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1.  Adapting Effective Narrative-based HIV Prevention Interventions to Increase Minorities’ Engagement in HIV/AIDS Services 
Health communication  2009;24(3):199-209.
Disparities related to barriers to care for HIV-positive and at-risk minorities continue to be a major public health problem. Adaptation of efficacious HIV prevention interventions for use as health communication innovations is a promising approach for increasing minorities’ utilization of HIV health and ancillary services. Role model stories, a widely-used, HIV prevention strategy, employ culturally tailored narratives to depict experiences of an individual modeling health risk reduction behaviors. This paper describes the careful development of a contextually appropriate role model story focused on increasing minorities’ engagement in HIV/AIDS health and related services. Findings from interviews with community members and focus groups with HIV-positive minorities indicated several barriers and facilitators related to engagement in HIV healthcare and disease management (e.g., patient/provider relationships) and guided the development of role model story narratives.
PMCID: PMC2746743  PMID: 19415552
2.  Building a children's health network: city-wide computer linkages among heterogeneous sites for pediatric primary care. 
For many infants and children in our cities, quality of care and health status outcomes suffer due to poor continuity and coordination among ambulatory care sites. Despite proximity to technologically-advanced secondary and tertiary institutions, primary care services for children are fragmented, multiple-site use is common, and data flow among providers serving the same patients is primitive. Preventive and acute health care is often incomplete or redundant, and aggregate information for public health purposes is insufficient. This paper focuses on the development of a city-wide computer-based pediatric health care network to improve provider decision-making and follow-through, parent role in their children's care, and community-wide data. A process of building consensus for a regional system is presented, addressing issues of establishing a uniform data base, coordination among heterogeneous institutions, system development, confidentiality, and integration with public health reporting and planning functions.
PMCID: PMC2247944  PMID: 7949985
3.  E-Prescribing: A Focused Review and New Approach to Addressing Safety in Pharmacies and Primary Care 
Research in social & administrative pharmacy : RSAP  2012;9(6):10.1016/j.sapharm.2012.09.004.
E-prescribing, the health information technology (HIT) that enables prescribers to electronically transmit prescriptions to community pharmacies has been touted as a solution for improving patient safety and overall quality of care. However, the impact of HIT, such as e-prescribing on medication errors in acute care settings has been widely studied and show that if poorly designed or implemented, HIT can pose a risk to patient safety by introducing a source of medication errors. Unlike acute care settings, safety issues related to e-prescribing in primary care settings (where e-prescriptions are generated and transmitted) and pharmacies (where e-prescriptions are received) have not received as much attention in the literature. This paper provides a focused review of patient safety issues related to using e-prescribing systems in primary care and pharmacies. In addition, the paper proposes using human factors engineering concepts to study e-prescribing safety in pharmacies and primary care settings to identify safety problems and recommendations for improvement.
PMCID: PMC3709012  PMID: 23062769
4.  A Conceptual Model for Health Care Information Systems 
The health care delivery system both needs and generates information in the course of providing service to its beneficiaries. The heightened interest of groups peripheral to the patient-provider relationship has resulted in ever increasing requests for information and serve to focus attention on the need for uniform data.
This paper describes initial efforts to identify and define a core grouping of health-care-related information which is expected to be of maximum use both to members of the health care team and external oversight agencies. To explore the concept of maximum utility, a model of the health care information system was postulated, and functional information categories identified. Application of other criteria resulted in identification of discrete items of information. Definitions and codes, where appropriate, are being developed. The potential usefulness of the concepts to the health care community at large are also discussed.
PMCID: PMC2231766
5.  Integrating Research, Surveillance, and Practice in Environmental Public Health Tracking 
Environmental Health Perspectives  2006;114(7):980-984.
