Findings from the 2023 Yearbook Section on Health Information Exchange.

OBJECTIVES: To summarize the recent literature and research and present a selection of the best papers published in 2022 related to Health Information Exchange (HIE). METHODS: A systematic review of the literature was performed by the two section editors with the help of a medical librarian. We searched bibliographic databases for HIE-related papers using both MeSH headings and keywords in titles and abstracts. A shortlist of ten candidate best papers was first selected by section editors before being peer-reviewed by Yearbook editors and independent external reviewers. RESULTS: Major themes of the set of ten articles included factors influencing the organizational adoption of HIE and clinicians' use of the information, use of HIE in non-traditional settings, patients' perspectives on HIE, and outcomes of using HIE. CONCLUSIONS: These studies provide suggestions for the research questions, theories, settings, methods, and outcomes that can be fruitfully used for further research on HIE.

Findings from the 2022 Yearbook Section on Health Information Exchange.

OBJECTIVES: To summarize the recent literature and research and present a selection of the best papers published in 2021 related to health information exchange (HIE). METHODS: A systematic review of the literature was performed by the two section editors with the help of a medical librarian. We searched bibliographic databases for HIE-related papers using both MeSH headings and keywords in titles and abstracts. A shortlist of candidate 15 best papers was first selected by section editors before being peer-reviewed by independent external reviewers. RESULTS: Major themes of the set of 15 articles included the issues to be addressed in building and maintaining HIEs, HIE implementation barriers and facilitators, and the outcomes of using HIEs. The outcomes of using HIE encompassed the impact on patient care and the ability of HIEs to provide a repository of data for further research. CONCLUSIONS: The growth of HIE has followed a course very similar to the growth of electronic health records (EHRs). Initial foci of research included technical issues in the deployment, followed by research on barriers to use. Now that EHRs are more widely implemented and used, the newer research involves the use of the electronic data contained in them. Although HIEs are currently at an earlier stage of maturity and development than EHRs and most of the articles in this review focused on implementation barriers, we have seen the beginning of research on the large amount of longitudinal and diverse data that HIEs can make available. As the implementation and use of HIEs continue to increase and become more widely deployed, we can expect that research about HIE and leveraging HIEs and the data they collect, will continue to increase.

Accelerating the deployment of a health information technology and informatics workforce through education, training, research, and evaluation.

Supported by stronger and more coordinated US federal funding and policies, driven by goals to deliver care more efficiently, and motivated to provide high quality care for an aging and more diverse population, public-private-sector organisations are redoubling efforts to implement information systems. Thus, there is a critical need to increase and broaden the pool of workers who can help organizations maximise the effectiveness of their investments in technology. There are in the US various current health informatics education and training initiatives and ongoing efforts to accelerate Health IT workforce development.

A proposed vision: the transatlantic observatory for meeting global health policy challenges through information and communications technology-enabled solutions (ARGOS).

In 2010 the ARGOS project was funded by the EC (DG RELEX) to contribute to the establishement of a "Transatlantic Observatory for meeting Global Health Policy Challenges through Information and Communication Technology-enabled solutions" to develop and promote common methods for responding to global eHealth challenges in the EU and the US. The European Institute for Health Records (EuroRec) was coordinating the project. The vision is that the Transatlantic Observatory will act as an international platform for dialogue and collaboration on health policy issues and will 1. build international consensus about how to improve the access, efficiency and quality of health services through ICT, 2. promote the importance of interoperability in eHealth, 3. help to define approaches to ensure that health data are easily available where it is needed, 4. identify optimal development paths.

Policy brief on the current status of certification of electronic Health Records in the US and Europe.

If Electronic Health Record systems are to provide an effective contribution to healthcare, a set of benchmarks need to be set to ensure quality control and interoperability of systems. This paper outlines the prevailing status of EHR certification in the US and the EU, compares and contrasts established schemes and poses opportunities for convergence of activity in the domain designed to advance certification endeavours generally. Several EU Member States have in the past proceeded with EHR systems quality labeling and/or certification, but these differ in scope, in legal framework under which they operate, in policies (legislation and financial incentives), in organization, and perhaps most importantly in the quality criteria used for benchmarking. Harmonization, therefore, became a must. Now, through EuroRec (with approaches ranging from self-assessment to third party certification depending on the level of confidence needed) and its Seals, the possibility to achieve this for EHR systems has started in the whole of Europe. The US HITECH Act also attempts to create incentives for all hospitals and eligible providers to adopt and use electronic information. A centerpiece of the Act is to put in place strong financial incentives to adopt and meaningfully use EHRs. The HHS/EHR Certification Programme makes use of ISO/IEC 170XX standards for accreditation, testing and certification. The approved test method addresses the functional and the interoperability requirements defined in the Final Rule criteria and standards. To date six Authorized Testing and Certification Bodies (ATCBs) are testing and certifying products in the US.

