exchange (HIE) between a hospital and three skilled nursing facilities (SNFs) reduced likelihood of patient readmission. SETTING/DATA: Secondary data; all discharges from a large academic medical center to SNFs between July 2013 and March 2017, combined with portal usage records from SNFs with HIE access. DESIGN: We use difference-in-differences to determine whether portal implementation reduced likelihood of readmission over time for patients discharged to HIE-enabled SNFs, relative to those discharged to nonenabled facilities. Additional descriptive analyses of audit log data characterize portal use within enabled facilities. DATA COLLECTION: Encounter-level clinical EHR data were merged with EHR audit log data that captured portal usage in the timeframe associated with a patient transition from hospital to SNF. PRINCIPAL FINDINGS: Declines in likelihood of 30-day readmission were not significantly different for patients in HIE-enabled vs control SNFs (diff-in-diff = 0.022; P = .431). We observe similar null effects with shorter readmission windows. The portal was used for 46 percent of discharges, with significant usage pattern variation within/across facilities. CONCLUSIONS: Implementation of a hospital-SNF EHR portal did not reduce readmissions from enabled SNFs. Emergent HIE use cases need to be better defined and leveraged for design and implementation that generates value in the context of postacute transitions.


Assuntos
Continuidade da Assistência ao Paciente/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Troca de Informação em Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos
4.
Can Assoc Radiol J ; 70(3): 212-218, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31376884

RESUMO

PURPOSE: Secondary usage of patient data has recently become of increasing interest for the development and application of computer analytic techniques. Strict oversight of these data is required and the individual patients themselves are integral to providing guidance. We sought to understand patients' attitudes to sharing their imaging data for research purposes. These images could provide a great wealth of information for researchers. METHODS: Patients from the Greater Toronto Area attending Sunnybrook Health Sciences Centre for imaging (magnetic resonance imagining, computed tomography, or ultrasound) examination areas were invited to participate in an electronic survey. RESULTS: Of the 1083 patients who were approached (computed tomography 609, ultrasound 314, and magnetic resonance imaging 160), 798 (74%) agreed to take the survey. Overall median age was 60 (interquartile range = 18, Q1 = 52, Q3 = 70), 52% were women, 42% had a university degree, and 7% had no high school diploma. In terms of willingness to share de-identified medical images for research, 76% were willing (agreed and strongly agreed), while 7% refused. Most participants gave their family physicians (73%) and other physicians (57%) unconditional data access. Participants chose hospitals/research institutions to regulate electronic images databases (70%), 89% wanted safeguards against unauthorized access to their data, and over 70% wanted control over who will be permitted, for how long, and the ability to revoke that permission. CONCLUSIONS: Our study found that people are willing to share their clinically acquired de-identified medical images for research studies provided that they have control over permissions and duration of access.


Assuntos
Confidencialidade/psicologia , Diagnóstico por Imagem/psicologia , Registros Eletrônicos de Saúde/estatística & dados numéricos , Troca de Informação em Saúde/estatística & dados numéricos , Opinião Pública , Sujeitos da Pesquisa/psicologia , Adolescente , Adulto , Fatores Etários , Idoso , Canadá , Segurança Computacional , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem
5.
J Surg Res ; 244: 174-180, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299433

RESUMO

BACKGROUND: The exchange of health information between primary care providers (PCPs) and surgeons is critical during transitions of care for older patients with multiple comorbidities; however, it is unknown to what extent this process occurs. This study was designed to characterize the extent to which factors associated with older patient's recovery, such as functional status, cognitive status, social status, and emotional factors, are shared among PCPs and surgical providers during care transitions. MATERIALS AND METHODS: We prospectively identified 15 patients aged over 60 y with ≥3 comorbidities referred for general and vascular surgery procedures at a Veterans Administrative and academic medical center. Semistructured Critical Decision Method interviews were conducted with patients along with their surgical providers and referring PCPs. Thematic content analysis was performed independently by five reviewers on the cognitive processes associated with functional status, cognitive status, social status, and emotional factors. Interrater reliability between providers and patients was assessed using Cohen's kappa. RESULTS: Forty-seven Critical Decision Method interviews were conducted, which included 20 paired interviews between a PCP and a surgeon and 16 paired interviews that involved a patient and a provider. The majority of patients reported experiencing poor information exchange between their PCP and surgeon (58%) and feeling they were primarily responsible for communicating their own health information during care transitions (67%). In paired interviews between PCPs and surgeons, there was nearly perfect agreement for the shared knowledge of cognitive (kappa: 0.83) and emotional (kappa 1) factors. In contrast, there was only minimal agreement for shared knowledge of functional status (kappa 0.38) and social status (kappa: 0.34). CONCLUSIONS: Information exchange between PCPs and surgical providers is often discordant during transitions of surgical care for medically complex older patients, particularly when it pertains to communicating their functional or social status.