The Centers for Disease Control and Prevention in the U.S. Department of Health and Human Services is working with selected state and local health departments, academic centers, and others to develop an environmental public health tracking initiative to improve geographic and temporal surveillance of environmental hazards, exposures, and related health outcomes. The objective is to support policy strategies and interventions for disease prevention by communities and environmental health agencies at the federal, state, and local levels. The first 3 years of the initiative focused on supporting states and cities in developing capacity, information technology infrastructure, and pilot projects to demonstrate electronic linkage of environmental hazard or exposure data and disease data. The next phase requires implementation across states. This transition could provide opportunities to further integrate research, surveillance, and practice through attention to four areas. The first is to develop a shared and transparent knowledge base that draws on environmental health research and substantiates decisions about what to track and the interpretation of results. The second is to identify and address information needs of policy and stakeholder audiences in environmental health. The third is to adopt mechanisms for coordination, decision making, and governance that can incorporate and support the major entities involved. The fourth is to promote disease prevention by systematically identifying and addressing population-level environmental determinants of health and disease.
PMCID: PMC1513336  PMID: 16835047
chronic disease; disease surveillance; environmental exposure; environmental health; environmental health indicators; environmental health policy; environmental monitoring; environmental public health tracking; population health; public health surveillance
6.  Doctor-patient communication in the e-health era 
The digital revolution will have a profound impact on how physicians and health care delivery organizations interact with patients and the community at-large. Over the coming decades, face-to-face patient/doctor contacts will become less common and exchanges between consumers and providers will increasingly be mediated by electronic devices.
In highly developed health care systems like those in Israel, the United States, and Europe, most aspects of the health care and consumer health experience are becoming supported by a wide array of technology such as electronic and personal health records (EHRs and PHRs), biometric & telemedicine devices, and consumer-focused wireless and wired Internet applications.
In an article in this issue, Peleg and Nazarenko report on a survey they fielded within Israel's largest integrated delivery system regarding patient views on the use of electronic communication with their doctors via direct-access mobile phones and e-mail. A previous complementary paper describes the parallel perspectives of the physician staff at the same organization. These two surveys offer useful insights to clinicians, managers, researchers, and policymakers on how best to integrate e-mail and direct-to-doctor mobile phones into their practice settings. These papers, along with several other recent Israeli studies on e-health, also provide an opportunity to step back and take stock of the dramatic impact that information & communication technology (ICT) and health information technology (HIT) will have on clinician/patient communication moving forward.
The main goals of this commentary are to describe the scope of this issue and to offer a framework for understanding the potential impact that e-health tools will have on provider/patient communication. It will be essential that clinicians, managers, policymakers, and researchers gain an increased understanding of this trend so that health care systems around the globe can adapt, adopt, and embrace these rapidly evolving digital technologies.
PMCID: PMC3461429  PMID: 22929000
E-health; Health informatics; Electronic health records; Physician-patient communication; Israel; E-mail; Telephone; Health information technology; Information and communication technology; Mobile health; Health care policy
7.  HIN5/439: A Web-based Information Sharing System for Patient Referral 
It is essential to have a proper health care delivery system for the efficient management of clinical resources for a nation. In Korea, we have observed numerous problems of missing or delaying clinical information when referring patients to a nearby secondary or tertiary care hospital. Patient referral is usually done at random but no reliable information is provided for appropriate care. Furthermore, no follow-up information is sent back to referring institutions when the care is completed such as discharge summary. The aim is therefore to develop and implement a Web-based information sharing system to facilitate health care delivery during the course of referring patient transfer.
Materials and Method:
Researchers first conducted a survey with clinicians to extract clinical expertise and relevant information to standardize a core set of information service protocols for sharing through the internet. Then, a model was proposed to distribute and share intra-hospital database among consenting networked clinicians around the region. The core set of protocols includes textual reports of laboratory test results, and imaging reports of endoscopy and diagnostic radiology procedures. Also, therapeutic and medication reports are also included.
The Web-based information sharing service is currently in use at patient referral center in Asian Medical Center, a tertiary care teaching hospital located in Seoul, Korea. So far, 11,587 patients were serviced in 1998. During hospitalization, each referring physician is given access code to check status of the referred patient. When the patient is discharged or transferred back to the referring institute, discharge summary and other adequate information are provided through simple file transfer.