Findings from the 2021 Yearbook Section on Health Information Management.

OBJECTIVES: To summarize the recent literature and research and present a selection of the best papers published in 2020 in the field of Health Information Management (HIM) and Health Informatics. METHODS: A systematic review of the literature for the IMIA Yearbook HIM section was performed by the two section editors with the help of a medical librarian. We searched bibliographic databases for HIM-related papers using both MeSH headings and keywords in titles and abstracts. A shortlist of the fifteen best candidate papers was first selected by section editors before being peer-reviewed by independent external reviewers. RESULTS: The three major themes of Health Information Exchange (transmitting, sharing, and accessing patient health-related data and information) (HIE), Data Quality, and Privacy and Security make up 80% of the fifteen papers, with individual papers on personal health records, information governance and the professionalism of the HIM field. CONCLUSIONS: Traditional HIM concerns about HIM practice and workforce as well as issues about the data in electronic health records (EHRs) including data quality, coding, health information exchange among entities within the healthcare systems and privacy and confidentiality continue to be a large part of the HIM research literature. Although there was little research applying these themes to pandemic concerns, HIM professionals have the expertise to make ccontributions to public health informatics research and this research would benefit from their involvement.

Findings from the Health Information Management Section of the 2020 International Medical Informatics Association Yearbook.

OBJECTIVES: To summarize the recent literature and research and present a selection of the best papers published in 2019 in the field of Health Information Management (HIM) and Health Informatics. METHODS: A systematic review of the literature was performed by the two section editors with the help of a medical librarian. The search through bibliographic databases for HIM-related papers was achieved using both MeSH headings and keywords in titles and abstracts. A shortlist of 15 candidate best papers was first selected by section editors before being peer-reviewed by independent external reviewers. RESULTS: Over half of the 15 papers addressed the issue of data quality in the electronic health record (EHR). In addition to the focus on data quality, there were papers on other topics of long-standing interest to the field of HIM. These topics include privacy, security, and confidentiality of health information, comparability of different coding vocabularies, classifications and terminologies, and the HIM workforce. Finally, there were papers on newer topics for the HIM field, including mobile Health (mHealth), EHR use by public health departments, and usability of different strategies for displaying information in the EHR. CONCLUSIONS: Traditional HIM concerns about HIM practice and workforce as well as issues about data in the EHR including data quality, coding, and privacy and confidentiality continue to be a large part of the HIM research literature. However, newer topics which reflect innovative and emerging technologies, usability assessments, and the application of the EHR outside the traditional clinical setting are starting to appear and more research is needed on these newer areas.

Don E. Detmer and the American Medical Informatics Association: an appreciation.

Don E. Detmer has served as President and Chief Executive Officer of the American Medical Informatics Association (AMIA) for the past five years, helping to set a course for the organization and demonstrating remarkable leadership as AMIA has evolved into a vibrant and influential professional association. On the occasion of Dr. Detmer's retirement, we fondly reflect on his professional life and his many contributions to biomedical informatics and, more generally, to health care in the U.S. and globally.

How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings.

