Interoperability among hospitals treating populations that have been marginalized

Objectives To understand how health-related social needs (HRSN) data are collected at US hospitals and implications for use. Materials and Methods Using 2023 nationally representative survey data on US hospitals (N = 2775), we described hospitals’ routine and structured collection and use of HRSN data and examined the relationship between methods of data collection and specific uses. Multivariate logistic regression was used to identify characteristics associated with data collection and use and understand how methods of data collection relate to use. Results In 2023, 88% of hospitals collected HRSN data (64% routinely, 72% structured). While hospitals commonly used data for internal purposes (eg, discharge planning, 79%), those that collected data routinely and in a structured format (58%) used data for purposes involving coordination or exchange with other organizations (eg, making referrals, 74%) at higher rates than hospitals that collected data but not routinely or in a non-structured format (eg, 93% vs 67% for referrals, P< .05). In multivariate regression, routine and structured data collection was positively associated with all uses of data examined. Hospital location, ownership, system-affiliation, value-based care participation, and critical access designation were associated with HRSN data collection, but only system-affiliation was consistently (positively) associated with use. Discussion While most hospitals screen for social needs, fewer collect data routinely and in a structured format that would facilitate downstream use. Routine and structured data collection was associated with greater use, particularly for secondary purposes. Conclusion Routine and structured screening may result in more actionable data that facilitates use for various purposes that support patient care and improve community and population health, indicating the importance of continuing efforts to increase routine screening and standardize HRSN data collection.

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Barriers and facilitators of the use of clinical informatics resources to facilitate pharmacogenomic implementation in resource-limited settings

Bosic-Reiniger,

Martin,

Brown

et al. 2024

JAMIA Open

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Objective Understand perceived barriers to and facilitators of using clinical informatics applications for pharmacogenomic (PGx) implementation in resource-limited settings. Materials and Methods We conducted a qualitative research study using a semi-structured interview guide informed by the Consolidated Framework for Implementation Research (CFIR). Interview questions assessed CFIR contextual determinants related to: electronic health record (EHR) infrastructure; clinical informatics personnel and resources; EHR integration of PGx test results; PGx clinical decision support (CDS) tools; institutional resources; and partner receptivity. Transcripts were coded and analyzed to identify themes. Results We interviewed 24 clinical informaticists and executive leaders working in rural or underserved health care settings in Montana (n = 15) and Colorado (n = 9) and identified three major themes: (1) EHR infrastructure limitations, (2) insufficient supporting resources, and (3) unique contextual considerations for resource-limited settings. EHR infrastructure limitations included limited agency related to EHR build and interoperability concerns. Theme 1 highlighted challenges associated with integrating structured data into the EHR and inadequate vendor support. Theme 2 included limited familiarity with PGx across the care team, cost concerns, and allocation of non-financial resources. Theme 3 highlighted perceptions about the clinical utility of PGx within rural and underrepresented populations. Potential facilitators, such as being able to act nimbly, were found to coexist among the reported barriers. Discussion and Conclusion Our results provide insight into the clinical informatics infrastructure in resource-limited settings and identify unique considerations for clinical informatics-facilitated PGx implementation. Future efforts in these settings should consider innovative partnerships and strategies to leverage facilitators and minimize barriers associated with integrating PGx CDS applications.

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Interoperability among hospitals treating populations that have been marginalized

Abstract: Objective: To test whether differences in hospital interoperability are related to the extent to which hospitals treat groups that have been economically and socially marginalized.

Cited by 4 publications

References 29 publications

Real-Time Prescription Benefit Tool Adoption Among US Hospitals

Real-Time Prescription Benefit Tool Adoption Among US Hospitals

The role of routine and structured social needs data collection in improving care in US hospitals

Barriers and facilitators of the use of clinical informatics resources to facilitate pharmacogenomic implementation in resource-limited settings

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