We are eager to report the first implementation of a Web-based information sharing system for efficient patient referral services in Korea. Though an evaluation of the system performance is still in progress, we have found the system practically usable and cost-effective in clinical environment. Therefore we suggest that a web based information sharing technique would be a method of choice for improving the management and efficiency of health care delivery system.
PMCID: PMC1761729
Health Care Delivery; World wide web; Information system
8.  A practice-based information system for multi-disciplinary care of chronically ill patients: what information do we need? The Community Care Coordination Network Database Group. 
Primary care physicians provide longitudinal care for chronically ill individuals in concert with many other community-based disciplines. The care management of these individuals requires data not traditionally collected during the care of well, or acutely ill individuals. These data not only concern the patient, in the form of patient functional status, mental status and affect, but also pertain to the caregiver, home environment, and the formal community health and social service system. The goal of the Community Care Coordination Network is to build a primary care-based information system to share patient data and communicate patient related information among the community-based multi-disciplinary teams. One objective of the Community Care Coordination Network is to create a Community Care Database for chronically ill individuals by identifying those data elements necessary for efficient multi-disciplinary care.
PMCID: PMC2247887  PMID: 7949995
9.  Racial and Ethnic Disparities in the VA Health Care System: A Systematic Review 
To better understand the causes of racial disparities in health care, we reviewed and synthesized existing evidence related to disparities in the “equal access” Veterans Affairs (VA) health care system.
We systematically reviewed and synthesized evidence from studies comparing health care utilization and quality by race within the VA.
Racial disparities in the VA exist across a wide range of clinical areas and service types. Disparities appear most prevalent for medication adherence and surgery and other invasive procedures, processes that are likely to be affected by the quantity and quality of patient–provider communication, shared decision making, and patient participation. Studies indicate a variety of likely root causes of disparities including: racial differences in patients’ medical knowledge and information sources, trust and skepticism, levels of participation in health care interactions and decisions, and social support and resources; clinician judgment/bias; the racial/cultural milieu of health care settings; and differences in the quality of care at facilities attended by different racial groups.
Existing evidence from the VA indicates several promising targets for interventions to reduce racial disparities in the quality of health care.
PMCID: PMC2324157  PMID: 18301951
racial and ethnic disparities; medication adherence; health care utilization
10.  Care for post-stroke patients at Malaysian public health centres: self-reported practices of family medicine specialists 
BMC Family Practice  2014;15:40.
Provision of post stroke care in developing countries is hampered by discoordination of services and limited access to specialised care. Albeit shortcomings, primary care continues to provide post-stroke services in less than favourable circumstances. This paper aimed to review provision of post-stroke care and related problems among Family Medicine Specialists managing public primary health care services.
A semi-structured questionnaire was distributed to 121 Family Physicians servicing public funded health centres in a pilot survey focused on improving post stroke care provision at community level. The questionnaire assessed respondents background and practice details i.e. estimated stroke care burden, current service provision and opinion on service improvement. Means and frequencies described quantitative data. For qualitative data, constant comparison method was used until saturation of themes was reached.
Response rate of 48.8% was obtained. For every 100 patients seen at public healthcentres each month, 2 patients have stroke. Median number of stroke patients seen per month is 5 (IQR 2-10). 57.6% of respondents estimated total stroke patients treated per year at each centre was less than 40 patients. 72.4% lacked a standard care plan although 96.6% agreed one was needed. Patients seen were: discharged from tertiary care (88.1%), shared care plan with specialists (67.8%) and patients who developed stroke during follow up at primary care (64.4%). Follow-ups were done at 8-12 weekly intervals (60.3%) with 3.4% on ‘as needed’ basis. Referrals ranked in order of frequency were to physiotherapy services, dietitian and speech and language pathologists in public facilities. The FMS’ perceived 4 important ‘needs’ in managing stroke patients at primary care level; access to rehabilitation services, coordinated care between tertiary centres and primary care using multidisciplinary care approach, a standardized guideline and family and caregiver support.
