US regional health information organizations and the nationwide health information network: any lessons for Canadians?

The creation of regional clinical data exchanges (usually referred to as RHIOs) is a centerpiece of the US national healthcare information technology strategy. How well are they doing and what lessons can we learn that might be applied here in Canada?     

Which health information systems for the evaluation of health actions?

The evaluation of health actions requires large amounts of information allowing an assessment of relevance, coherence, efficacy, efficiency and impact of these interventions. Information systems should support evaluation processes by helping to obtain pertinent indicators, tracers and standard operating procedures. To reach this objective, specific functions need to be implemented, including traceability, documentation, investigation and scientific awareness. But this supposes that health information systems respect quality criteria that this article defines. The following criteria are considered: simplicity, validity, acceptability, informative value, representativeness, continuity, reactivity, fluidity, flexibility of the system, and also confidentiality of information. The historical developments of medical informatics have induced the creation of independent information systems, answering to specific objectives. This lack of integration is an obstacle to the evaluation of health actions because of the difficulty to view transversally and longitudinally the sequence of actions for a same patient. Thus integrated health information systems, organised around patient care episodes, are necessary to support evaluation and to contribute effectively to decision making in public health, because the evaluation of health actions implies the availability of information about the individuals who are the targets of these actions.     

Meeting the health information needs of health workers: what have we learned?

The information challenges facing health workers worldwide include lack of routine systems for seeking and sharing information, lack of high-quality and current health information, and lack of locally relevant materials and tools. This issue of Journal of Health Communication presents three studies of health information needs in India, Senegal, and Malawi that demonstrate these information challenges, provide additional insight, and describe innovative strategies to improve knowledge and information sharing. Results confirm that health workers' information needs differ on the basis of the level of the health system in which a health worker is located, regardless of country or cultural context. Data also reveal that communication channels tailored to health workers' needs and preferences are vital for improving information access and knowledge sharing. Meetings remain the way that most health workers communicate with each other, although technical working groups, professional associations, and networks also play strong roles in information and knowledge sharing. Study findings also confirm health workers' need for up-to-date, simple information in formats useful for policy development, program management, and service delivery. It is important to note that data demonstrate a persistent need for a variety of information types--from research syntheses, to job aids, to case studies--and suggest the need to invest in multifaceted knowledge management systems and approaches that take advantage of expanding technology, especially mobile phones; support existing professional and social networks; and are tailored to the varying needs of health professionals across health systems. These common lessons can be universally applied to expand health workers' access to reliable, practical, evidence-based information.     

Grand challenges of public health: How can health information systems support facing them?

Objectives

Achieving Universal Health Coverage (UHC) and establishing robust Civil Registration and Vital Statistics (CRVS) systems are two urgent priorities and grand challenges of global health, especially in Low and Middle Income Countries (LMICs). It is argued that addressing both these priorities requires strong supportive Health Information Systems (HIS), which to date have been elusive to develop.

Does participation in health information exchange improve hospital efficiency?

The federal government allocated nearly $30 billion to spur the development of information technology infrastructure capable of supporting the exchange of interoperable clinical data, leading to growth in hospital participation in health information exchange (HIE) networks. HIEs have the potential to improve care coordination across healthcare providers, leading ultimately to increased productivity of health services for hospitals. However, the impact of HIE participation on hospital efficiency remains unclear. This dynamic prompts the question asked by this study: does HIE participation improve hospital efficiency. This study estimates the effect of HIE participation on efficiency using a national sample of 1017 hospitals from 2009 to 2012. Using a two-stage analytic design, efficiency indices were determined using the Malmquist algorithm and then regressed on a set of hospital characteristics. Results suggest that any participation in HIE can improve both technical efficiency change and total factor productivity (TFP). A second model examining total years of HIE participation shows a benefit of one and three years of participation on TFP. These results suggest that hospital investment in HIE participation may be a useful strategy to improve hospital operational performance, and that policy should continue to support increased participation and use of HIE. More research is needed to identify the exact mechanisms through which HIE participation can improve hospital efficiency.     

Which components of health information technology will drive financial value?