Assuntos
Troca de Informação em Saúde/estatística & dados numéricos , Transferência de Pacientes/organização & administração , Médicos de Atenção Primária/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Centros Médicos Acadêmicos/estatística & dados numéricos , Fatores Etários , Idoso , Tomada de Decisão Clínica , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Planejamento de Assistência ao Paciente/organização & administração , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Estudos Prospectivos , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos , United States Department of Veterans Affairs/estatística & dados numéricos , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos
6.
JMIR Mhealth Uhealth ; 7(6): e12631, 2019 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-31215516

RESUMO

BACKGROUND: Hospital-based health promotion resources to assist pregnant women in adopting a healthy lifestyle and optimizing gestational weight gain are important, but with limited effects. Increasingly, women are using mobile apps to access health information during the antenatal period. OBJECTIVE: The aims of the study were to investigate app-usage by Chinese women during pregnancy and to gain a better understanding of their views and attitudes toward apps containing health information. METHODS: A mixed methods study design was applied. Study participants were recruited from 2 maternity hospitals in Shanghai, China, between March and July 2018. A self-administered Web-based survey was conducted with 535 pregnant Chinese women on their sources of health information and reasons for using apps during pregnancy. A total of 4 semistructured focus groups were also conducted with the pregnant women (n=28). RESULTS: The use of pregnancy-related apps and the internet was common among the respondents. Almost half of the women had used pregnancy-related apps. Specifically, the use of apps for health information declined as pregnancy progressed from 70% (35/50) in the first trimester to 41.3% (143/346) in the third trimester. The main reason for using an app was to monitor fetal development (436/535, 81.5%), followed by learning about nutrition and recording diet in pregnancy (140/535, 26.2%). The women found that the apps were useful and convenient and can support lifestyle modifications during pregnancy. However, some apps also contained misinformation or incorrect information that could cause anxiety as reported by the participants. Many women expressed the need for developing an app containing evidence-based, well-informed, and tailored health information to support them during pregnancy. CONCLUSIONS: The study suggests that apps were widely used by many Chinese women during pregnancy to monitor fetal development, to obtain diet and physical activity information, and to track their body changes. The women highly appreciated the evidence-based information, expert opinions, and tailored advice available on apps. Smartphone apps have the potential to deliver health information for pregnant women.


Assuntos
Troca de Informação em Saúde/normas , Aplicativos Móveis/normas , Gestantes/psicologia , Adulto , China , Estudos Transversais , Feminino , Grupos Focais/métodos , Troca de Informação em Saúde/estatística & dados numéricos , Humanos , Aplicativos Móveis/estatística & dados numéricos , Gravidez , Pesquisa Qualitativa
7.
Int J Med Inform ; 128: 1-6, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31160006

RESUMO

OBJECTIVE: To determine the impact in the adoption of electronic health records and health information exchanges by local health departments on population health. METHODS: The study analyzed 433 local health departments population-based data across 433 counties in the United States. Controlling for high school graduation rate, percentage of adults with some post- secondary education, race, median household income, percentage rural, population size served, governance structure of local health departments and revenue, the study used multiple linear regression to analyze the impact in the adoption of health information technology by local health departments on the population health of a county. RESULTS: Electronic health records adoption was statistically significant at improving population health at the county level. Health information exchange adoption was not statistically significant. CONCLUSION: When local health departments adopt electronic health records, it improves health- related quality of life and reduces years of potential life lost. POLICY IMPLICATIONS: The value derived from the adoption of electronic health records by local health departments deserves attention because of its abilities to enhance the services provided at local health departments. It is important for local health departments to use health information technology to electronically capture patient information to improve upon the services received at community health centers.


Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Troca de Informação em Saúde/estatística & dados numéricos , Informática Médica/estatística & dados numéricos , Saúde da População/estatística & dados numéricos , Qualidade de Vida , Adulto , Idoso , Feminino , Humanos , Governo Local , Masculino , Pessoa de Meia-Idade , População Rural , Estados Unidos
8.
Health Serv Res ; 54(5): 981-993, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31112303

RESUMO

OBJECTIVE: To quantify the impact of two approaches (directed and query-based) to health information exchange (HIE) on potentially avoidable use of health care services. DATA SOURCES/STUDY SETTING: Data on ambulatory care providers' adoption of HIE were merged with Medicare fee-for-service claims from 2008 to 2014. Providers were from 13 counties in New York served by the Rochester Regional Health Information Organization (RHIO). STUDY DESIGN: Linear regression models with provider and year fixed effects were used to estimate changes in the probability of utilization outcomes for Medicare beneficiaries attributed to providers adopting directed and/or query-based HIE compared with beneficiaries attributed to providers who had not adopted HIE. DATA COLLECTION: Providers' HIE adoption status was determined through Rochester RHIO registration records. RHIO and claims data were linked via National Provider Identifiers. PRINCIPAL FINDINGS: Query-based HIE adoption was associated with a 0.2 percentage point reduction in the probability of an ambulatory care sensitive hospitalization and a 1.1 percentage point decrease in the likelihood of an unplanned readmission. Directed HIE adoption was not associated with any outcome. CONCLUSIONS: The Centers for Medicare & Medicaid Services' (CMS) EHR certification criteria includes requirements for directed HIE, but not query-based HIE. Pending further research, certification criteria should place equal weight on facilitating query-based and directed exchange.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Registros Eletrônicos de Saúde/normas , Troca de Informação em Saúde/normas , Hospitais/normas , Disseminação de Informação/métodos , Armazenamento e Recuperação da Informação/métodos , Medicare/estatística & dados numéricos , Adulto , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Troca de Informação em Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , New York , Estados Unidos
9.
Pediatr Blood Cancer ; 66(8): e27795, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31069926

RESUMO

BACKGROUND: Little is known about the specific information parents of children with cancer search for online. Understanding the content of parents' searches over time could offer insight into what matters most to parents and identify knowledge gaps that could inform more comprehensive approaches to family education and support. METHODS: We describe parents' health-related Google searches starting six months before cancer diagnosis and extending through the date of study enrollment, which was at least one month after initiating cancer treatment. Searches were obtained retrospectively and grouped into health-related and non-health-related categories. The median time to parent enrollment from date of cancer diagnosis was 264 days. RESULTS: Parents searched for health-related topics more frequently than the general population (13% vs 5%). Health-related searches increased in the months preceding the child's cancer diagnosis and most commonly pertained to symptoms and logistics, "directions to hospital." Health-related search volume peaked about a month after cancer diagnosis when general health-related searches were present in addition to cancer-specific searches. Eighteen percent of health-related searches were cancer specific, and of these cancer-specific searches, 54% pertained to support, for example "cancer quote for son." CONCLUSIONS: Google search content offers insight into what matters to parents of cancer patients. Understanding search content could inform more comprehensive approaches to family education and support initiatives.


Assuntos
Troca de Informação em Saúde/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Internet/estatística & dados numéricos , Oncologia/estatística & dados numéricos , Neoplasias/diagnóstico , Pais/educação , Adulto , Criança , Tomada de Decisões , Feminino , Humanos , Masculino , Estudos Retrospectivos , Inquéritos e Questionários
10.
J Med Syst ; 43(5): 105, 2019 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-30879188

RESUMO

Many hospitals are in the process of replacing their legacy anesthesia information management system (AIMS) with an Electronic Health Record (EHR) system, within which the AIMS is integrated. Using the legacy AIMS security access log table, we studied the extent to which anesthesia providers were accessing historical anesthesia records (January 2006 - March 2017) following implementation of an EHR (April 2017). Statistical analysis was by segmented regression. At the time of implementation of the EHR, in 44.8% (SE = 0.3%) of cases, there was a prior anesthetic record for the patient that had been documented in the legacy AIMS. Following EHR implementation, the mean number of preoperative clinical views of all prior anesthetic records divided by the total number of cases performed decreased to 2.3% (0.3%) from the baseline of 25.1% (0.8%). The estimated ratio of the 2 means was 0.18 (95% CI 0.11 to 0.31, P < 0.00001). For views of unique records, the decrease was to 2.2% (0.3%) from the baseline of 18.3% (0.5%). The estimated ratio was 0.23 (95% CI 0.15 to 0.35, P < 0.00001). These results show that, following conversion to an integrated EHR, providing access to historical anesthesia records by maintaining the legacy AIMS is not an effective strategy to promote review of such records as part of the preoperative evaluation process. Because such records provide important information for many patients, providing linked access to such records within the EHR as part of the patient encounter may be a more effective approach.