Post discharge stroke care guidelines and access to rehabilitation services at primary care is needed for post stroke patients residing at home in the community.
PMCID: PMC3945040  PMID: 24580779
Post stroke; Primary care; Healthcare delivery
11.  Geographic Health Information Systems: A Platform To Support The ‘Triple Aim’ 
Health affairs (Project Hope)  2013;32(9):1608-1615.
Despite the rapid growth of electronic health data, most data systems do not connect individual patient records to data sets from outside the health care delivery system. These isolated data systems cannot support efforts to recognize or address how the physical and environmental context of each patient influences health choices and health outcomes. In this article we describe how a geographic health information system in Durham, North Carolina, links health system and social and environmental data via shared geography to provide a multidimensional understanding of individual and community health status and vulnerabilities. Geographic health information systems can be useful in supporting the Institute for Healthcare Improvement’s Triple Aim Initiative to improve the experience of care, improve the health of populations, and reduce per capita costs of health care. A geographic health information system can also provide a comprehensive information base for community health assessment and intervention for accountable care that includes the entire population of a geographic area.
PMCID: PMC4076782  PMID: 24019366
12.  In a maternity shared-care environment, what do we know about the paper hand-held and electronic health record: a systematic literature review 
The paper hand-held record (PHR) has been widely used as a tool to facilitate communication between health care providers and a pregnant woman. Since its inception in the 1950s, it has been described as a successful initiative, evolving to meet the needs of communities and their providers. Increasingly, the electronic health record (EHR) has dominated the healthcare arena and the maternity general practice shared-care arrangement seems to have adopted this initiative. A systematic review was conducted to determine perspectives of the PHR and the EHR with regards to data completeness; experiences of users and integration of care between women and health care providers.
A literature search was conducted that included papers from 1985 to 2012. Studies were chosen if they fulfilled the inclusion criteria, reporting on: data completeness; experiences of users and integration of care between women and health care providers. Papers were extracted by one reviewer in consultation with two reviewers with expertise in maternity e-health and independently assessed for quality.
A total of 43 papers were identified for the review, from an initial 6,816 potentially relevant publications. No papers were found that reported on data completeness in a maternity PHR or a maternity EHR, in a shared-care setting. Women described the PHR as important to their antenatal care and had a generally positive perception of using an EHR. Hospital clinicians reported generally positive experiences using a PHR, while both positive and negative impressions were found using an EHR. The few papers describing the use of the PHR and EHR by community clinicians were also divergent and inconclusive with regards to their experiences. In a general practice shared-care model, the PHR is a valuable tool for integration between the woman and the health care provider. While the EHR is an ideal initiative in the maternity setting, facilitating referrals and communication, there are issues of fragmentation and continued paper use.
There was a surprising gap in knowledge surrounding data completeness on maternity PHRs or EHRs. There is also a paucity of available impressions from community clinicians using both forms of the records.
PMCID: PMC3912922  PMID: 24475912
Paper hand-held record; Electronic health record; General practitioner; Maternity; Antenatal; Shared-care; Hospital clinician
13.  Curriculum Recommendations of the AACP-PSSC Task Force on Caring for the Underserved 
A task force was convened by the American Association of Colleges of Pharmacy (AACP) and the Pharmaceutical Services Support Center (PSSC) and charged with the development of a curriculum framework to guide pharmacy programs in educating students on caring for the underserved. Utilizing a literature-based model, the task force constructed a framework that delineated evidence-based practice, clinical prevention and health promotion, health systems and policy, and community aspects of practice. Specific learning outcomes tailored to underserved populations were crafted and linked to resources readily available to the academy.
