Collaborating for COVID-19: Hospital Health Information Exchange and Public Health Partnership.

Background: The coronavirus disease (COVID-19) pandemic highlighted the need for effective communication and information sharing among health care organizations and public health systems (PHSs). Health information exchange (HIE) plays a vital role in improving quality control and efficiency in hospital settings, particularly in underserved areas. Objective: This study aimed to investigate the variation of HIE availability among hospitals based on their collaboration with the PHS and affiliation with Accountable Care Organizations (ACOs) in 2020, as well as variation by community social determinants of health. Methods: The primary data set used for this study comprised the linked data set of the 2020 American Hospital Association (AHA) Annual Survey and the AHA Information Technology Supplement. The measures used included the hospital's participation in HIE networks, availability of data exchange, and HIE measures during the COVID-19 pandemic, including whether hospitals effectively received electronically transmitted information from outside providers for COVID-19 treatment. Results: The sample size of hospitals ranged from 1,316 to 1,436, depending on different outcomes related to HIE questions. Of the hospitals surveyed, ∼67% reported public health collaboration and ACO affiliation, while 7% reported neither. Hospitals without public health collaboration or ACO affiliation were more likely to be located in underserved areas. Compared with hospitals without public health collaboration or ACO affiliation, hospitals with both were 9% more likely to report the availability of electronically transmitted clinical information from outside providers and to participate in local and national HIE networks. Furthermore, these hospitals were 30% (marginal effect [ME] = 0.30, p < 0.001) more likely to report effective receipt of information from outside providers for COVID-19 treatment and 12% (ME = 0.12, p = 0.02) more likely to always/often receive clinical information for COVID-19 treatment electronically. Conclusions: Hospital collaboration with the PHS and ACO affiliation are associated with greater availability of electronic health data, particularly during the COVID-19 pandemic.

Health worker registries: managing the health care workforce

Registries play an instrumental role in facilitating the transfer, aggregation, and analysis of standardized data in health information exchange (HIE). One such example is a health worker registry (HWR), a central, authoritative registry that maintains the unique identities of health workers according to a defined, minimum data set. Currently, data comprising workers' information—such as education, licensure, and place of employment—are collected through disparate methods and maintained in a variety of information systems. Harmonization of these data via an HWR can support interoperability and comparability of worker information across systems, thereby facilitating efficient workforce enumeration, planning, regulation and deployment, verification of training and education, identification of workforce shortages, and rapid communication and coordination of emergency response. In fact, HWR technologies played a role in coordinating response to both Ebola in West Africa in 2014 and more recently in response to COVID-19, making a HWR integral to nations' infrastructure upgrades postpandemic. This chapter identifies who is considered a "health worker” and why a registry of these individuals is a useful component of an HIE, especially in the wake of the COVID-19 pandemic. It also provides guidance on selection of data elements and standards to include in the development of an HWR. © 2023 Elsevier Inc. All rights reserved.

Facility registries: metadata for where care is delivered

Comprehensively identifying and monitoring health facilities where care is delivered is critical to care coordination as well as public health. This became poignantly clear during the COVID-19 pandemic. Currently, few sources exist which can provide canonical identification of healthcare facilities. Furthermore, quantifying facility-specific services and infrastructure in a standard manner ranges from insufficient to nonexistent. A health facility registry provides a central authority to store, manage, and share health facility identification, services, and resources data with a wide range of stakeholders. Such universal collection and standardization of these data may support care coordination, public health responsiveness, quality improvement, health services research, health service planning, and health policy development. This chapter introduces the concept of a facility registry and provides scenarios in which stakeholders would benefit from facility data. The chapter further discusses unique identifiers, data collection, and the metadata necessary for establishing and maintaining a facility registry. © 2023 Elsevier Inc. All rights reserved.

Introduction to health information exchange

To support health care and public health in managing the array of information available about patients and populations, health systems have adopted a variety of information and communications technologies (ICT). Examples include electronic health record systems that document patient symptoms, diseases, and medications as well as health care processes. Yet, many ICT systems operate as islands unto themselves, unable to connect or share information with other ICT systems. Such fragmentation of data and information is an impediment to achieving the goal of efficient, coordinated health care delivery. It was further a major challenge during the COVID-19 pandemic when information was rapidly needed yet challenging to access. Health information exchange (HIE) seeks to address the challenges of connecting disparate ICT systems, enabling information to be available when and where it is needed by clinicians, administrators, and public health authorities. This chapter robustly defines HIE, including its core components and various forms. This chapter further discusses the role of HIE in supporting care delivery and public health. © 2023 Elsevier Inc. All rights reserved.

