Status of health information exchange: a comparison of six countries

Payne, Thomas H.; Lovis, Christian; Gutteridge, Charles; Pagliari, Claudia; Natarajan, Shivam; Cui, Yong; Zhao, Lueping

doi:10.7189/jogh.09.020427

Cited by 51 publications

(44 citation statements)

References 17 publications

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“…The proposed model offers hospitals a focused EHR development model that can positively impact the adoption and use of EHRs by overcoming information system design barriers and contribute to improved data quality and data use. 22 The study findings and the proposed HDX model fulfill the requirements for a health information exchange (HIE) outlined in a recent study, 21 which compared the status of HIEs in six countries, including India. The study used exemplar HIE scenarios focusing on the transfer of care and referral, and mentioned that HIE requires electronic medical record systems or other systems to gather clinical information (at both the point of capture and at the recipient organizations), incentives, secure networks for HIE, and appropriate policy and regulatory environments.…”

Section: Discussionmentioning

confidence: 74%

“…Although an effective and efficient electronic HDX is an important health system strengthening goal for most countries, there is wide variation in what countries have been able to achieve, especially in LMICs like India. 21 The HDX model presented here shows how different workflows in hospitals can be connected through an EHR network to create an EHR for a patient. The EHR network can integrate patient data from administrative, billing, clinical, nursing, laboratory, pharmacy, and radiology systems.…”

Section: Discussionmentioning

confidence: 99%

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Standard health data exchange model enables the use and reuse of data to improve maternal health programs and services: a case study from India

Kumar

Mostafa

2021

Journal of Global Health Reports

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BackgroundThe evidence on development of a health data exchange (HDX) in India is lacking, both in terms of the use of data for patient care (use) and aggregate data use (reuse) to improve maternal health services and programs. This study describes the requirements and proposes an HDX model development, focused on the adoption and use of design standardization. MethodsA landscape analysis was conducted through a literature review to understand the existing HDX models. A qualitative case study focusing on a tertiary care state government hospital in India was performed. Twenty key informants were selected through purposive sampling and virtual interviews were undertaken. A mix of deductive and primarily inductive data analysis was conducted using the NVIVO 12.0 software. FindingsFollowing an iterative design process and based on the essential requirements suggested by the key informants, an inter-organizational HDX scheme was developed. The HDX model leverages the electronic health records to enable the use of data for patient care, and use of aggregate patient data to support management and administrative decisions at the institutional, state-wide and national levels. The model describes how to balance the inter-organizational and intra-organizational data exchange needs. Integrating systems at the local level with those at the state and the national level was identified as one of the key components of this process. ConclusionsThe patient-level data is critical for the delivery of best attainable health care. At the same time, the aggregate data is critical, especially in the domain of decision-making and global health. The development of a versatile HDX model is a pre-requisite for a successful use and reuse of data, by ensuring that no functionality is lost and that the data is used in the best way possible.Electronic health records (EHRs) are essential to a health services-oriented digital health framework 1 that strengthens health systems and improves the access, equity, safety, and quality of health services. However, the uptake of EHRs has been limited, despite the World Health Organization (WHO) publishing an EHR manual for lower-and middle-income countries (LMICs) more than a decade ago. 2 National EHRs are a high priority in high-income countries and there has been broad adoption of EHRs across different levels of healthcare service delivery in these countries. However, the development and use of modern EHR systems in LMICs are nascent or nonexistent. 3 EHRs enable the capture, analysis, use, and exchange of patient-level data for both patient care and population health management. 4,5 Yet, LMICs have limited capacity for health data exchange (HDX) across organizational boundaries. 6 A recent report by the WHO and United Nations Children's Fund highlights the limited or absence of data exchange capabilities in LMICs. 7 International donors and governments are increasingly prioritizing investments to support the use of patient data captured in EHRs for patient care and their reuse in the aggregate form fo...