The AACP-PSSC curriculum framework was shared with the academy in 2007. Schools and Colleges are urged to share experiences with implementation so that the impact of the tool can be evaluated. The task force recommends that the AACP Institutional Research Advisory Committee be involved in gathering assessment data. Implementation of the curriculum framework can help the academy fulfill the professional mandate to proactively provide the highest quality care to all, including underserved populations.
PMCID: PMC2508729  PMID: 18698398
underserved populations; curriculum; community-based learning
14.  Turning Vision into Reality: Successful Integration of Primary Healthcare in Taber, Canada 
Healthcare Policy  2007;3(1):80-95.
Primary healthcare offers significant benefits to Canadians and to the healthcare system as a whole. The Taber Integrated Primary Healthcare Project (TIPHP) was a three-year primary healthcare renewal initiative involving rural physicians and the Chinook Health Region in Taber, Alberta, Canada. The goal of the project was to improve healthcare services delivery through integration of the services provided by the physician group and the health region in one rural community. Four main enablers emerged as fundamental to the integration process: community assessment and shared planning; evidence-based, interdisciplinary care; an integrated electronic information system; and investment in processes and structures that support change.
The outcome of the project has been the implementation of a new model of healthcare delivery that embraces an integrated collaborative team approach in delivering population-based, primary healthcare. Importantly, the TIPHP has influenced regional healthcare policy related to primary healthcare renewal strategies and partnerships.
PMCID: PMC2645121  PMID: 19305757
15.  PAMFOnline: Integrating EHealth with an Electronic Medical Record System 
The Institute of Medicine stressed the need for continuous healing relationships, yet the delivery of health care has traditionally been confined to the physician office or hospital. We implemented an eHealth application tightly integrated with our electronic medical record system that provides patients with a convenient, continuously available communication channel to their physician’s office. Patients can view summary data from their medical record, including the results of diagnostic tests, and request medical advice, prescription renewals, appointments, or updates to their demographic information. We have found that patients embrace this new communication channel and are using the service appropriately. Patients especially value electronic messaging with their physicians and timely access to their test results. While initially concerned about an increase in work, physicians have found that use of electronic messaging can be an efficient method for handling non-urgent communication with their patients. Online tools for patients, when integrated with an electronic medical record, can provide patients with better access to health information, improve patient satisfaction, and improve operational efficiency.
PMCID: PMC1479999  PMID: 14728252
16.  Electronic exchange of discharge summaries between hospital and municipal care from health personnel's perspectives 
Information and communication technologies (ICT) are seen as potentially powerful tools that may promote integration of care across organisational boundaries. Here, we present findings from a study of a Norwegian project where an electronic interdisciplinary discharge summary was implemented to improve communication and information exchange between the municipal care service and the associated hospital.
To investigate the implications of introduction and use of the electronic discharge summary for health staff, and relate it to the potential for promoting integration of care across the hospital-municipality boundary.
We conducted semi-structured interviews with 49 health care providers. The material was analysed using a three-step process to identify the main themes and categories.
The study showed that the electronic discharge summary contributed to changes in health staff's work processes as well as increased legibility of summaries, and enabled municipal care staff to be better prepared for receiving patients, even though the information content mostly remained unaltered and was not always accurate.
Introduction of electronic discharge summaries did not result in a significant increase in integration of care. However, the project was a catalyst for the collaborating participants to address their interaction from new perspectives.
PMCID: PMC2859705  PMID: 20421964
integrated care; ICT; municipal health care; hospital; discharge summary; electronic message system
17.  The Last Mile: Using Fax Machines to Exchange Data between Clinicians and Public Health 
Online Journal of Public Health Informatics  2011;3(3):ojphi.v3i3.3892.
There is overlap in a wide range of activities to support both public health and clinical care. Examples include immunization registries (IR), newborn screening (NBS), disease reporting, lead screening programs, and more. Health information exchanges create an opportunity to share data between the clinical and public health environments, providing decision support to clinicians and surveillance and tracking information to public health. We developed mechanisms to support two-way communication between clinicians in the Indiana Health information Exchange (IHIE) and the Indiana State Department of Health (ISDH). This paper describes challenges we faced and design decisions made to overcome them.