BACKGROUND: Adoption of EHRs by U.S. ambulatory practices has been slow despite the perceived benefits of their use. Most evaluations of EHR implementations in the literature apply to large practice settings. While there are similarities relating to EHR implementation in large and small practice settings, the authors argue that scale is an important differentiator. Focusing on small ambulatory practices, this paper outlines the benefits and barriers to EHR use in this setting, and provides a "field guide" for these practices to facilitate successful EHR implementation. DISCUSSION: The benefits of EHRs in ambulatory practices include improved patient care and office efficiency, and potential financial benefits. Barriers to EHRs include costs; lack of standardization of EHR products and the design of vendor systems for large practice environments; resistance to change; initial difficulty of system use leading to productivity reduction; and perceived accrual of benefits to society and payers rather than providers. The authors stress the need for developing a flexible change management strategy when introducing EHRs that is relevant to the small practice environment; the strategy should acknowledge the importance of relationship management and the role of individual staff members in helping the entire staff to manage change. Practice staff must create an actionable vision outlining realistic goals for the implementation, and all staff must buy into the project. The authors detail the process of implementing EHRs through several stages: decision, selection, pre-implementation, implementation, and post-implementation. They stress the importance of identifying a champion to serve as an advocate of the value of EHRs and provide direction and encouragement for the project. Other key activities include assessing and redesigning workflow; understanding financial issues; conducting training that is well-timed and meets the needs of practice staff; and evaluating the implementation process. SUMMARY: The EHR implementation experience depends on a variety of factors including the technology, training, leadership, the change management process, and the individual character of each ambulatory practice environment. Sound processes must support both technical and personnel-related organizational components. Additional research is needed to further refine recommendations for the small physician practice and the nuances of specific medical specialties.

Findings from the 2019 International Medical Informatics Association Yearbook Section on Health Information Management.

OBJECTIVES: To summarize the recent literature and research and present a selection of the best papers published in 2018 in the field of Health Information Management (HIM) and Health Informatics. METHODS: A systematic review of the literature was performed, with the help of a medical librarian, by the two editors of the HIM section of the International Medical Informatics Association (IMIA) Yearbook. In order to include papers that would address the special theme of the 2019 Yearbook on artificial intelligence (AI) as well as HIM, we searched bibliographic databases for HIM-related papers with an AI focus using both Medical Subject Headings (MeSH) descriptors and keywords in titles and abstracts. A shortlist of 15 candidate best papers was first selected by section editors before being peer-reviewed by independent external reviewers. RESULTS: While there were a significant number of manuscripts that addressed issues relevant to HIM, there were virtually none with MeSH headings indicating an HIM focus. Manuscripts that were considered related to the HIM field in terms of the practice of health information management as well as the profession included those that examined using machine learning and other AI approaches to identify protected health information in clinical text to aid with de-identification, automated coding approaches to translate free-text into standardized codes, and natural language processing approaches to extract clinical data to assist with populating cancer and other registries. CONCLUSIONS: The papers discussed in the HIM section reflect the special theme of the use of AI in healthcare on issues particularly relevant to the field of HIM. This synopsis discusses these papers and recommends that HIM practitioners be more involved in research and that researchers in AI and related areas recognize the applicability and relevance of their work to the field of HIM.

Advancing the framework: use of health data--a report of a working conference of the American Medical Informatics Association.

The fields of health informatics and biomedical research increasingly depend on the availability of aggregated health data. Yet, despite over fifteen years of policy work on health data issues, the United States (U.S.) lacks coherent policy to guide users striving to navigate the ethical, political, technical, and economic challenges associated with health data use. In 2007, building on more than a decade of previous work, the American Medical Informatics Association (AMIA) convened a panel of experts to stimulate discussion about and action on a national framework for health data use. This initiative is being carried out in the context of rapidly accelerating advances in the fields of health informatics and biomedical research, many of which are dependent on the availability of aggregated health data. Use of these data poses complex challenges that must be addressed by public policy. This paper highlights the results of the meeting, presents data stewardship as a key building block in the national framework, and outlines stewardship principles for the management of health information. The authors also introduce a taxonomy developed to focus definitions and terminology in the evolving field of health data applications. Finally, they identify areas for further policy analysis and recommend that public and private sector organizations elevate consideration of a national framework on the uses of health data to a top priority.

Integrated personal health records: transformative tools for consumer-centric care.