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Standard health data exchange model enables the use and reuse of data to improve maternal health programs and services: a case study from India

Kumar

Mostafa

2021

Journal of Global Health Reports

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“…Similarly, previous studies have cited several limitations and barriers to implementing and maintaining HIE systems. [33][34][35][36] However, most previous HIE studies have been observational, which has the potential to underestimate benefits due to selection bias and confounding influences. Conversely, RCTs have suggested that HIE can improve health care delivery by identifying medication discrepancies, previous test results, and changes in various clinical parameters over time.…”

Section: Discussionmentioning

confidence: 99%

Health Information Exchange between Specialists and General Practitioners Benefits Rural Patients

et al. 2021

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Background Health information exchange (HIE) may improve diagnostic accuracy, treatment efficacy, and safety by providing treating physicians with expert advice. However, most previous studies on HIE have been observational in nature. Objectives To examine whether collaboration between specialists and general practitioners (GPs) in rural areas via HIE can improve outcomes among patients at low-to-moderate risk of cardiovascular disease, kidney disease, and stroke. Methods In this randomized controlled trial, the Miyagi Medical and Welfare Information Network was used for HIE. We evaluated the clinical data of 1,092 patients aged ≥65 years living in the rural areas of the Miyagi Prefecture and receiving care from GPs only. High-risk patients were immediately referred to specialists, whereas low-to-moderate risk patients were randomly assigned to an intervention group in which GPs were advised by specialists through HIE (n = 518, 38% male, mean age = 76 ± 7 years) or a control group in which GPs received no advice by specialists (n = 521, 39% male, mean age = 75 ± 7 years). Results In the intention-to-treat analysis, all-cause mortality and cumulative incidence of serious adverse events (e.g., hospital admission or unexpected referral to specialists) did not differ between the groups. However, per-protocol analysis controlling for GP adherence with specialist recommendations revealed significantly reduced all-cause mortality (p = 0.04) and cumulative serious adverse event incidence (p = 0.04) in the intervention group compared with the control group. Conclusion HIE systems may improve outcomes among low-to-moderate risk patients by promoting greater collaboration between specialists and GPs, particularly in rural areas with few local specialists.

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“…Additionally, increasing demand for exchanging electronic health records and medical images has made the growth of healthcare information networks indispensable. Many countries have built [17][18][19] or are developing [20][21][22] their national healthcare information network. Such a system provides a common platform for information exchange across diverse healthcare entities.…”

Section: Introductionmentioning

confidence: 99%

Designing a novel hybrid healthcare teleconsultation network: a benchtop study of telepathology in Iran and a systematic review

Taghipour

Sepehri

2020

BMC Med Inform Decis Mak

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Background: Growing demand for medical services has increased patient waiting time due to the limited number or unbalanced distribution of healthcare centers. Healthcare teleconsultation networks are one of the potentially powerful systems to overcome this problem. Medical pathology can hugely benefit from teleconsultation networks because having second opinions is precious for many cases; however, resource planning (i.e., assignment and distribution of pathology consultation requests) is challenging due to bulky medical images of patients. This results in high setup and operational costs. The aim of this study is to design an optimal teleconsultation network for pathology labs under the supervision of medical sciences universities in Tehran, Iran. Methods: To avoid the setup cost, we first propose a modified hybrid peer-to-peer (P2P) overlay architecture for our telepathology network, using Iran's National Healthcare Information Network (SHAMS) as the underlying infrastructure. Then we apply optimization techniques to solve the request assignment and distribution problems in the network. Finally, we present a novel mathematical model with the objective of minimizing the variable operational costs of the system. Results: The efficiency of the proposed method was evaluated by a set of practical-sized network instances simulated based on the characteristics of SHAMS. The results show that the presented model and architecture can obtain optimal solutions for network instances up to 350 nodes, which covers our target network. Conclusions: We believe that the proposed method can be beneficial for designing large-scale medical teleconsultation networks by adjusting the constraints according to the rules and conditions of each country. Our findings showed that teleconsultation networks in countries with strong information technology (IT) infrastructures are under the influence of consultation fees, while in countries with weak IT infrastructure, the transmission costs are more critical. To the best of our knowledge, no research has so far addressed resource planning in medical teleconsultation networks using optimization techniques. Besides, the target network, i.e., pathology labs under the supervision of medical sciences universities in Tehran and the SHAMS network, are discussed for the first time in this work.

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Status of health information exchange: a comparison of six countries

Cited by 51 publications

References 17 publications

Standard health data exchange model enables the use and reuse of data to improve maternal health programs and services: a case study from India

Standard health data exchange model enables the use and reuse of data to improve maternal health programs and services: a case study from India

Health Information Exchange between Specialists and General Practitioners Benefits Rural Patients

Designing a novel hybrid healthcare teleconsultation network: a benchtop study of telepathology in Iran and a systematic review

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