Monitoring HIV Care in the United States Indicators and Data Systems (2012) / Chapter Skim
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5 The Role of Health Information Technology and Data System Integration in the Collection of HIV Care Data
5 The Role of Health Information Technology and Data System Integration in the Collection of HIV Care Data
Pages 273-298
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From page 273... ...
UTILIZATION AND CONFIGURATION OF HEALTH INFORMATION TECHNOLOGY TO IMPROVE THE COLLECTION OF HIV CARE DATA Health IT generally refers to the various computer technologies that are used by providers, consumers, payers, insurers, and other groups to manage and transmit health information (PCAST, 2010)
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individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization Personal health record An electronic record of an individual's health-related information (PHR) that is managed, shared, and controlled by the individual.
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. Uses of Health Information Technology for the Collection of HIV Care Data and Management of HIV Care Clinical data needed to monitor indicators of HIV care are often contained in EHRs or EMRs.
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They also may be used to generate reports such as to identify no-show rates for HIV patients or to monitor trends in laboratory test results. Such features can help HIV care providers comply with mandated reporting requirements (HRSA, 2011)
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Some PHRs also include features that allow patients to schedule and receive reminders about their appointments, refill prescriptions, research medical conditions, and communicate with their providers. Like EHRs, many PHRs conform to nationally recognized interoperability standards and therefore can be used in HIE (HHS, 2008)
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From page 278... ...
Each site was implementing a different type of health IT ranging from a web-based information tool for HIV care providers to an application to allow HIV patients to complete a questionnaire on medication adherence, depression, and substance abuse via touch screen computers prior to meeting with their health care provider. The investigators identified 6 key considerations for IT adoption across the SPNS sites.
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279 THE ROLE OF HEALTH INFORMATION TECHNOLOGY BOX 5-1 Key Considerations for the Adoption of Health IT by HIV Care Providers Programmatic Capacity Prior to implementation of new health IT strategies, it is important to assess computer resources and explore existing IT infrastructure to see whether new capabilities can be added in to it, rather than implementing a completely new sys tem. The IT intervention should be developed with future growth and sustainability in mind.
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. Challenges to the Adoption of Health Information Technology Despite its potential benefits, evidence suggests that adoption of health IT is occurring at a slow pace in settings where PLWHA receive care, such as physician offices, hospitals, and community health centers (CHCs)
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; lack of support from providers (Bhattacherjee and Hikmet, 2007; Lardiere, 5 "Fully functional" was defined as having functionalities for collection of patient demographic information, electronic prescribing, computerized physician order entry, clinical notes, clinical decision support, and public health reporting (Lardiere, 2009)
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Act, a component of the ARRA, supports adoption and use of EHRs by authorizing incentive payments through Medicare and Medicaid, major payers of care for PLWHA, to physicians and hospitals that use EHRs and demonstrate their "meaningful use" (Jha et al., 2010) .6 The three main components of meaningful use for the first phase of the HITECH Act, which began in 2011, are the use of certified 6 Under the Medicare EHR incentive program, eligible health professionals can receive as much as $44,000 over a 5-year period.
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, is composed of standards, services, and policies to enable secure health information exchange over the Internet. The NwHIN is meant to help achieve the goals of the HITECH Act by enabling "health information to follow the consumer, be available for clinical decision making, and support appropriate use of health care information beyond direct patient care so as to improve population health" (ONC, 2011b)
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. Lessons from the Veterans Health Administration and Kaiser Permanente on the Use of Integrated Electronic Health Records Although not representative of other health care organizations, the experiences of large integrated care organizations, such as VHA and Kaiser Permanente (KP)
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. As noted previously, there is often little incentive for providers outside of integrated networks, which may include care sites such as CHCs where many PLWHA receive care, to invest in integrated EHRs.
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The Indiana Network for Patient Care has been an operational statewide health information exchange for more than 10 years, linking hospitals, public health departments, and state Medicaid data to deliver clinical data to care settings throughout Indiana and has served as a model of HIE across the nation. New York State in 2006 began a significant investment in health data integration with the Healthcare Efficiency and Affordability Law for New Yorkers (HEAL-NY)
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Data integration does exist for patient monitoring, but usually this is done within delivery networks where systems are already integrated and/or incentives can better justify data integration. These examples are relevant to PLWHA in these systems, but most PLWHA receive care outside of integrated delivery networks.
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. If implemented as planned, these changes could help to lay the groundwork for increased data system interoperability and to simplify the assessment of the state of HIV care at the national level.
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, formerly the British Columbia Linked Health Database, contains data on nearly every person in British Columbia and links individuallevel health care utilization, population demographics and vital statistics, 11 The two primary methods for data linkage are deterministic linkage and probabilistic linkage. In deterministic linkage, a predefined subset of linking variables have to agree to be considered a match and linked.
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. Data linkage has been used in several HIV-related research studies carried out in the United States to improve the completeness of data for surveillance and for monitoring HIV care.
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• Increased exchange of health-related information among providers of HIV care and supportive services has the potential to improve care coordination and longitudinal tracking of care. Some inte grated health care systems, such as the Veterans Health Administra tion and Kaiser Permanente, effectively manage patient information across providers within their networks, but most PLWHA receive care and supportive services outside of these networks and many receive care across multiple organizations.
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The Department of Health and Human Ser vices and the Office of the National Coordinator for Health Infor mation Technology should provide technical assistance and policy guidance to state and local health departments, clinical providers, and other agencies serving individuals with HIV to improve the interoperability of data systems relevant to monitoring HIV care and supportive services.
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2011. Our Journey in Health IT and Health Information Exchange -- Working Towards Ubiquitous, Computable Care Data in Kaiser Permanente.
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2010. Electronic Medical Record/Electronic Health Record Systems and Office-Based Physicians: United States, 2009 and Preliminary 2010 State Estimates.
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2011. Use of electronic personal health record systems to encourage HIV screen ing: An exploratory study of patient and provider perspectives.
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2007. An organizational learning perspective on the assimila tion of electronic health records among small physician practices.
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2011. Factors motivat ing and affecting health information exchange usage.
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