Assuntos
Anestesia/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Troca de Informação em Saúde/estatística & dados numéricos , Registros Eletrônicos de Saúde/organização & administração , Humanos , Assistência Perioperatória
11.
Home Healthc Now ; 37(1): 33-35, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30608465

RESUMO

Nurses report significant gaps in communication among patients discharged from the hospital with home healthcare (HHC) services. The aim of this pilot study was to quantify the contents of HHC admission packets used to guide nurses' first home visit after hospital discharge. We evaluated 20 randomly selected charts of older adults admitted to HHC after a hospitalization for heart failure. Admission packets contained nearly 50 pages of material, which frequently included duplicate documents printed from the hospital-based electronic health record (EHR). Despite the plethora of documents, most packets omitted key information, such as patients' cognitive and functional status, and even discharge summaries, which would be relevant and actionable for HHC nurses. Moreover, admission packets contained multiple, often discordant, EHR-generated medication lists, which makes reconciliation challenging for nurses and puts vulnerable patients at risk for adverse drug events. Overall, there is an urgent need to improve health information exchange between hospitals and HHC agencies, which will simultaneously promote nurse efficiency and patient safety.


Assuntos
Continuidade da Assistência ao Paciente/organização & administração , Troca de Informação em Saúde/estatística & dados numéricos , Serviços de Assistência Domiciliar/organização & administração , Reconciliação de Medicamentos/organização & administração , Enfermeiras de Saúde Comunitária/organização & administração , Alta do Paciente/estatística & dados numéricos , Idoso , Feminino , Humanos , Projetos Piloto
12.
Int J Med Inform ; 122: 1-6, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30623778

RESUMO

INTRODUCTION: Timely, complete and accurate patient data is needed in care decisions along the continuum of care. To access patient data from other organizations, there are three types of regional health information exchange systems (RHIS) in use In Finland. Some regions use multiple RHISs while others do not have a RHIS available. The recently introduced National Patient Data Repository (Kanta) is increasingly used for health information exchange (HIE). OBJECTIVES: The purpose of this study was to assess usage of paper, RHISs and Kanta by context in 2017; evolution of paper use over the years; and predictors of paper use in 2017 among Finnish physicians for HIE system development. METHODS: Data from national electronic health record (EHR) usage and user experience surveys were taken from 2010 (prior to ePrescription system implementation), 2014 (prior to implementation of Kanta) and 2017 (Kanta was in full use in the public sector and in large private organizations). The web-based surveys were targeted to all physicians engaged in clinical work in Finland. RESULTS: Kanta was the most frequently used means of HIE in 2017. Paper use had reduced significantly from 2010 to 2014. The trend continued in 2017. Still, up to half of the physicians reported using paper daily or weekly in 2017. There were great variations in paper use by healthcare sector, available RHIS type and EHR system used. In multivariable analysis (with all other variables constant), predictors of more frequent use of paper than electronic means for HIE were: private sector or hospital, access to Master Patient Index RHIS (type 1), multiple RHIS (type 4) or no RHIS (type 5), two particular EHR systems, older age, less experience, operative, psychiatric or diagnostic specialties, and male gender. CONCLUSIONS: Usability of HIE systems including EHRs as access points to HIE need to be improved to facilitate usage of electronic HIE. Usage ensures more timely and complete patient data for safe, coordinated care. Specialty-specific needs and requirements call for more user participation in HIE design. Especially older professionals need training to better exploit HIS for HIE.