We developed systems to help clinicians communicate with the ISDH IR and with the NBS program. Challenges included (1) a minority of clinicians who use electronic health records (EHR), (2) lack of universal patient identifiers, (3) identifying physicians responsible for newborns, and (4) designing around complex security policies and firewalls.
To communicate electronically with clinicians without EHRs, we utilize their fax machines. Our rule-based decision support system generates tailored forms that are automatically faxed to clinicians. The forms include coded input fields that capture data for automatic transfer into the IHIE when they are faxed back. Because the same individuals have different identifiers, and newborns’ names change, it is challenging to match patients across systems. We use a stochastic matching algorithm to link records. We scan electronic clinical messages (HL7 format) coming into IHIE to find clinicians responsible for newborns. We have designed an architecture to link IHIE, ISDH, and our systems.
PMCID: PMC3615797  PMID: 23569620
newborn; screening; informatics; public health; immunization; registry health information exchange
18.  Capturing Information Needs of Care Providers to Support Knowledge Sharing and Distributed Decision Making 
This paper reports on work carried out to elicit information needs at a trans-disciplinary, nurse-managed health care clinic that serves a medically disadvantaged urban population. The trans-disciplinary model provides a “one-stop shop” for patients who can receive a wide range of services beyond traditional primary care. However, this model of health care presents knowledge sharing challenges because little is known about how data collected from the non-traditional services can be integrated into the traditional electronic medical record (EMR) and shared with other care providers. There is also little known about how health information technology (HIT) can be used to support the workflow in such a practice.
The objective of this case study was to identify the information needs of care providers in order to inform the design of HIT to support knowledge sharing and distributed decision making.
A participatory design approach is presented as a successful technique to specify requirements for HIT applications that can support a trans-disciplinary model of care.
Using this design approach, the researchers identified the information needs of care providers working at the clinic and suggested HIT improvements to integrate non-traditional information into the EMR. These modifications allow knowledge sharing among care providers and support better health decisions.
We have identified information needs of care providers as they are relevant to the design of health information systems. As new technology is designed and integrated into various workflows it is clear that understanding information needs is crucial to acceptance of that technology.
PMCID: PMC3613015  PMID: 23616896
Information needs; participatory design; requirements analysis and design; clinical information technology; nursing workflow; provider-provider communications
19.  Advancing Personalized Health Care through Health Information Technology: An Update from the American Health Information Community's Personalized Health Care Workgroup 
The Personalized Health Care Workgroup of the American Health Information Community was formed to determine what is needed to promote standard reporting and incorporation of medical genetic/genomic tests and family health history data in electronic health records. The Workgroup has examined and clarified a range of issues related to this information, including interoperability standards and requirements for confidentiality, privacy, and security, in the course of developing recommendations to facilitate its capture, storage, transmission, and use in clinical decision support. The Workgroup is one of several appointed by the American Health Information Community to study high-priority issues related to the implementation of interoperable electronic health records in the United States. It is also a component of the U.S. Department of Health and Human Services' Personalized Health Care Initiative, which is designed to create a foundation upon which information technology that supports personalized, predictive, and pre-emptive health care can be built.
PMCID: PMC2442266  PMID: 18436899
20.  Improving drug abuse treatment delivery through adoption of harmonized electronic health record systems 
Substance abuse and rehabilitation  2011;2011(2):125-131.