BACKGROUND: Integrated personal health records (PHRs) offer significant potential to stimulate transformational changes in health care delivery and self-care by patients. In 2006, an invitational roundtable sponsored by Kaiser Permanente Institute, the American Medical Informatics Association, and the Agency for Healthcare Research and Quality was held to identify the transformative potential of PHRs, as well as barriers to realizing this potential and a framework for action to move them closer to the health care mainstream. This paper highlights and builds on the insights shared during the roundtable. DISCUSSION: While there is a spectrum of dominant PHR models, (standalone, tethered, integrated), the authors state that only the integrated model has true transformative potential to strengthen consumers' ability to manage their own health care. Integrated PHRs improve the quality, completeness, depth, and accessibility of health information provided by patients; enable facile communication between patients and providers; provide access to health knowledge for patients; ensure portability of medical records and other personal health information; and incorporate auto-population of content. Numerous factors impede widespread adoption of integrated PHRs: obstacles in the health care system/culture; issues of consumer confidence and trust; lack of technical standards for interoperability; lack of HIT infrastructure; the digital divide; uncertain value realization/ROI; and uncertain market demand. Recent efforts have led to progress on standards for integrated PHRs, and government agencies and private companies are offering different models to consumers, but substantial obstacles remain to be addressed. Immediate steps to advance integrated PHRs should include sharing existing knowledge and expanding knowledge about them, building on existing efforts, and continuing dialogue among public and private sector stakeholders. SUMMARY: Integrated PHRs promote active, ongoing patient collaboration in care delivery and decision making. With some exceptions, however, the integrated PHR model is still a theoretical framework for consumer-centric health care. The authors pose questions that need to be answered so that the field can move forward to realize the potential of integrated PHRs. How can integrated PHRs be moved from concept to practical application? Would a coordinating body expedite this progress? How can existing initiatives and policy levers serve as catalysts to advance integrated PHRs?

Findings from 2017 on Health Information Management

OBJECTIVE: To summarize the recent literature and research and present a selection of the best papers published in 2017 in the field of Health Information Management (HIM) and Health Informatics. METHODS: A systematic review of the literature was performed by the two HIM section editors of the International Medical Informatics Association (IMIA) Yearbook with the help of a medical librarian. We searched bibliographic databases for HIM-related papers using both MeSH descriptors and keywords in titles and abstracts. A shortlist of 15 candidate best papers was first selected by section editors before being peer-reviewed by independent external reviewers. RESULTS: Health Information Exchange was a major theme within candidate best papers. The four papers ultimately selected as 'Best Papers' represent themes that include health information exchange, governance and policy issues, results of health information exchange, and methods of integrating information from multiple sources. Other articles within the candidate best papers include these themes as well as those focusing on authentication and de-identification and usability of information systems. CONCLUSIONS: The papers discussed in the HIM section of IMIA Yearbook reflect the overall theme of the 2018 edition of the Yearbook, i.e., the tension between privacy and access to information. While most of the papers focused on health information exchange, which reflects the "access" side of the equation, most of the others addressed privacy issues. This synopsis discusses these key issues at the intersection of HIM and informatics.

Toward a national framework for the secondary use of health data: an American Medical Informatics Association White Paper.

Secondary use of health data applies personal health information (PHI) for uses outside of direct health care delivery. It includes such activities as analysis, research, quality and safety measurement, public health, payment, provider certification or accreditation, marketing, and other business applications, including strictly commercial activities. Secondary use of health data can enhance health care experiences for individuals, expand knowledge about disease and appropriate treatments, strengthen understanding about effectiveness and efficiency of health care systems, support public health and security goals, and aid businesses in meeting customers' needs. Yet, complex ethical, political, technical, and social issues surround the secondary use of health data. While not new, these issues play increasingly critical and complex roles given current public and private sector activities not only expanding health data volume, but also improving access to data. Lack of coherent policies and standard "good practices" for secondary use of health data impedes efforts to strengthen the U.S. health care system. The nation requires a framework for the secondary use of health data with a robust infrastructure of policies, standards, and best practices. Such a framework can guide and facilitate widespread collection, storage, aggregation, linkage, and transmission of health data. The framework will provide appropriate protections for legitimate secondary use.

Health data use, stewardship, and governance: ongoing gaps and challenges: a report from AMIA's 2012 Health Policy Meeting.

Large amounts of personal health data are being collected and made available through existing and emerging technological media and tools. While use of these data has significant potential to facilitate research, improve quality of care for individuals and populations, and reduce healthcare costs, many policy-related issues must be addressed before their full value can be realized. These include the need for widely agreed-on data stewardship principles and effective approaches to reduce or eliminate data silos and protect patient privacy. AMIA's 2012 Health Policy Meeting brought together healthcare academics, policy makers, and system stakeholders (including representatives of patient groups) to consider these topics and formulate recommendations. A review of a set of Proposed Principles of Health Data Use led to a set of findings and recommendations, including the assertions that the use of health data should be viewed as a public good and that achieving the broad benefits of this use will require understanding and support from patients.

The future state of clinical data capture and documentation: a report from AMIA's 2011 Policy Meeting.