Assuntos
Registros Eletrônicos de Saúde/estatística & dados numéricos , Troca de Informação em Saúde/estatística & dados numéricos , Sistemas de Informação em Saúde/estatística & dados numéricos , Papel/normas , Médicos/psicologia , Adulto , Idoso , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
13.
J Med Libr Assoc ; 106(4): 455-463, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30271286

RESUMO

Objectives: The research sought to determine if the health advice provided in online discussion forms aimed at parents of young children is accurate and in agreement with evidence found in evidence-based resources and to discover whether or not these forums are an avenue for misinformation. Methods: To determine which online forums to use, Google was searched using five common childhood ailments. Forums that appeared five or more times in the first five pages of the Google search for each question were considered. Of these forums, those that met the inclusion criteria were used. Data from a six-month time period was collected and categorized from the discussion forums to analyze the advice being provided about common childhood ailments. Evidence-based resources were used to analyze the accuracy of the advice provided. Results: Two discussion forums were chosen for analysis. Seventy-four questions from one and 131 questions from the other were health related. Data were not analyzed together. Of the health-related questions on the 2 forums, 65.5% and 51.8%, respectively, provided some type of advice. Of the advice provided, 54.1% and 47.2%, respectively, agreed with the evidence provided in evidence-based resources. A further 16.2% and 6.3% was refuted or was somewhat refuted by the evidence found in evidence-based resources. Conclusion: While roughly half of the health-related advice provided in online discussion forums aimed at parents of young children is accurate, only a small portion of the advice is incorrect; therefore, these sources are not a major concern for the spread of misinformation.


Assuntos
Informação de Saúde ao Consumidor/métodos , Disseminação de Informação/métodos , Internet/estatística & dados numéricos , Criança , Comunicação , Troca de Informação em Saúde/estatística & dados numéricos , Humanos , Pais , Pesquisa Qualitativa
14.
Int J Med Inform ; 119: 1-7, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30342677

RESUMO

OBJECTIVE: Consumers' willingness to allow the distribution of their health data is a prerequisite for the success of any health information exchange (HIE) initiative. Several mechanisms are being used by healthcare organizations to exchange health information electronically. Our goal is to investigate how patients' preferences regarding information exchange (i.e., privacy concern, opt-in intention, and perceived health information sensitivity) are affected by different HIE models and exchange architectures. METHODS: We designed a series of scenarios for controlled online experiments. Totally, 1416 respondents participated in seven experiments. Each experiment includes a separate scenario and 27 questions to measure outcome variables and demographics. Data were collected from a wide range of adult population in the U.S. and all the experiments were performed in English. RESULTS: The findings demonstrate that there are significant differences in patients' perceptions of different HIE mechanisms in terms of privacy concern and opt-in intention. Consumers believe that the patient-controlled HIE at the regional level is the most preferred model to protect health information privacy and they are willing to opt-in to this model. However, there is no solid evidence to show that different HIE mechanisms would affect the consumers' perceived health information sensitivity. CONCLUSIONS: This study supports the importance of patient-controlled HIE models that potentially enable patients to access, manage, integrate, and share their medical information with multiple healthcare organizations. The results show in-depth consumer adoption patterns across multiple HIE models and architectures which are required to identify optimal approaches for HIE implementation using different exchange mechanisms.


Assuntos
Informação de Saúde ao Consumidor/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Troca de Informação em Saúde/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Adulto , Humanos , Percepção , Privacidade
15.
Medicine (Baltimore) ; 97(41): e12714, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30313069

RESUMO

This study aims to analyze the behavior changes of health workers in township hospitals by exploring their individual service, health information utilization, and health information exchange before and after intervention.A cross-sectional survey was conducted from September, 2016 to December, 2016 in Qianjiang city, Hubei Province, China. A total of 432 township hospital health workers were investigated from 12 township hospitals. t test and chi-square test were adopted in the difference analysis to compare the behavior changes and factors of the control and intervention groups before and after intervention. t test and U test were used to analyze the behaviors and the key impact factors of health workers in township hospitals. The hypothesis test of the behavior changes in the township hospitals were analyzed using the partial least squares (PLS) method.No significant difference was observed between the control and intervention groups of health workers in township hospitals. Significant differences were observed in the behavior attitude (BA), perceived behavior control (PBC), behavior intention (BI), and behaviors of information utilization and exchange in the intervention group. A significant difference was observed in the indicators of subjective norm (SN), BI, and behaviors with respect to information exchange. A large increment was observed in the intervention group. Based on results of PLS, the individual service, health information utilization, and health information exchange established relationships with BA, SN, PBC, and BI to a certain degree.A cause and effect relationship can be observed among BA, SN, PBC, BI, and behaviors of health workers in the township hospitals. BI can promote behavior changes among township hospital health workers. Moreover, different behaviors are demonstrated by different people because of BA, SN, PBC, and BI. The results of this study can contribute to improving the feasibility, pertinence, and effects of health service, and can serve as the guide in understanding health workers' behaviors.