A great divide currently exists between mainstream health care and specialty substance use disorders (SUD) treatment, concerning the coordination of care and sharing of medical information. Improving the coordination of SUD treatment with other disciplines of medicine will benefit SUD patients. The development and use of harmonized electronic health record systems (EHR) containing standardized person-level information will enable improved coordination of healthcare services. We attempt here to illuminate the urgent public health need to develop and implement at the national level harmonized EHR including data fields containing standardized vocabulary/terminologies relevant to SUD treatment. The many advantages and barriers to harmonized EHR implementation in SUD treatment service groups, and pathways to their successful implementation, are also discussed. As the US Federal Government incentivizes Medicare and Medicaid Service providers nationwide for “meaningful use” of health information technology (HIT) systems, relevant stakeholders may face relatively large and time-consuming processes to conform their local practices to meet the federal government’s “meaningful use” criteria unless they proactively implement data standards and elements consistent with those criteria. Incorporating consensus-based common data elements and standards relevant to SUD screening, diagnosis, and treatment into the federal government’s “meaningful use” criteria is an essential first step to develop necessary infrastructure for effective coordination of HIT systems among SUD treatment and other healthcare service providers to promote collaborative-care implementation of cost-effective, evidence-based treatments and to support program evaluations.
PMCID: PMC3149797  PMID: 21822398
electronic health records; substance use disorders treatment; addiction; dependence; research; Clinical Trials Network
21.  Improving drug abuse treatment delivery through adoption of harmonized electronic health record systems 
A great divide currently exists between mainstream health care and specialty substance use disorders (SUD) treatment, concerning the coordination of care and sharing of medical information. Improving the coordination of SUD treatment with other disciplines of medicine will benefit SUD patients. The development and use of harmonized electronic health record systems (EHR) containing standardized person-level information will enable improved coordination of healthcare services. We attempt here to illuminate the urgent public health need to develop and implement at the national level harmonized EHR including data fields containing standardized vocabulary/terminologies relevant to SUD treatment. The many advantages and barriers to harmonized EHR implementation in SUD treatment service groups, and pathways to their successful implementation, are also discussed. As the US Federal Government incentivizes Medicare and Medicaid Service providers nationwide for “meaningful use” of health information technology (HIT) systems, relevant stakeholders may face relatively large and time-consuming processes to conform their local practices to meet the federal government’s “meaningful use” criteria unless they proactively implement data standards and elements consistent with those criteria. Incorporating consensus-based common data elements and standards relevant to SUD screening, diagnosis, and treatment into the federal government’s “meaningful use” criteria is an essential first step to develop necessary infrastructure for effective coordination of HIT systems among SUD treatment and other healthcare service providers to promote collaborative-care implementation of cost-effective, evidence-based treatments and to support program evaluations.
PMCID: PMC3149797  PMID: 21822398
electronic health records; substance use disorders treatment; addiction; dependence; research; Clinical Trials Network
22.  Impact of a Clinical Decision Support System on Pharmacy Clinical Interventions, Documentation Efforts, and Costs 
Hospital Pharmacy  2013;48(9):744-752.
Health care organizations are turning to electronic clinical decision support systems (CDSSs) to increase quality of patient care and promote a safer environment. A CDSS is a promising approach to the aggregation and use of patient data to identify patients who would most benefit from interventions by pharmacy clinicians. However, there are limited published reports describing the impact of CDSS on clinical pharmacy measures. In February 2011, Good Shepherd Medical Center, a 425-bed acute care community hospital in East Texas, implemented a CDSS (TheraDoc clinical surveillance system). Prior to CDSS implementation, clinicians struggled with obtaining and documenting the data needed to support clinical initiatives. The value of having both clinical and staff pharmacists utilizing the CDSS has improved communication and knowledge among staff and improved relationships with medical staff, nursing, and case management. The department of pharmacy increased its clinical interventions from an average of 1,986 per month to 4,065 per month; this represents a 105% increase in the number of interventions. The annual estimated cost savings after CDSS implementation is $2,999,508, representing a 96% increase per year and translating into a $1,469,907 annual return on investment.
