Slide Presentation from the AHRQ 2008 Annual Conference
On September 9, 2008, Marc Overhage gave this presentation at the 2008 Annual Conference.
Select to access the PowerPoint® presentation (2.6 MB).
Slide 1
Blank Slide
Slide 2
Overcoming Barriers to Expanding Health Information Exchange (HIE)
Notes:
- The goal is to identify the gaps in understanding, barriers and disconnects that may exist with providers' adoption of, and membership in, the Indiana Network for Patient Care.
Slide 3
Health Information Exchange (HIE)
- Current system fragments patient information and creates redundant, inefficient efforts:
- Public health
- Primary care physician
- Specialty physician
- Ambulatory center (e.g. imaging centers)
- Payors
- Pharmacy
- Laboratory
- Hospitals
- Note: Icons for each of the above are placed around a circle composed of arrows pointing in every direction.
- Future system will consolidate information and provide a foundation for unifying efforts:
- Payers
- Public health
- Ambulatory centers
- Physician office
- Outpatient RX
- Labs
- Hospital
- Note: Icons for each of the above are placed around a circle which contains two images representing Data Repository and Network Applications. Arrows point from the icons to the circle which represents the Health Information Exchange.
Slide 4
Most Difficult Challenges for 42 Operational HIEs
The table shows:
- Developing a sustainable business model:
- Very Difficult Challenge: 15
- Moderately Difficult Challenge:15
- Total: 30
- Addressing technical aspects including architecture, applications and connectivity:
- Very Difficult Challenge: 4
- Moderately Difficult Challenge: 25
- Total: 29
- Defining the value that accrues to users:
- Very Difficult Challenge:14
- Moderately Difficult Challenge:15
- Total: 29
- Engaging practicing clinicians in your coverage area:
- Very Difficult Challenge: 0
- Moderately Difficult Challenge: 29
- Total: 29
- Addressing privacy and confidentiality issues—HIPAA and other:
- Very Difficult Challenge: 3
- Moderately Difficult Challenge: 24
- Total: 27
- Securing upfront funding:
- Very Difficult Challenge: 10
- Moderately Difficult Challenge: 16
- Total:26
- Note: eHealth Initiative: 2008 Survey on Health Information Exchange
Slide 5
The document image from "Research Brief: Findings from HSC and NIHCM Foundation," No. 2, February 2008, shows an article entitled "Creating Sustainable Local Health Information Exchanges: Can Barriers to Stakeholder Participation be Overcome?"
Notes:
- Four exchanges (IHIE, HB, CareSpark, Tampa Bay Regional Health Information Organizations [RHIO])
Slide 6
HIE Barriers
- Weigh benefits, upfront and ongoing costs of the business, legal and technical issues
- Concerns:
- Data will be used for marketing purposes
- Patients will be redirected to other providers
- Use of data for hospital performance measurement
- HIE data policies would make them non-compliant with federal patient privacy requirements
- Balance competitive strategies with playing good corporate citizen role
Slide 7
The map shows the State of Indiana with hospitals marked and the area around Indianapolis highlighted.
Slide 8
Block Randomized Sampling
The table shows:
- Small Hospitals:
- Initial Sample: 43
- Total INPC participant: 5
- Total previously contacted:16
- Total not previously contacted: 27
- Small Physician Groups:
- Initial Sample: 39
- Total INPC participant: 0
- Total previously contacted:0
- Total not previously contacted: 39
- Large Physician Groups:
- Initial Sample: 40
- Total INPC participant: 6
- Total previously contacted: 11
- Total not previously contacted: 29
Slide 9
Survey and Interview Guide Development
- Literature review and brainstorming to identify potential barriers
- Expert review and feedback
- Pilot with nine organizations
- Revised survey
- Office of Management and Budget (OMB) review
- Final survey
Slide 10
Data Collection
- Telephone Contact
- E-mail Packet
- HIE description and definition.
- Description of the INPC.
- Survey information:
- Web Survey
- Telephone Interview
Slide 11
The slide shows a pile of "HIE Non-Participants" surveys with notes made in the margins.
Slide 12
Analytical Methods
- A grounded theory approach will be used to identify emergent themes
- Grounded means "based on and connected to the context-dependent observations and perceptions of the social scene;" so the informants' own words will guide development of codes*
- Two individuals will independently review the field notes, annotating important themes in the margins
- Two other researchers will carefully review the documentation and note major themes
- The team will meet up to four times to reach consensus on identifying and naming the patterns and themes
- Note: *Crabtree BF, Miller WL. Doing Qualitative Research.
Newbury Park, CA, Sage, 1992.
Slide 13
Rural Hospital Informant's Words
- Rural hospital in Lawrence Co near Bloomington:
- Already have an interface from hospital system to their employed physicians' Electronic Medical Record (EMR) which provides most of the benefit to be received from an HIE.
- Costs
- Physicians not thrilled with change
- Rural hospital in Gibson Co in southwest IN:
- Not sure they understand the difference between and EMR and HIE?
- Need to upgrade bandwidth for communication
- Need help financially (grants)
- Need available IT staff
- Older MDs want paper—need to be sold
Slide 14
Rural Hospital Informant's Words
- Rural hospital between Ft Wayne and Muncie in Northwest IN:
- Not sure they understand difference between EMR and HIE
- Bandwidth is the largest issue
Slide 15
Physician Informant's Words
- Large specialty urban physician group in central IN:
- Physicians must see the benefit to THEM
- MDs "hold data close"
- Strategic IT projects are being addressed
- Large specialty urban physician group in central IN:
- Small specialty physician practice in southeastern IN:
Slide 16
Non-barriers
- Concerns about how their data will be used among hospitals:
- Competitive positioning
- For quality measurement
- For payment negotiations
- Patient privacy
- Critical mass of data
Current as of January 2009
Internet Citation:
Overcoming Barriers to Expanding HIE. Slide Presentation from the AHRQ 2008 Annual Conference (Text Version). January 2009. Agency
for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/annualmtg08/090908slides/Overhage.htm