Future directions for health information exchange

Health information exchange (HIE) now exists in diverse forms within and across countries. However, our HIE infrastructure is fragmented, which impedes the ability to meet the needs of varied data sharing use cases—particularly public health data needs that became evident during the COVID-19 pandemic. In response, several efforts—some within the United States and some outside the United States—have started to undertake work to help tie existing HIE approaches together into a more seamless whole. While the societal benefits of doing so are clear, there are substantial cost and complexity involved, leaving it an open question as to how successful they will be. This chapter describes three major efforts underway to advance HIE infrastructure at scale—the Trusted Exchange Framework and Common Agreement (a US policy strategy), the Joint Action Towards the European Health Data Space (an EU initiative), and the emerging concept of health data utility models as more comprehensive repositories of health data with strong government requirements for participation. For each, we describe the effort as well as discuss potential challenges to implementation and success in achieving the intended outcomes. We also discuss a complementary issue related to health data integration and usability of exchanged health information that will become more acute as efforts to advance data sharing at scale are pursued. © 2023 Elsevier Inc. All rights reserved.

Are smart contracts too smart for Supply Chain 4.0? A blockchain framework to mitigate challenges: IMS

PurposeSmart contracts are self-executing computer programmes that have the potential to be used in several applications instead of traditional written contracts. With the recent rise of smart systems (e.g. Internet of things) and digital platforms (e.g. blockchain), smart contracts are gaining high interest in both business and academia. In this work, a framework for smart contracts was proposed with using reputation as the system currency, and conducts currency mining through fulfilling the physical commitments that are agreed upon.Design/methodology/approachA game theory model is developed to represent the proposed system, and then a system dynamics simulator is used to check the response of the blockchain with different sizes.FindingsThe numerical results showed that the proposed system could identify the takeover attacks and protect the blockchain from being controlled by an outsider. Another important finding is that careful setting of the maximum currency amount can improve the scalability of the blockchain and prevent the currency inflation.Research limitations/implicationsThis work is proposed as a conceptual framework for supply chain 4.0. Future work will be dedicated to implement and experiment the proposed framework for other characteristics that may be encountered in the context of supply chain 4.0, such as different suppliers' tiers, different customer typologies and smart logistics applications, which may reveal other challenges and provide additional interesting insights.Practical implicationsBy using the proposed framework, smart contracts and blockchains can be implemented to handle many issues in the context of operations and supply chain 4.0, especially in times of turbulence such as the COVID-19 global pandemic crisis.Originality/valueThis work emphasizes that smart contracts are not too smart to be applied in the context of supply chain 4.0. The proposed framework of smart contracts is expected to serve supply chain 4.0 by automating the knowledge work and enabling scenario planning through the game theory model. It will also improve online transparency and order processing in real-time through secured multitier connectivity. This can be applied in global supply chain functions backed with digitization, notably during the time of the pandemic, in which e-commerce and online shopping have changed the rules of the game.

Social Media for Public Health: Framework for Social Media-Based Public Health Campaigns.

The pervasiveness of social media is irrefutable, with 72% of adults reporting using at least one social media platform and an average daily usage of 2 hours. Social media has been shown to influence health-related behaviors, and it offers a powerful tool through which we can rapidly reach large segments of the population with tailored health messaging. However, despite increasing interest in using social media for dissemination of public health messaging and research exploring the dangers of misinformation on social media, the specifics of how public health practitioners can effectively use social media for health promotion are not well described. In this viewpoint, we propose a novel framework with the following 5 key principles to guide the use of social media for public health campaigns: (1) tailoring messages and targeting them to specific populations-this may include targeting messages to specific populations based on age, sex, or language spoken; interests; or geotargeting messages at state, city, or zip code level; (2) including members of the target population in message development-messages should be designed with and approved by members of the community they are designed to reach, to ensure cultural sensitivity and trust-building; (3) identifying and addressing misinformation-public health practitioners can directly address misinformation through myth-busting messages, in which false claims are highlighted and explained and accurate information reiterated; (4) leveraging information sharing-when designing messages for social media, it is crucial to consider their "shareability," and consider partnering with social media influencers who are trusted messengers among their online followers; and (5) evaluating impact by measuring real-world outcomes, for example measuring foot traffic data. Leveraging social media to deliver public health campaigns enables us to capitalize on sophisticated for-profit advertising techniques to disseminate tailored messaging directly to communities that need it most, with a precision far beyond the reaches of conventional mass media. We call for the Centers for Disease Control and Prevention as well as state and local public health agencies to continue to optimize and rigorously evaluate the use of social media for health promotion.