PMCID: PMC3857121  PMID: 24421548
antibiotic stewardship; clinical decision support system; costs; documentation; interventions; pharmacy; surveillance
23.  Pediatric Hospital Medicine and Children with Medical Complexity: Past, Present, and Future 
Children with medical complexity, regardless of underlying diagnoses, share similar functional and resource use consequences, including: intensive service needs, reliance on technology, polypharmacy, and/or home care or congregate care to maintain a basic quality of life, high health resource utilization, and, an elevated need for care coordination. The emerging field of complex care is focused on the holistic medical care of these children, which requires both broad general pediatrics skills and specific expertise in care coordination and communication with patients, families, and other medical and non-medical care providers. Many pediatric hospitalists have developed an interest in care coordination for CMC, and pediatric hospitalists are in an ideal location to embrace complex care. As a result of these factors, complex care has emerged as a field with many pediatric hospitalists at the helm, in arenas ranging from clinical care of these patients, research into their care, and education of future providers. The objective of this section of the review article is to outline the past, present, and possible future of children with medical complexity within several arenas in the field of pediatric hospital medicine, including practice management, clinical care, research, education, and quality improvement.
PMCID: PMC3359150  PMID: 22483081
24.  Developing a good practice model to evaluate the effectiveness of comprehensive primary health care in local communities 
BMC Family Practice  2014;15:99.
This paper describes the development of a model of Comprehensive Primary Health Care (CPHC) applicable to the Australian context. CPHC holds promise as an effective model of health system organization able to improve population health and increase health equity. However, there is little literature that describes and evaluates CPHC as a whole, with most evaluation focusing on specific programs. The lack of a consensus on what constitutes CPHC, and the complex and context-sensitive nature of CPHC are all barriers to evaluation.
The research was undertaken in partnership with six Australian primary health care services: four state government funded and managed services, one sexual health non-government organization, and one Aboriginal community controlled health service. A draft model was crafted combining program logic and theory-based approaches, drawing on relevant literature, 68 interviews with primary health care service staff, and researcher experience. The model was then refined through an iterative process involving two to three workshops at each of the six participating primary health care services, engaging health service staff, regional health executives and central health department staff.
The resultant Southgate Model of CPHC in Australia model articulates the theory of change of how and why CPHC service components and activities, based on the theory, evidence and values which underpin a CPHC approach, are likely to lead to individual and population health outcomes and increased health equity. The model captures the importance of context, the mechanisms of CPHC, and the space for action services have to work within. The process of development engendered and supported collaborative relationships between researchers and stakeholders and the product provided a description of CPHC as a whole and a framework for evaluation. The model was endorsed at a research symposium involving investigators, service staff, and key stakeholders.
The development of a theory-based program logic model provided a framework for evaluation that allows the tracking of progress towards desired outcomes and exploration of the particular aspects of context and mechanisms that produce outcomes. This is important because there are no existing models which enable the evaluation of CPHC services in their entirety.
PMCID: PMC4038362  PMID: 24885812
25.  Practical considerations to guide development of access controls and decision support for genetic information in electronic medical records 
Genetic testing is increasingly used as a tool throughout the health care system. In 2011 the number of clinically available genetic tests is approaching 2,000, and wide variation exists between these tests in their sensitivity, specificity, and clinical implications, as well as the potential for discrimination based on the results.
As health care systems increasingly implement electronic medical record systems (EMRs) they must carefully consider how to use information from this wide spectrum of genetic tests, with whom to share information, and how to provide decision support for clinicians to properly interpret the information. Although some characteristics of genetic tests overlap with other medical test results, there are reasons to make genetic test results widely available to health care providers and counterbalancing reasons to restrict access to these test results to honor patient preferences, and avoid distracting or confusing clinicians with irrelevant but complex information. Electronic medical records can facilitate and provide reasonable restrictions on access to genetic test results and deliver education and decision support tools to guide appropriate interpretation and use.
This paper will serve to review some of the key characteristics of genetic tests as they relate to design of access control and decision support of genetic test information in the EMR, emphasizing the clear need for health information technology (HIT) to be part of optimal implementation of genetic medicine, and the importance of understanding key characteristics of genetic tests when designing HIT applications.
PMCID: PMC3229457  PMID: 22047175
genetic tests; electronic medical records; privacy; storage of genetic information; access to genetic information; types of genetic information

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