Research Portfolio

These are some of the past and current research activities conducted by CHIDS faculty and fellows. CHIDS research portfolio consists of six major research domains:

HIT Design and Usability

Development of a Model Electronic Health Record Format for Children

Electronic health records (EHRs), when fully implemented well, are comprehensive systems that support the health record-related needs clinicians and all their patients. Unfortunately, for a variety of reasons, EHR systems often do not adequately support the provision of health care to children. The objective of this project is to develop a Model EHR Format for children, which specifies: a minimum set of data elements; applicable data standards; usability; functionality; and, interoperability requirements. Then, to demonstrate that it can be readily used, and package it in a way that facilitates broad incorporation into EHR systems. The project output will help facilitate improved care coordination and management throughout the children’s health ecosystem. In cooperation with Westat. Support provided by AHRQ. More information available at: healthit.ahrq.gov/health-it-tools-and-resources/childrens-electronic-health-record-ehr-format.

Understanding Development Methods from Other Industries to Improve the Design of Consumer Health IT

Despite the potential power of consumer health IT to allow consumers to become more engaged with and assume greater control over their health management activities, health care consumers have not consistently been eager to adopt the technology. By contrast, consumer products in other industries are very widely used. By identifying design principles and methods that led to the success of other consumer products, and evaluating them so that they may be extended to the design and development of consumer health IT, we may facilitate improved consumer health IT application development and ergo improved consumer health management. In cooperation with Westat. Support provided by AHRQ. Designing Consumer Health IT: A Guide for Developers and Systems Designers. (Prepared by Westat under Contract No. HHSA290200900023I.) AHRQ Publication No. 12-0066-EF. Rockville, MD: Agency for Healthcare Research and Quality. September 2012. (PDF, 3 MB). Agarwal R, Anderson C, Crowley K, et al. Improving Consumer Health IT Application Development: Lessons From Other Industries, Background Report. (Prepared by Westat, under Contract No. HHSA290200900023I.) Rockville, MD: Agency for Healthcare Research and Quality. May 2011. AHRQ Publication No. 11-0065-EF. (PDF, 1.47 MB)

Requirements for a mHealth Lab Results Management Application for Cardiologists

The management (ordering, receipt, review, communication, and follow-up) of laboratory and other test results plays a significant role in the medical practice activities of all clinicians, and cardiologists in particular. These processes are often beset by communication inefficiencies, unavailability of needed data, delays in data transmission, and other challenges. Our assessment of market research, technical architectures and standards, peer reviewed and grey literature, and multiple focus group discussions with cardiologists and nurses have validated this care gap, and identified an opportunity for a tool to manage laboratory results via a mobile health (mhealth) platform. The tool is intended to enable timely, efficient and effective accomplishment of related activities. CHIDS has developed the core requirements for this mhealth lab results management application for cardiologists that leverages the capabilities of cloud computing. In cooperation with Intertwine Health Solutions. Support provided by Maryland Industrial Partnerships (MIPS).

EHR Information Design and Usability Toolkit

While health IT systems are expected to improve clinician effectiveness, efficiency and reduce medication errors, studies have found that issues related to usability, information design and information fragmentation with these systems can have the opposite effect and degrade practice performance. The objective of this project is to develop, evaluate, and disseminate a toolkit by which clinicians, health care organizations, health IT vendors, certification organizations, and others can assess, in an objective way, (1) how well the usability and information design of EHR systems in the primary care setting supports primary care activities, (2) whether the HER adheres to best practice information design principles, and (3) what are the limitations in information design that might adversely impact the quality or safety of care. Johnson CM, Johnston D, Crowley PK, et al. EHR Usability Toolkit: A Background Report on Usability and Electronic Health Records (Prepared by Westat under Contract No. HHSA 290-2009-00023I). AHRQ Publication No. 11-0084-EF. Rockville, MD: Agency for Healthcare Research and Quality. August 2011. (PDF, 1.03 MB)

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Health Information Exchange, Medical Home and Care Coordination

Promoting Sustainable HIE: Health Information Exchange Evaluation Framework and DC RHIO Assessment

Downloads: 2011 HIMSS Presentation | Project Report

The District of Columbia Regional Health Information Organization (DC RHIO) desired an independent, third-party assessment of its structure, governance, and activities. CHIDS has developed a multi-dimensional assessment model for the DC RHIO, evaluated its performance in multiple areas and offered a set of recommendations to guide DC RHIOs future evolution. The research and associated recommendations are based on the information and documents provided by key stakeholders of the DC RHIO, an environmental scan of HIE efforts across the nation, best practices published in the literature, and benchmarking with three leading HIE efforts.