Information exchange of law enforcement agencies within the EU in context of COVID 19 outbreak

This article discusses the readiness of information exchange of law enforcement agencies in the EU. In context of the outbreak of COVID-19 there is a need for effective information exchange between law enforcement agencies. The need for intensified information exchange and gathering relevant data is necessary in order to tackle organized crime in the EU. COVID-19 has shown the complexity of security and health issues and the limited institutional capacity of states to deal the crisis individually. The authors argue that the EU and its member states face a challenging security environment in which information exchange is the most relevant tool for managing the crisis. © 2022 The Authors

Updating Website Workflows to Efficiently Meet Changing User Needs During the COVID-19 Pandemic

Assess whether changes implemented to an Extension website increased website traffic and met user needs.Social distancing, quarantining, and staying at home due to COVID-19 had significant impacts on media consumption (Nielson Insights, 2020). According to the Pew Research Center, about 53% of US adults reported the internet was essential for them during the pandemic, with another 34% saying it was important (Vogels et al, 2020).General public and multiplier groups (eg, educators, health professionals, media).The website team coordinated new, updated, and curated content for consumers and health professionals around timely food, nutrition and health information related to the pandemic.Google Analytics was used to assess website statistics. A web feedback form was added to new articles. Social media was used to promote/market content.Google Analytics (2019 vs 2020) showed increases in: pageviews (2.4 vs 3 million), site users (1.6 vs 2 million), and sessions (1.8 vs 2.4 million). There were positive increases in percent change for website traffic: direct traffic (36%), organic search (29%), and social media (53%). Specifically, positive increases in percent change for Facebook (112%) and Twitter (90%). Over 2,500 web feedback form responses were included in the analysis. Respondents said information was helpful to them (89%) and shared information with over 157,800 people (eg, friends, family, neighbors, colleagues, students, parents, clients, and seniors). Approximately 90% of responses were unique. Themes from open-ended comments included: helping keep families safe (food safety), recipes and activities for families at home with children, and food resource management tips.Curating and creating content relevant to COVID-19 and promoting on social media increased website traffic. Using a standard web feedback form provided information about what content was useful to users. Templates and organizational structures helped state and county level Extension, support staff, and college students easily add content that was reviewed.

Leveraging PEPFAR-Supported Health Information Systems for COVID-19 Pandemic Response.

Since 2003, the US President's Emergency Plan for AIDS Relief (PEPFAR) has supported implementation and maintenance of health information systems for HIV/AIDS and related diseases, such as tuberculosis, in numerous countries. As the COVID-19 pandemic emerged, several countries conducted rapid assessments and enhanced existing PEPFAR-funded HIV and national health information systems to support COVID-19 surveillance data collection, analysis, visualization, and reporting needs. We describe efforts at the US Centers for Disease Control and Prevention (CDC) headquarters in Atlanta, Georgia, USA, and CDC country offices that enhanced existing health information systems in support COVID-19 pandemic response. We describe CDC activities in Haiti as an illustration of efforts in PEPFAR countries. We also describe how investments used to establish and maintain standards-based health information systems in resource-constrained settings can have positive effects on health systems beyond their original scope.

Information exchange of law enforcement agencies within the EU in context of COVID 19 outbreak

This article discusses the readiness of information exchange of law enforcement agencies in the EU. In context of the outbreak of COVID-19 there is a need for effective information exchange between law enforcement agencies. The need for intensified information exchange and gathering relevant data is necessary in order to tackle organized crime in the EU. COVID-19 has shown the complexity of security and health issues and the limited institutional capacity of states to deal the crisis individually. The authors argue that the EU and its member states face a challenging security environment in which information exchange is the most relevant tool for managing the crisis.

The value of community-integrated health information exchanges: three recent examples from El Paso, Texas.

The foundational role of health information exchanges (HIEs) is to facilitate communication between clinical partners in real time. Once this infrastructure for the secure and immediate flow of patient information is built, however, HIEs can benefit community public health and clinical care in myriad other ways that are in line with their mission, goals, patient privacy, and funding structures. We encourage the development of community-integrated HIEs and list specific steps that can be taken toward community integration. We give three examples of those steps in action from a community HIE in El Paso, TX. Each local partnership, in combination with technology innovation, resulted in the development of informatics tools to address community health needs and generated long-term benefits, especially for the most vulnerable patients. Two examples relate to different aspects of the COVID-19 pandemic and a third to the Afghan refugee evacuation.

The Role of Telehealth and Clinical Informatics in Data Driven Primary Care Redesign.

Clinical informatics linked inpatient and emergency department use to clinical data to evaluate utilization for population segments. Trend analysis demonstrates how remote registered nurse care management and the COVID-79 pandemic reduced emergency department utilization in adult populations with high social needs.