Much of what is currently documented in the electronic health record is in response toincreasingly complex and prescriptive medicolegal, reimbursement, and regulatory requirements. These requirements often result in redundant data capture and cumbersome documentation processes. AMIA's 2011 Health Policy Meeting examined key issues in this arena and envisioned changes to help move toward an ideal future state of clinical data capture and documentation. The consensus of the meeting was that, in the move to a technology-enabled healthcare environment, the main purpose of documentation should be to support patient care and improved outcomes for individuals and populations and that documentation for other purposes should be generated as a byproduct of care delivery. This paper summarizes meeting deliberations, and highlights policy recommendations and research priorities. The authors recommend development of a national strategy to review and amend public policies to better support technology-enabled data capture and documentation practices.

Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA.

In response to mounting evidence that use of electronic medical record systems may cause unintended consequences, and even patient harm, the AMIA Board of Directors convened a Task Force on Usability to examine evidence from the literature and make recommendations. This task force was composed of representatives from both academic settings and vendors of electronic health record (EHR) systems. After a careful review of the literature and of vendor experiences with EHR design and implementation, the task force developed 10 recommendations in four areas: (1) human factors health information technology (IT) research, (2) health IT policy, (3) industry recommendations, and (4) recommendations for the clinician end-user of EHR software. These AMIA recommendations are intended to stimulate informed debate, provide a plan to increase understanding of the impact of usability on the effective use of health IT, and lead to safer and higher quality care with the adoption of useful and usable EHR systems.

The future of health IT innovation and informatics: a report from AMIA's 2010 policy meeting.

While much attention has been paid to the short-term impact that widespread adoption of health information technology (health IT) will have on the healthcare system, there is a corresponding need to look at the long-term effects that extant policies may have on health IT system resilience, innovation, and related ethical, social/legal issues. The American Medical Informatics Association's 2010 Health Policy Conference was convened to further the national discourse on the issues surrounding these longer-term considerations. Conference participants self-selected into three broad categories: resilience in healthcare and health IT; ethical, legal, and social challenges; and innovation, adoption, and sustainability. The discussions about problem areas lead to findings focusing on the lack of encouragement for long-term IT innovation that may result from current health IT policies; the potential impact of uneven adoption of health IT based on the exclusions of the current financial incentives; the weaknesses of contingency and risk mitigation planning that threaten system resilience; and evolving standards developed in response to challenges relating to the security, integrity, and availability of electronic health information. This paper discusses these findings and also offers recommendations that address the interwoven topics of innovation, resilience, and adoption. The goal of this paper is to encourage public and private sector organizations that have a role in shaping health information policy to increase attention to developing a national strategy that assures that health IT innovation and resilience are not impeded by shorter-term efforts to implement current approaches emphasizing adoption and meaningful use of electronic health records.

Preventability of adverse drug events involving multiple drugs using publicly available clinical decision support tools.

PURPOSE: The results of a retrospective evaluation of the frequency and preventability of adverse drug events (ADEs) involving multiple drugs among hospital inpatients are reported. METHODS: Data collected in a previous cohort study of 180 actual ADEs and 552 potential ADEs (PADEs) at six community hospitals in Massachusetts were analyzed to determine the frequency and types of multiple-drug ADEs and the extent to which the ADEs might have been prevented using publicly available clinical decision-support (CDS) knowledge bases. None of the hospitals had a computerized prescriber-order-entry system at the time of data collection (January 2005-August 2006). RESULTS: A total of 17 ADEs (rate, 1.4 per 100 admissions) and 146 PADEs (rate, 12.2 per 100 admissions) involving multiple drugs were identified. The documented events were related to drug duplication (n = 126), drug-drug interaction (n = 21), additive effects (n = 14), and therapeutic duplication (n = 7) or a combination of those factors. The majority of actual ADEs were due to drug-drug interactions, most commonly involving opioids, benzodiazepines, or cardiac medications; about 75% of the PADEs involved excessive drug doses resulting from order duplication or the prescribing of combination drugs with overlapping ingredients, usually products containing acetaminophen and an opioid. It was determined that 5 (29.4%) of the ADEs and 131 (89.7%) of the PADEs could have been detected through the use of the evaluated CDS tools. CONCLUSION: A substantial number of actual ADEs and PADEs in the community hospital setting may be preventable through the use of publicly available CDS knowledge bases.