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ItemThe Association Between State-Level Health Information Exchange Laws and Hospital Participation in Community Health Information Organizations(AMIA, 2018) Brown-Podgorski, Brittany L.; Hilts, Katy Ellis; Kash, Bita A.; Schmit, Cason D.; Vest, Joshua R.; Health Policy and Management, School of Public HealthEvidence suggests that health information exchange (HIE) is an effective strategy to improve efficiency and quality of care, as well as reduce costs. A complex patchwork of federal and state legislation has developed over time to encourage HIE activity. Hospitals and health systems have adopted various HIE models to meet the requirements of these statutes and regulations. Given the complexity of HIE laws, it is important to understand how these legal levers influence HIE engagement. We combined data from two unique data sources to examine the association between state-level HIE laws and hospital engagement in community HIEs. Our results identified three legal provisions of state laws (HIE authorization, financial & non-financial incentives, opt-out consent) that increased the likelihood of community HIE engagement. Other provisions decreased the likelihood of engagement. This analysis provides foundational evidence about the utility of HIE laws. More research is needed to determine causal relationships. ItemThe associations between query-based and directed health information exchange with potentially avoidable use of health care services(Wiley, 2019-05-21) Vest, Joshua R.; Unruh, Mark Aaron; Shapiro, Jason S.; Casalino, Lawrence P.; Health Policy and Management, School of Public HealthObjective 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. ItemThe benefits of health information exchange: an updated systematic review(Oxford Academic, 2018-09) Menachemi, Nir; Rahurkar, Saurabh; Harle, Christopher A.; Vest, Joshua R.; Health Policy and Management, School of Public HealthObjective Widespread health information exchange (HIE) is a national objective motivated by the promise of improved care and a reduction in costs. Previous reviews have found little rigorous evidence that HIE positively affects these anticipated benefits. However, early studies of HIE were methodologically limited. The purpose of the current study is to review the recent literature on the impact of HIE. Methods We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct our systematic review. PubMed and Scopus databases were used to identify empirical articles that evaluated HIE in the context of a health care outcome. Results Our search strategy identified 24 articles that included 63 individual analyses. The majority of the studies were from the United States representing 9 states; and about 40% of the included analyses occurred in a handful of HIEs from the state of New York. Seven of the 24 studies used designs suitable for causal inference and all reported some beneficial effect from HIE; none reported adverse effects. Conclusions The current systematic review found that studies with more rigorous designs all reported benefits from HIE. Such benefits include fewer duplicated procedures, reduced imaging, lower costs, and improved patient safety. We also found that studies evaluating community HIEs were more likely to find benefits than studies that evaluated enterprise HIEs or vendor-mediated exchanges. Overall, these finding bode well for the HIEs ability to deliver on anticipated improvements in care delivery and reduction in costs. ItemThe complementary nature of query-based and directed health information exchange in primary care practice(Oxford Academic, 2020-01) Vest, Joshua R.; Unruh, Mark A.; Casalino, Lawrence P.; Shapiro, Jason S.; Health Policy and Management, School of Public HealthObjective Many policymakers and advocates assume that directed and query-based health information exchange (HIE) work together to meet organizations’ interoperability needs, but this is not grounded in a substantial evidence base. This study sought to clarify the relationship between the usage of these 2 approaches to HIE. Materials and Methods System user log files from a regional HIE organization and electronic health record system were combined to model the usage of HIE associated with a patient visit at 3 federally qualified health centers in New York. Regression models tested the hypothesis that directed HIE usage was associated with query-based usage and adjusted for factors reflective of the FITT (Fit between Individuals, Task & Technology) framework. Follow-up interviews with 8 key informants helped interpret findings. Results Usage of query-based HIE occurred in 3.1% of encounters and directed HIE in 23.5%. Query-based usage was 0.6 percentage points higher when directed HIE provided imaging information, and 4.8 percentage points higher when directed HIE provided clinical documents. The probability of query-based HIE was lower for specialist visits, higher for postdischarge visits, and