Air Force Medical Home: Personal Health Records and Secure Messaging for Military Personnel Pilot Program

Although there is significant momentum behind the use of personal health records and other tools for managing and exchanging personal health information, there is very little systematic evidence related to their benefits, especially with respect to clinical outcomes. CHIDS is working with the Air Force Medical Service (AFMS) on a pilot implementation of a personal health record (PHR) and patient-provider secure messaging (SM) technology within the clinical context of specific disease cohorts. We are interested in understanding the potential influence of PHR with secure messaging on attitudinal measures, health outcomes, and utilization of healthcare services. In cooperation with Deloitte. Support provided by AFMS.

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HIT Adoption and Diffusion

The Determinants of EMR Adoption by Physician Practices.

This study investigates the assimilation of EHRS technology through the lens of physician identity. It hypothesizes that electronic health record are perceived by physicians as both reinforcing and threatening their core identities as caregiver and medical professional. It further predicts that the effects of caregiver identity evolution on EHRS assimilation are moderated by governmental influence. We use detailed survey data from over 200 practices spread across the US to test the research hypotheses. The findings demonstrate that physician identity evolution is an important driver of the extent to which EHRS are assimilated within the practice. The study provides recommendations for policy makers about the role of governmental influence and how EHRS technology should be positioned for optimal uptake. Working paper available.

Beyond Compliance: Meaningful Use as a Catalyst for Improved Performance

The “Meaningful Use” of EHR technology has spurred spirited debate and discussion around compliance and achieving ARRA stimulus incentives. The current guidelines focus attention on the role of meaningful use in reducing healthcare costs and enhancing care outcomes. Realization of such value, however, is critically dependent on the ability of care delivery organizations to successfully overcome adoption and implementation challenges. This project places the concept of meaningful use of EHR technology in a broader context, suggesting that it is important to look beyond the compliance criteria to organizational transformations that can maximize the value equation. CHIDS and Infosys Technologies have developed the Strategic Framework for ARRA Meaningful Use Optimization that combines the latest academic research on EHR implementation and professional expertise aligned to the Infosys Value Realization Method™ in order to drive improved clinical and financial results. In cooperation with Infosys Technologies.

Predicting the Likelihood of EMR Adoption at the Hospital Level in the USA.

This study, positioned at the inter-organizational level, draws upon research in the adoption and diffusion of innovations to predict the likelihood of EMR adoption by hospitals. Likelihood of EMR adoption is driven by organizational factors such as the presence, concentration, and experience with complementary HIT; and an environmental factor, spatial proximity, reflecting the presence of contagion from physically proximate facilities that have adopted EMRs. A hazard model is fitted to data from a sample drawn from a multi-year survey spanning 1970 to 2004 of almost 4,000 hospitals. We find interesting and surprising geographic variations in EMR adoption. Management Science, Vol. 56, No. 10, August 2010, 1219-1241. Research briefing available for download.

Adoption of Electronic Health Records in the Presence of Privacy Concerns.

Privacy concerns can inhibit the adoption of EHRs. We draw from literature on attitude formation and change to develop hypotheses that individuals can be persuaded to support the use and ultimately adopt EHRs, even in the presence of significant privacy concerns if arguments about the value of EHRs are framed properly. Using a pseudo-experimental methodology, we assess the impact of privacy concerns on the relationship between argument framing, issue involvement, attitude and likelihood of adoption. The study yields important implications for the design of awareness campaigns related to EHRs. MIS Quarterly, Vol. 33, No. 2, June 2009, 339-370.

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Impact and Comparative Effectiveness of Digital Health

Impact of a Computerized Clinical Documentation System on Consultants in a Pediatric ICU.

Computerized clinical documentation systems (CCDS) that allow clinicians to create electronic notes are an important component of electronic medical records. Yet, there is limited understanding of the impacts of this technology on the efficiency and effectiveness of health care delivery. This study, conducted in partnership with Children’s National Medical Center, Washington DC, used time and motion analyses and surveys of hospital personnel to quantify the outcomes of using CCDS in a pediatric ICU setting. Project report available here.

Impact of an Office-Based E-prescribing System on Prescribing Processes and Outcomes.