Assuntos
Atitude do Pessoal de Saúde , Controle Comportamental , Sistemas de Informação em Saúde/estatística & dados numéricos , Recursos Humanos em Hospital/psicologia , Administração em Saúde Pública , Adulto , China , Estudos Transversais , Feminino , Controle de Formulários e Registros/organização & administração , Troca de Informação em Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/organização & administração
16.
Comput Methods Programs Biomed ; 164: 101-109, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30195418

RESUMO

BACKGROUND AND OBJECTIVES: Telecare Medicine Information System (TMIS) enables physicians to efficiently and conveniently make certain diagnoses and medical treatment for patients over the insecure public Internet. To ensure patients securely access to medicinal services, many authentication schemes have been proposed. Although numerous cryptographic authentication schemes for TMIS have been proposed with the aim to ensure data security, user privacy and authentication, various forms of attacks make these schemes impractical. METHODS: To design a truly secure and practical authentication scheme for TMIS, a new biometrics-based authentication key exchange protocol for multi-server TMIS without sharing the system private key with distributed servers is presented in this work. RESULTS: Our proposed protocol has perfect security features including mutual authentication, user anonymity, perfect forward secrecy and resisting various well-known attacks, and these security feathers are confirmed by the BAN logic and heuristic cryptanalysis, respectively. CONCLUSIONS: A secure biometrics-based authentication key exchange protocol for multi-server TMIS is presented in this work, which has perfect security properties including perfect forward secrecy, supporting user anonymity, etc., and can withstand various attacks such as impersonation attack, off-line password guessing attack, etc.. Considering security is the most important factor for an authentication scheme, so our scheme is more suitable for multi-server TMIS.


Assuntos
Identificação Biométrica/métodos , Segurança Computacional/normas , Troca de Informação em Saúde/normas , Telemedicina/normas , Identificação Biométrica/normas , Identificação Biométrica/estatística & dados numéricos , Segurança Computacional/estatística & dados numéricos , Confidencialidade , Lógica Fuzzy , Troca de Informação em Saúde/estatística & dados numéricos , Humanos , Sistemas de Informação/normas , Sistemas de Informação/estatística & dados numéricos , Telemedicina/estatística & dados numéricos
18.
J Biomed Inform ; 85: 1-9, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30017975

RESUMO

OBJECTIVE: Seamless access to information about the individuals and organizations involved in the care of a specific patient ("care teams") is crucial to effective and efficient care coordination. This is especially true for vulnerable and complex patient populations such as pediatric patients with special needs. Despite wide adoption of electronic health records (EHR), current EHR systems do not adequately support the visualization and management of care teams within and across health care organizations. Electronic health information exchange has the potential to address this issue. In the present study, we assessed the adequacy of available health information exchange data standards to support the information needs related to care coordination of complex pediatric patients. METHODS: We derived data elements from the information needs of clinicians and parents to support patient care teams; and mapped them to data elements in the Health Level Seven (HL7) Consolidated Clinical Document Architecture (C-CDA) standard and in the HL7 Fast Healthcare Interoperability Resources (FHIR) standard. We also identified additional C-CDA data elements and FHIR resources that include patients' care team members. RESULTS: Information about care team members involved in patient care is generally well-represented in the C-CDA and FHIR specifications. However, there are gaps related to patients' non-clinical events and care team actions. In addition, there is no single place to find information about care team members; rather, information about practitioners and organizations may be available in several different types of C-CDA data elements and FHIR resources. CONCLUSION: Through standards-based electronic health information exchange, it appears to be feasible to build patient care team representations irrespective of the location of patient care. In order to gather care team information across disparate systems, exchange of multiple C-CDA documents and/or execution of multiple FHIR queries will be necessary. This approach has the potential to enable comprehensive patient care team views that may help improve care coordination.