Standardizing Primary Health Care Referral Data Sets in Nigeria: Practitioners' Survey, Form Reviews, and Profiling of Fast Healthcare Interoperability Resources (FHIR).

BACKGROUND: Referral linkages are crucial for efficient functioning of primary health care (PHC) systems. Fast Healthcare Interoperability Resource (FHIR) is an open global standard that facilitates structuring of health information for coordinated exchange among stakeholders. OBJECTIVE: The objective of this study is to design FHIR profiles and present methodology and the profiled FHIR resource for Maternal and Child Health referral use cases in Ebonyi state, Nigeria-a typical low- and middle-income country (LMIC) setting. METHODS: Practicing doctors, midwives, and nurses were purposefully sampled and surveyed. Different referral forms were reviewed. The union of data sets from surveys and forms was aggregated and mapped to base patient FHIR resource elements, and extensions were created for data sets not in the core FHIR specification. This study also introduced FHIR and its relation to the World Health Organization's (WHO's) International Classification of Diseases. RESULTS: We found many different data elements from the referral forms and survey responses even in urban settings. The resulting FHIR standard profile is published on GitHub for adaptation or adoption as necessary to aid alignment with WHO recommendations. Understanding data sets used in health care and clinical practice for information sharing is crucial in properly standardizing information sharing, particularly during the management of COVID-19 and other infectious diseases. Development organizations and governments can use this methodology and profile to fast-track FHIR standards adoption for paper and electronic information sharing at PHC systems in LMICs. CONCLUSIONS: We presented our methodology for profiling the referral resource crucial for the standardized exchange of new and expectant moms' information. Using data from frontline providers and mapping to the FHIR profile helped contextualize the standardized profile.

The impact of operational disruptions on performance in surgical settings: moderating roles of risk management infrastructure and information exchange

Purpose>Drawing on normal accident and high-reliability organizational theories, this study examines the impact of magnitude and likelihood of disruptions on surgical procedure performance. More importantly, the authors investigate the moderating role played by information exchange and risk management infrastructure in mitigating the negative effect of disruption on performance.Design/methodology/approach>A nationwide multi-respondent survey was administered to operating room personnel to collect information on their experiences with disruptions experienced in surgeries. The survey data are analyzed to examine the relationship between operational disruptions and procedure performance. Additionally, the moderating roles of risk management infrastructure and information exchange on the relationship between disruptions and performance are investigated. The results obtained from the empirical analysis are validated using data from an ethnographic investigation of surgeries at a major hospital.Findings>The results show that both the magnitude and the likelihood of a disruption adversely impact procedure performance. Interestingly, the authors find that risk management infrastructure and information exchange play different roles in mitigating the effect of disruptions on performance. The authors find that while risk management infrastructure helps mitigate the effect of magnitude of service disruptions, information exchange helps reduce the effects of likelihood of disruptions. The findings lend strong support to the theoretical assertions. By means of the participant–observer data collected from over 100 surgeries as part of the ethnographic investigation, the authors validate the key findings. The findings suggest that disruptions are common occurrences in surgical settings, but their performance impact may be lessened or altogether avoided with the proper information and risk management mechanisms in place.Originality/value>This survey research extends the understanding of risk management by considering a context that is highly prone to disruptions. The authors adopt existing constructs pertaining to supply chain disruptions within this context and find new insights. The findings of the study show differential roles played by information exchange and risk management infrastructure in mitigating disruptions. This nuanced understanding provides directions for aligning efforts towards risk mitigation in surgical settings in a more focused way. This study supplements findings from survey data analysis with an examination of data collected by means of ethnographic investigation.

Daily Visualization of Statewide COVID-19 Healthcare Data

To manage a localized outbreak or global pandemic like COVID-19, Public Health agencies (PH) and health systems utilize a variety of information systems. Although existing PH information systems enable capture of data on laboratory-confirmed cases of COVID-19, the current pandemic has illuminated several deficits in the existing U.S. information infrastructure, including gaps in access to and visualization of near-real-time (daily) impacts to the healthcare system. To address these gaps, we leveraged our state-wide health information exchange-derived dataset that represents nearly all healthcare facilities in Indiana. The resultant dashboard has evolved to present data on hospitalization, emergency department utilization, and other metrics of interest to PH and a broader constituency across the state.

Using FHIR to Support COVID-19 Vaccine Safety Electronic Case Reports in America.