higher for encounters with nurse practitioners. Informants used query-based HIE after directed HIE to obtain additional information, support transitions of care, or in cases of abnormal results. Discussion The complementary nature of directed and query-based HIE indicates that both HIE functionalities should be incorporated into EHR Certification Criteria. Conclusions Quantitative and qualitative findings suggest that directed and query-based HIE exist in a complementary manner in ambulatory care settings. ItemA corpus-based approach for automated LOINC mapping(Oxford University Press, 2014-01-01) Fidahussein, Mustafa; Vreeman, Daniel J.; Department of Medicine, IU School of MedicineObjective To determine whether the knowledge contained in a rich corpus of local terms mapped to LOINC (Logical Observation Identifiers Names and Codes) could be leveraged to help map local terms from other institutions. Methods We developed two models to test our hypothesis. The first based on supervised machine learning was created using Apache's OpenNLP Maxent and the second based on information retrieval was created using Apache's Lucene. The models were validated by a random subsampling method that was repeated 20 times and that used 80/20 splits for training and testing, respectively. We also evaluated the performance of these models on all laboratory terms from three test institutions. Results For the 20 iterations used for validation of our 80/20 splits Maxent and Lucene ranked the correct LOINC code first for between 70.5% and 71.4% and between 63.7% and 65.0% of local terms, respectively. For all laboratory terms from the three test institutions Maxent ranked the correct LOINC code first for between 73.5% and 84.6% (mean 78.9%) of local terms, whereas Lucene's performance was between 66.5% and 76.6% (mean 71.9%). Using a cut-off score of 0.46 Maxent always ranked the correct LOINC code first for over 57% of local terms. Conclusions This study showed that a rich corpus of local terms mapped to LOINC contains collective knowledge that can help map terms from other institutions. Using freely available software tools, we developed a data-driven automated approach that operates on term descriptions from existing mappings in the corpus. Accurate and efficient automated mapping methods can help to accelerate adoption of vocabulary standards and promote widespread health information exchange. ItemDevelopment and Assessment of a Public Health Alert Delivered through a Community Health Information Exchange(2010-10) Gamache, Roland; Stevens, Kevin C; Merriwether, Rico; Dixon, Brian E.; Grannis, ShaunTimely communication of information to health care providers during a public health event can improve overall response to such events. However, current methods for sending information to providers are inefficient and costly. Local health departments have traditionally used labor-intensive, mail-based processes to send public health alerts to the provider community. This article describes a novel approach for delivering public health alerts to providers by leveraging an electronic clinical messaging system within the context of a health information exchange. Alerts included notifications related to the 2009 H1N1 flu epidemic, a syphilis outbreak, and local rabies exposure. We describe the process for sending electronic public health alerts and the estimated impact on efficiency and cost effectiveness. ItemElectronic Laboratory Data Quality and the Value of a Health Information Exchange to Support Public Health Reporting Processes(2011-10) Dixon, Brian E.; McGowan, Julie J; Grannis, Shaun JThere is increasing interest in leveraging electronic health data across disparate sources for a variety of uses. A fallacy often held by data consumers is that clinical data quality is homogeneous across sources. We examined one attribute of data quality, completeness, in the context of electronic laboratory reporting of notifiable disease information. We evaluated 7.5 million laboratory reports from clinical information systems for their completeness with respect to data needed for public health reporting processes. We also examined the impact of health information exchange (HIE) enhancement methods that attempt to improve completeness. The laboratory data were heterogeneous in their completeness. Fields identifying the patient and test results were usually complete. Fields containing patient demographics, patient contact information, and provider contact information were suboptimal. Data processed by the HIE were often more complete, suggesting that HIEs can support improvements to existing public health reporting processes. ItemEstimating Increased Electronic Laboratory Reporting Volumes for Meaningful Use: Implications for the Public Health Workforce(2014-02) Dixon, Brian E.; Gibson, P Joseph; Grannis, Shaun JObjective: To provide formulas for estimating notifiable disease reporting volume from ‘meaningful use’ electronic laboratory reporting (ELR). Methods: We analyzed two years of comprehensive ELR reporting data from 15 metropolitan hospitals and laboratories. Report volumes were divided by population counts to derive generalizable estimators. Results: Observed volume of notifiable disease reports in a metropolitan area were more than twice national averages. ELR volumes varied by institution type, bed count, and by the level of effort required of health department staff. Conclusions: Health departments may experience a significant increase in notifiable disease reporting following efforts to fulfill meaningful use requirements, resulting in increases in workload that may further strain public health resources. Volume estimators provide a method for predicting ELR transaction volumes, which may support administrative planning in health departments. ItemHealth Information Exchange Use in Primary Care(2020-08) Apathy, Nathan Calvert; Harle, Christopher A.; Vest, Joshua R.; Blackburn, Justin; Adler-Milstein, Julia; Dixon, Brian E.The United States has invested over $40 billion in digitizing the health care system, yet the anticipated gains in improved care coordination, quality, and cost savings remain largely unrealized. This is due in part to limited interoperability and low rates of health information exchange (HIE) use, which can support care coordination and improve provider decision-making. Primary care providers are central to the US health care delivery system and frequently function as care coordinators, yet capability and HIE use gaps among these providers limit the potential of these digital systems to achieve their intended goals. I study HIE use in the context of primary care to examine 1) factors associated with provider HIE use, 2) the extent and nature of team-based HIE use, and 3) differences in HIE system use patterns across discrete groups of system users. First, I use a national sample of primary care providers to analyze market and practice factors related to HIE use for patient referrals. Overall, I find that only 43% of primary care provider referrals used HIE. Furthermore, I find substantial variation in HIE use rates across electronic health record (EHR) vendors. Second, I use HIE system log data to understand the breadth and depth of HIE use among teams, a care model underpinning primary care delivery reform efforts. I find that although use of HIE systems remains low, in primary care settings it overwhelmingly takes place in a manner consistent with team-based care workflows. Furthermore, team-based use does not differ in breadth from single provider HIE use, but illustrates less depth before and after visits. Third, I apply cluster analysis to 16 HIE use measures representing 7 use attributes, and identify 5 discrete user groups. I then compare two of these user groups and find user-level variation in volume and efficiency of use, both of which have implications for HIE system design and usability improvements. Ultimately, these findings help to inform how HIE use can be increased and improved in primary care, moving the US health care system closer to realizing the coordination, quality, and cost savings made possible by a digitized delivery system. ItemHealth Information Technology and Accountable Care Organizations: A Systematic Review and Future Directions(AcademyHealth, 2019-07-08) Balio, Casey P.; Apathy, Nate C.; Danek, Robin L.; Health Policy and Management, School of Public HealthBackground: Since the inception of Accountable Care Organizations (ACOs), many have acknowledged the potential synergy between ACOs and health information technology (IT) in meeting quality and cost goals. Objective: We conducted a systematic review of the literature in order to describe what research has been conducted at the intersection of health IT and ACOs and identify directions for future research. Methods: We identified empirical studies discussing the use of health IT via PubMed search with subsequent snowball reference review. The type of health IT, how health IT was included in the study, use of theory, population, and findings were extracted from each study. Results: Our search resulted in 32 studies describing the intersection of health IT and ACOs, mainly in the form of electronic health records and health information exchange. Studies were divided into three streams by purpose; those that considered health IT as a factor for ACO participation, health IT use by current ACOs, and ACO performance as a function of health IT capabilities. Although most studies found a positive association between health IT and ACO participation, studies that address the performance of ACOs in terms of their health IT capabilities show more mixed results. Conclusions: In order to better understand this emerging relationship between health IT and ACO performance, we propose future research should consider more quasi-experimental studies, the use of theory, and merging health, quality, cost, and health IT use data across ACO member organizations.