Local health department adoption of electronic health records and health information exchanges and its impact on population health.

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.

Utilizing telemedicine in oncology settings: Patient favourability rates and perceptions of use analysis using Chi-Square and neural networks.

BACKGROUND: Telemedicine is an alternative to traditional face-to-face doctor-patient office visits. Although telemedicine is becoming more prevalent, few studies have looked at the perceived favorability rate among patients utilizing telemedicine over the traditional office visit to a provider's office considering data samples from more than 5 clinics in northern Louisiana. OBJECTIVE: This study aims to measure patient favorability of using telemedicine to receive care. This study looks at the perceived positive and negative favorability rates of patients in the oncology settings. The researchers analyzed how age, income level, and education level influenced the perceived patient favorability rates and their willingness to utilize telemedicine. METHODS: The investigators used Chi-Square analysis to identify favorability with respect to age education and income levels. In addition to this Artificial Neural Networks were used to identify the threshold for favorability with respect to age, income, and education. RESULTS: Chi-Square tests of association showed that of the variables analyzed, only education level had a statistically significant relationship with a patient's favorability rate of telemedicine utilization. While our neural network analysis indicated that the threshold for income, age, and education are $34,999, 66 years, and a college degree. CONCLUSION: In this article the investigators have successfully demonstrated the use of Artificial Neural Networks in identifying favorability of telemedicine used in addition to the traditional statistical methods such as Chi-Square. Thereby, creating a path for future research using advanced computational techniques like Artificial Neural Networks in analyzing human behavior.

EHR implementation in a new clinic: a case study of clinician perceptions.

Driven by the Health Information Technology for Economic and Clinical Health (HITECH) Act large numbers of physicians and hospitals are now implementing electronic health records (EHR) with the general expectation that such systems will improve the quality, safety and efficiency of health care services. Studies of conversions from paper to electronic records paint a mixed picture with healthcare providers pleased with some aspects of their EHRs but dissatisfied with others. These prior studies focused on conversions from paper to electronic records. Many provider impressions, therefore, may have been influenced by reactions to the process of being required to change well established patterns. In order to help separate such reactions from true evaluations of the efficacy of the EHR, we decided to survey the providers in a new health center. To insure that the information gathered was not merely anecdotal, we used a well-established format starting with a semi-structured interview which facilitates analysis and recognition of major themes. We included questions around several important areas including workflow, communication, patient satisfaction, productivity, documentation, and quality of care. Ten main themes emerged: impeding patient flow, hindering communication in office, improving communication after the visit, improving tracking of patient care, spending less time with patients, requiring more training, wanting more features, diminishing productivity, appreciating benefits of templates, and enhancing internal communication. The need for better training appeared to be of especially high importance as it impacted several of the other themes. We believe that our study helps validate the similar concerns expressed in studies of transitions from paper to electronic record systems. Our method may be generally useful to other clinics because it facilitates timely recognition of themes, both positive and negative, that clinicians and clinic managers would want to know at an early stage. Prompt knowledge of such developing themes may help to accentuate the positive aspects of the EHR and to prevent negative themes from developing into serious problems that might be considered serious unintended consequences of EHR usage.

Mitigating error vulnerability at the transition of care through the use of health IT applications.

Adverse drug events are largely considered to be errors in which the severity of effects could be lessened or even prevented through more effective medication reconciliation practices. Transitions of care, particularly at the time of discharge from the hospital, represent a time of heightened error vulnerability that contributes to medication discrepancy occurrences. The observed vulnerability can be attributed to communication and care continuity gaps across health care settings and can often lead to preventable errors. Health IT tools developed through research can identify factors which increase the risk of medication discrepancies. Additionally, the implementations of optimized clinical workflow processes to form effective transitions of care are approaches to decreasing medication discrepancies which may lead to adverse drug events. While federal policies and certifying organizations have implemented quality initiatives to increase focus on medication reconciliation practices in the hospital and primary care settings, the same practices must be implemented after a patient is discharged to their homes or another health care facility in order to mitigate error vulnerabilities that occur at the transition of care. This paper provides an overview of health IT system capabilities and their applications within and across health care delivery settings to facilitate care coordination to ensure continuity of care.