Objectives: The financial effects of electronic health records (EHRs) and health information exchange (HIE) are largely unknown, despite unprecedented federal incentives for their use. We sought to understand which components of EHRs and HIE are most likely to drive financial savings in the ambulatory, inpatient, and emergency department settings. Study Design: Framework development and a national expert panel. Methods: We searched the literature to identify functionalities enabled by EHRs and HIE across the 3 healthcare settings. We rated each of 233 functionality-setting combinations on their likelihood of having a positive financial effect. We validated the top-scoring functionalities with a panel of 28 national experts, and we compared the high-scoring functionalities with Stage 1 meaningful use criteria. Results: We identified 54 high-scoring functionality- setting combinations, 27 for EHRs and 27 for HIE. Examples of high-scoring functionalities included providing alerts for expensive medications, providing alerts for redundant lab orders, sending and receiving imaging reports, and enabling structured medication reconciliation. Of the 54 high-scoring functionalities, 25 (46%) are represented in Stage 1 meaningful use. Many of the functionalities not yet represented in meaningful use correspond with functionalities that focus directly on healthcare utilization and costs rather than on healthcare quality per se. Conclusions: This work can inform the development and selection of future meaningful use measures; inform implementation efforts, as cliniciansand hospitals choose from among a "menu" of measures for meaningful use; and inform evaluation efforts, as investigators seek to measure the actual financial impact of EHRs and HIE.     

Opening Pandora's box? Freedom of information and health services research

The introduction, or extension, of freedom of information legislation in Britain and other Western countries seems certain to influence the climate for health services research. However, researchers should be clear that, although such legislation may improve access to certain types of data, it will also create new problems and dilemmas. Statutory freedom of information regimes are likely to raise difficult issues of adaptation and compliance for health service bodies. Researchers may find that this translates into reluctance to agree access and accentuates difficulties in managing field relationships. They may, inter alia, face difficult dilemmas in deciding whether, or how, to report non-compliance, judging whether to extend research into areas where consent has not been obtained and weighing the benefits of using the official rules to insist on disclosure against the dis-benefits of jeopardising relationships. Health services researchers should regard freedom of information legislation, not simply as a resource, but a topic deserving study in its own right.     

How does searching for health information on the Internet affect individuals' demand for health care services?

The emergence of the Internet made health information, which previously was almost exclusively available to health professionals, accessible to the general public. Access to health information on the Internet is likely to affect individuals' health care related decisions. The aim of this analysis is to determine how health information that people obtain from the Internet affects their demand for health care. I use a novel data set, the U.S. Health Information National Trends Survey (2003-07), to answer this question. The causal variable of interest is a binary variable that indicates whether or not an individual has recently searched for health information on the Internet. Health care utilization is measured by an individual's number of visits to a health professional in the past 12 months. An individual's decision to use the Internet to search for health information is likely to be correlated to other variables that can also affect his/her demand for health care. To separate the effect of Internet health information from other confounding variables, I control for a number of individual characteristics and use the instrumental variable estimation method. As an instrument for Internet health information, I use U.S. state telecommunication regulations that are shown to affect the supply of Internet services. I find that searching for health information on the Internet has a positive, relatively large, and statistically significant effect on an individual's demand for health care. This effect is larger for the individuals who search for health information online more frequently and people who have health care coverage. Among cancer patients, the effect of Internet health information seeking on health professional visits varies by how long ago they were diagnosed with cancer. Thus, the Internet is found to be a complement to formal health care rather than a substitute for health professional services.     

Do the media provide transparent health information? A cross-cultural comparison of public information about the HPV vaccine

The media is a powerful tool for informing the public about health treatments. In particular, the Internet has gained importance as a widely valued source for health information for parents and adolescents. Nonetheless, traditional sources, such as newspapers, continue to report on health innovations. But do websites and newspaper reports provide balanced information? We performed a systematic media analysis to evaluate and compare media coverage of the human papillomavirus (HPV) vaccine on websites and in newspapers in Germany and Spain. We assessed to what extent the media provide complete (pros and cons), transparent (absolute instead of relative numbers), and correct information about the epidemiology and etiology of cervical cancer as well as the effectiveness and costs of the HPV vaccine. As a basis for comparison, a facts box containing current scientific evidence about cervical cancer and the HPV vaccine was developed. The media analysis included 61 websites and 141 newspaper articles in Germany, and 41 websites and 293 newspaper articles in Spain. Results show that 57% of German websites and 43% of German newspaper reports communicated correct estimates of epidemiological data, whereas in Spain 39% of the websites and 20% of the newspaper did so. While two thirds of Spanish websites explicitly mentioned causes of cervical cancer as well as spontaneous recovery, German websites communicated etiological information less frequently. Findings reveal that correct estimates about the vaccine's effectiveness were mentioned in 10% of German websites and 6% of German newspaper reports; none of the Spanish newspaper reports and 2% of Spanish websites reported effectiveness correctly. Only German websites (13%) explicitly referred to scientific uncertainty regarding the vaccine's evaluation. We conclude that the media lack balanced reporting on the dimensions completeness, transparency, and correctness. We propose standards for more balanced reporting on websites and in newspapers.     