Assuntos
Registros Eletrônicos de Saúde/normas , Troca de Informação em Saúde/normas , Nível Sete de Saúde/normas , Criança , Biologia Computacional/normas , Registros Eletrônicos de Saúde/estatística & dados numéricos , Troca de Informação em Saúde/estatística & dados numéricos , Nível Sete de Saúde/estatística & dados numéricos , Humanos , Equipe de Assistência ao Paciente/normas , Equipe de Assistência ao Paciente/estatística & dados numéricos , Pediatria/normas , Pediatria/estatística & dados numéricos , Estados Unidos
19.
BMC Health Serv Res ; 18(1): 405, 2018 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-29866179

RESUMO

BACKGROUND: As more hospitals adopt Electronic Health Records (EHR), focus has shifted to how these records can be used to improve patient care. One barrier to this improvement is limited information exchange between providers. In this work we examine the role of EHR vendors, hypothesizing that vendors strategically control the exchange of clinical care summaries. Their strategy may involve the creation of networks that easily exchange information between providers with the same vendor but frustrate exchange between providers with different vendors, even as both Federal and State policies attempt to incentivize exchange through a common format. METHODS: Using data from the 2013 American Hospital Association's Information Technology Supplement, we examine the relationship between a hospital's decision to share clinical care summaries outside of their network and EHR vendor market share, measured by the percentage of hospitals that have the same vendor in a Hospital Referral Region. RESULTS: Our findings show that the likelihood of a hospital exchanging clinical summaries with hospitals outside its health system increases as the percentage of hospitals with the same EHR vendor in the region increases. The estimated odds of a hospital sharing clinical care summaries outside their system is 5.4 (95% CI, 3.29-8.80) times greater if all hospitals in the Hospital Referral Region use the same EHR Vendor than the corresponding odds for a hospital in an area with no hospitals using the same EHR Vendor. When reviewing the relationship of vendor market concentration at the state level we find a positive significant relationship with the percentage of hospitals that share clinical care summaries within a state. We find no significant impact from state policies designed to incentivize information exchange through the State Health Information Exchange Cooperative Program. CONCLUSION: There are benefits to exchanging using proprietary methods that are strengthened when the vendors are more concentrated. In order to avoid closed networks that foreclose some hospitals, it is important that future regulation attempt to be more inclusive of hospitals that do not use large vendors and are therefore unable to use proprietary methods for exchange.


Assuntos
Comportamento de Escolha , Comércio , Registros Eletrônicos de Saúde/estatística & dados numéricos , Troca de Informação em Saúde/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Humanos , Marketing de Serviços de Saúde , Registro Médico Coordenado
20.
Comput Methods Programs Biomed ; 161: 209-232, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29852963

RESUMO

BACKGROUND AND OBJECTIVE: Health Information Exchange (HIE) is known as a technology that electronically shares all clinical and administrative data throughout healthcare settings. Despite this technology has a great potential in the healthcare industry, there is a limited and sparse evidence of articles which illustrated the impact of HIE on quality of care and cost-effectiveness. This work presents a systematic review that evaluates the impact of HIE on quality and cost-effectiveness, and the rates of HIE adoption and participation in healthcare organizations. METHODS: We systematically searched all English papers that were indexed in four major databases (Science Direct, PubMed, IEEE and Web of Science) between 2005 and 2016. Consequently, 32 identified papers appeared in 21 international journals and conferences. Eligible studies independently were critically appraised, collected within data extraction form and then thematically analyzed by two reviewers and if necessary, the third author. The selected papers have been classified based on 11 main categories including publication year, journal and conference names, country and study design, types of data exchanged, healthcare levels, disease or disorder, participants in organizations and individuals, settings characteristics and HIE types, the impact of HIE on quality and cost-effectiveness, and the rates of HIE adoption and participation. RESULTS: Of the 32 articles, 25 studies investigated the financial and clinical impact of HIE. Overwhelmingly, HIE studies have reported positive findings for quality and cost-effectiveness of care. 15 of HIE studies (60%) demonstrated positive financial effects and 16 studies (64%) reported positive effects on quality improvement of patient care. However, the overall quality of the evidences was low. In this regard, cohort study (59.38%) was the most common used study design. Nine studies presented the rates of HIE adoption and participation. The lowest and highest participation rates were 15.7% and 79%, respectively. CONCLUSIONS: HIE can be considered as a superior potential for healthcare information system, resulting to promote patient care quality and reduce costs related to resource utilization. However, further researches are needed in order to provide a better understanding of this domain and accordingly attain new opportunities to increase users' participation and motivation for successfully adopting this technology.


Assuntos
Análise Custo-Benefício , Troca de Informação em Saúde/economia , Troca de Informação em Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde , Assistência Ambulatorial/organização & administração , Serviço Hospitalar de Emergência/organização & administração , Custos de Cuidados de Saúde , Humanos , Projetos de Pesquisa
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