During the COVID-19 pandemic, the Pan American Health Organization (PAHO) promoted several activities to strengthen the countries' emergency response. Vaccines represented a breakthrough in the pandemic evolution, even though they have not been equitably distributed. As most vaccines have received emergency authorizations for their timely delivery, vaccine safety surveillance has been highlighted for detecting early signals of potential adverse events following immunization (AEFI, also known as ESAVI). The objective of this article is to share the different steps, methodologies, and preliminary results of a regional policy to strengthen the ESAVI surveillance system in the Americas, including the adoption of HL7 FHIR for health information exchange between countries and PAHO.

Improvement of the Japanese healthcare data system for the effective management of patients with COVID-19: A national survey.

OBJECTIVE: The burden of data entry in public platforms used for reporting patients with novel coronavirus disease 2019 (COVID-19) is a challenge in the healthcare setting. The key to mitigating the burden of data entry is system integration and elimination of double data entry. In addition, the linkage between public platforms and electronic medical records (EMRs) involves external networks, which are an important target for security management. The purpose of this study was to elucidate the status and challenges of infrastructure for continuous data reporting from hospitals in Japan. MATERIALS AND METHODS: An online survey of Japanese care delivery institutions was conducted from January 25 to February 22, 2021, to obtain data on the admission of patients with COVID-19, use of information infrastructures, and status of network connections with external organizations. The survey request was distributed to each care delivery institution by Japanese health authorities. RESULTS: Of the care delivery institutions that responded to the survey, 53.9% treated patients with COVID-19. Of these institutions, 73.3% used EMRs. 57.8% of the EMRs were connected to an external network. The purpose of connecting to the external network was to contribute to regional health information-sharing with other hospitals (22.0%), report online medical insurance claims (27.5%), and conduct intrahospital system maintenance (61.5%). A frequent concern about connecting an EMR to an external network was data leakage. DISCUSSION: In cases where the frequency of reporting patients with COVID-19 is high, health authorities should provide information regarding anti-data-leakage measures and coordinate frameworks for efficient, sustainable data collection. CONCLUSIONS: We obtained information on existing infrastructures for patient data sharing among care delivery institutions and public health authorities. Our findings may be referenced by the government to make informed decisions about investments.

Reopen Offline Business during a Pandemic? Characterization of Health Certificate Exchange for Human Movement Management

The COVID-19 pandemic has significantly restricted the regular offline business activities. Nevertheless, as certain offline business activities are still indispensable, to conduct offline business under pandemic control becomes a valuable research question. This paper addressed this problem by studying business movement management based on health certificate exchange. We first observed three patterns of health certificate exchange multiplicity that serve as a basis for business movement management. Then, we reviewed published literature along two orthogonal directions, health certificates and exchange systems. We studied different health certificates published during the COVID-19 pandemic to identify the categories of health certificates and their characteristics. Meanwhile, we further studied different design paradigms and characteristics of health certificate exchange systems. Last, we mapped our findings on health certificate exchange into the four challenges of movement management systems in a pandemic, namely flexible controllability, scalable accessibility, adaptive reusability, and spatiotemporal traceability, and conceptualized how such the requirements should be achieved and a complete system should operate. © 2021 IEEE.

The Cosmos Collaborative: A Vendor-Facilitated Electronic Health Record Data Aggregation Platform.

OBJECTIVE: Learning healthcare systems use routinely collected data to generate new evidence that informs future practice. While implementing an electronic health record (EHR) system can facilitate this goal for individual institutions, meaningfully aggregating data from multiple institutions can be more empowering. Cosmos is a cross-institution, single EHR vendor-facilitated data aggregation tool. This work aims to describe the initiative and illustrate its potential utility through several use cases. METHODS: Cosmos is designed to scale rapidly by leveraging preexisting agreements, clinical health information exchange networks, and data standards. Data are stored centrally as a limited dataset, but the customer facing query tool limits results to prevent patient reidentification. RESULTS: In 2 years, Cosmos grew to contain EHR data of more than 60 million patients. We present practical examples illustrating how Cosmos could further efforts in chronic disease surveillance (asthma and obesity), syndromic surveillance (seasonal influenza and the 2019 novel coronavirus), immunization adherence and adverse event reporting (human papilloma virus and measles, mumps, rubella, and varicella vaccination), and health services research (antibiotic usage for upper respiratory infection). DISCUSSION: A low barrier of entry for Cosmos allows for the rapid accumulation of multi-institutional and mostly de-duplicated EHR data to power research and quality improvement queries characteristic of learning healthcare systems. Limitations are being vendor-specific, an "all or none" contribution model, and the lack of control over queries run on an institution's healthcare data. CONCLUSION: Cosmos provides a model for within-vendor data standardization and aggregation and a steppingstone for broader intervendor interoperability.