Federal investment in health information technology: how to motivate it?

Health care market failures include inefficient standard making, problems with coordination among local providers to optimize care, and inability to measure quality accurately, inexpensively, or reliably. Study of other industries suggests policy directions for health information technology and the magnitude of gains from improving market functioning, which are very large. A perspective drawn from U.S. industrial history--in particular railroads and the interstate highway system--suggests an investment level roughly consistent with recent estimates drawn from the medical literature. The benefits of quick action probably outweigh the benefits of delaying and choosing the perfect funding mechanism.     

What type of information is needed to inform mental health policy?

The most valuable research integrates from thre levels of investigation: clinical efficacy, "real life" effectiveness (including cost-effectiveness) and policy research. Successful applications of systematic reviews have largely been limited to clinical efficacy questions. The contribution of systematic reviews/meta-analyses to effectiveness and economic questions in mental health has been very minor and their contribution to inform policy is negligible. The latter is unlikely to change due to the different type of information that policy makers need.     

How do patients evaluate and make use of online health information?

Increasing numbers of people are turning to the Internet for health advice despite reports that sites vary in terms of their quality. How do they decide whether or not to trust the advice they find online? A staged model of trust development is proposed and tested here in a longitudinal study in which fifteen women faced with decisions concerning the menopause and hormone replacement therapy (HRT) were observed while searching the Internet for information and advice over four consecutive weeks and then kept diaries over a six-month follow-up period. The women were all resident in the North-East of England and were recruited through advertisements in the local media. The study provided general support for a three-stage model of trust in which participants firstly engaged in rapid heuristic processing of information, efficiently sifting and rejecting general sales sites and portals but sometimes rejecting high-quality content because of poor design. Well-designed sites were then effectively interrogated for credible and personalized content before being designated trustworthy. The women appeared to act much like ‘scientists’ using web material to generate and test hypotheses and theories about HRT, although their capacity to deal with certain forms of risk information was limited. They subsequently reported integrating online advice with offline advice from friends, family and physicians in order to be fully confident in their final decisions. Women felt that the Internet influenced their decision-making and improved communications with physicians. Personalized stories from like-minded others improved trust perceptions. Despite the use of the Internet the physician was still seen as the primary source of information and advice.     

Use of online health information to manage children’s health care: a prospective study investigating parental decisions

Background

The use of the internet to access information is rapidly increasing; however, the quality of health information provided on various online sites is questionable. We aimed to examine the underlying factors that guide parents’ decisions to use online information to manage their child’s health care, a behaviour which has not yet been explored systematically.

Methods

Parents (N?=?391) completed a questionnaire assessing the standard theory of planned behaviour (TPB) measures of attitude, subjective norm, perceived behavioural control (PBC), and intention as well as the underlying TPB belief-based items (i.e., behavioural, normative, and control beliefs) in addition to a measure of perceived risk and demographic variables. Two months later, consenting parents completed a follow-up telephone questionnaire which assessed the decisions they had made regarding their use of online information to manage their child’s health care during the previous 2 months.

Results

We found support for the TPB constructs of attitude, subjective norm, and PBC as well as the additional construct of perceived risk in predicting parents’ intentions to use online information to manage their child’s health care, with further support found for intentions, but not PBC, in predicting parents’ behaviour. The results of the TPB belief-based analyses also revealed important information about the critical beliefs that guide parents’ decisions to engage in this child health management behaviour.

Conclusions

This theory-based investigation to understand parents’ motivations and online information-seeking behaviour is key to developing recommendations and policies to guide more appropriate help-seeking actions among parents.