Presentation for RADS 601 ( Health Informatics and Health Information Technology ) - 20/11/19 Student of Master of Science in Data Science for Healthcare ( International Program ) ( Clinical Epidemiology and Biostatistics, Mahidol University, Thailand )

1. Evidences base for Health
Information Exchange
Htun Teza
6238135 RADS/M
RADS601 : Health Informatics and Health Information Technology

3. • 26 studies are conducted in United States
• Canada, Finland and Israel have 2 publications
• Each for Canada and South Korea

4. For Use of HIE

5. State of Minnesota HIE Model
1. Push
2. Pull
3. Query
4. Integrate

6. State Certified HIE service provider
• Health Information Organization (HIO): oversees,
governs, and facilitates HIE among providers
• Health Data Intermediary (HDI): provides the
technical capabilities or related products and
services to enable HIE among providers

9. According to ONC 2018 data brief (no. 43)
• In United States, 7 in 10 hospitals participate in at
least one nation-wide health information network.
• Stand alone or third party health information
system programs (Health Data Intermediary) are
most common way to exchange.

10. According to the paper,
In ambulatory setting, HIE is more likely to be adopted by
• Larger practice size
• Multispecialty rather than single specialty
• Owned by a system or a chain, rather than privately
owned by a physician
• Non-profits rather than for-profit entities

12. To engage in HIE, EHR system have to
• extract relevant information;
• package it in standardized formats;
• securely send to another organization and
• receive information from another source,
either directly or through an intermediary such as an HIE Service
Provider,
• store received information for later use or integrate the information into the
EHR system/workflow.

13. Commonly cited barriers to use or adopt HIE systems
• Incomplete patient information
• Inefficient workflow
• Poorly designed interface and update features

14. Internal organization environments are facilitators for
implementations.
• Leadership
• IT Readiness
• Desire of expected outcomes from HIE
• Selection of HIE functions most likely to have financial
benefits

15. Sustainability
• The greatest barrier is competition
• Limits collaboration, which is necessary to support
HIE system
• It is to be regulated by law, such as HITECH act

16. “asking Amazon to share
their data with
Walmart.”
David Blumenthal, M.D.
National HIT Coordinator
ONC
2009-2011

17. • Office of the National Coordinator for Health
Information Technology (ONC) was established in
2004, by executive order 13335
• Health Information Technology for Economic and
Clinical Health Act (HITECH Act) of 2009

18. Adoption of EHR in acute hospitals since HITECH

19. Adoption of HER in office based physicians since
HITECH

20. For effectiveness of HIE

21. ONC vision

22. • The author tried to analyze 136 publications from 6
countries
• Even that, conflicting results albeit not
contradicting

23. • Difficult to study
• Difficult to conclude
• For each ‘negative’ study, there is at least one
‘positive’ one

24. • Retrospective or Prospective
• To compare the effects of using or not using of HIE
• Retrospective studies have limited conclusions
• RCT have highly specific focus, and HIE have wide
range of purposes

25. • Retrospective Studies are the majority
• Associating of HIE use with one clinical variable
• All studies on direct effects, but not the overall
effect

26. Ambulatory setting
• It shows improved quality of care
• 1 RCT studies shows HIE increases the ability to
detect medication adherence problems
• But shows no improvement after being identified
and addressed

27. Hospital Admissions and Readmissions
• 3 studies show reduced hospital admissions
• Another 3 studies show no such results

28. Laboratory and Radiology testing
• In ED studies, reduced duplicative tests
• Shows reduced ED costs per patient
• But does it reduce overall expenditure?
• In ambulatory setting, one study shows increased
rate of lab tests, but another shows a reduction.

29. Three studies show association of HIE with
• Reduction of time for processing of social security
disability claims
• Identification of frequent ED users
• Improved patient satisfaction scores in hospitals

30. Public Health setting
• Improved automated laboratory reporting
• Improved completeness of reporting for notifiable
diseases, such as outbreaks
• Improved identification of HIV patients

31. "You need information to be able to
do population health management.
You can serve an individual quite
well; you can deliver excellent
customer service if you wait for
someone to walk through the door
and then you go and pull their chart.
What you can't do with paper charts
is ask the question, 'Who didn't walk
in the door?'
Dr. Farzad Mostashari
National Coordinator
ONC 2011-2013

32. • Current studies suggest some benefits
• For reducing the use of some resources
• For improving the quality of care

33. Conclusion
• While the barriers for using HIE systems as stated
before exists, the only way to overcome such
barriers is to use the system

34. • Physicians who took the time to switch to EHRs in the early days
of the HITECH Act—back when they were still being incentivized
rather than penalized—are far ahead of physicians who resisted
the change
• They’re seeing the benefits to their practices and their patients,
and are also much better positioned for future developments
• your only real option is to stop resisting the change

35. • For now, HIE systems are not mature enough
• Currently are not sufficiently studied
• While we believe that HIEs are critical to the continuity
of care and benefits for patients and providers, little
evidence exists based on current studies
• They are non conclusive

36. • Future studies need to address more
comprehensive questions
• More rigorous study designs
• More systematic approach to studying HIE

37. • Prospective studies in mature HIE settings
• Assessing patients who are more likely to benefit for
HIE
• Comparing appropriate outcomes for use and non-use
of HIE
• Overall outcomes, impacts, benefits or harms are still
needed to be studied

38. Thank You
Questions?