E-prescribing has been advocated as an important tool for improving prescribing. With the implementation of the Medicare Modernization Act, Congress has set goals for the uptake of e-prescribing across the country. This three year study uses focus groups, interviews, detailed ethnographic case studies, a survey, and analysis of claims data to examine the impact of electronic prescribing on practice workflow, costs, physician and nurse attitudes, patient safety, and medication errors. Investigating whether e-prescribing is acceptable to physicians and improves prescribing processes will provide critical data on whether e-prescribing can be successfully expanded nationwide. Funded by AHRQ. See publication: “Cognitive Frames about Health Information Technology: Adoption and Effective Use of Electronic Prescribing in Physician Practices,” JAMIA 2010;17:425-431

Revenue Value of Information Technology for Global Healthcare Manufacturer

Historically the IT function in organizations has been viewed as a cost center, and organizations have sought to optimize and reduce investments in IT. However, some forward looking organizations are increasingly acknowledging the strategic role that IT can play in delivering revenue, that is, the revenue generated as a result of investments in IT solutions or services. CHIDS researchers conducted a series of studies to develop a Revenue Value of IT Framework tailored to the unique needs of a global healthcare manufacturer. The Framework assists both in quantifying opportunities as well as a planning tool to conceptualize potential sources of revenue facilitated by IT.

Quantifying the Economic Impact of Communication Inefficiencies in US Hospitals.

Communication is a critical activity underlying all care delivery processes in hospitals. Studies indicate that communication inefficiencies are widespread in hospital settings, yet limited work has attempted to quantify the economic burden of this inefficiency. Using a multi-phase approach that employs qualitative and quantitative methods, we first develop an economic model that estimates the total loss to the US healthcare system due to poor communications in hospital settings based on wasted doctor and nurse time, and increased length of stay. We then develop a detailed model for the discharge planning process using operations management techniques that can be customized for a hospital to quantify the communication inefficiency related to specific activities. We find that U.S. hospitals waste over $12 billion annually as a result of communication inefficiency among care providers. Increase in length of stay accounts for 53 percent of the annual economic burden. A 500-bed hospital loses over $4 million annually as a result of communication inefficiencies. See publication: “Quantifying the Economic Impact of Communication Inefficiencies in US Hospitals. Journal of Healthcare Management. 2010 Jul-Aug;55(4):265-81.

Cost-Effectiveness Model that Considers the Role of Social Networks in Disease Progression

Human beings are fundamentally social creatures surrounded by networks of individuals in which information and behaviors are translated and disseminated. Empirical research over the years has identified that these networks also impact an individual’s health decisions and outcomes. Cost effectiveness analysis (CEA) and Comparative effectiveness analysis, relying on Markov Models, have been widely used to effectively model disease progression and to discern the costs and benefits of relative treatments for simulated cohorts of individuals. These models, however, do not account for any social ties or networks between individuals that are present in the real world. CHIDS has developed a prototype for a comparative effectiveness model that accounts for social networks in disease progression. If we were able to understand which network ties had the most effect and link them back to their key members, we would be able to allocate resources toward these individuals whose behavioral change would have the most collateral impact. Working paper available.

Cost-Effectiveness of Screening for High Risk Plaque and the Reduction of Acute Myocardial Infarction

Acute atherothrombotic disease is the underlying cause of 70 percent of Acute Myocardial Infarction (AMI) cases, and the rupture of high-risk plaque (HRP) is implicated in a majority of sudden cardiac deaths. Several therapeutic approaches are highly effective if only these individuals can be identified. We assess a new paradigm of screening for HRP through a blood test, confirmatory diagnosis utilizing imaging, and pharmaceutical treatment. We design a Markov model to estimate the benefits, costs, and incremental cost-effectiveness of annual blood based biomarker screening for HRP in a cohort of individuals who do not suffer from hyperlipidemia. The incremental cost-effectiveness ratio (ICER) for screening followed by drug therapy indicated screening for high risk plaque is a potentially cost-effective way to prevent AMIs in asymptomatic patients. Working paper available.

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Consumers Health IT

Understanding Development Methods from Other Industries to Improve the Design of Consumer Health IT

Despite the potential power of consumer health IT to allow consumers to become more engaged with and assume greater control over their health management activities, health care consumers have not consistently been eager to adopt the technology. By contrast, consumer products in other industries are very widely used and have exhibited exponential adoption rates. By identifying design principles and methods that have led to the success of other consumer products, and evaluating them so that they may be extended to the design and development of consumer health IT, we may facilitate improved consumer health IT application development and, as a result, improved consumer health management. In cooperation with Westat. Support provided by AHRQ.

Personal Health Information Management and the Design of Consumer Health IT.

The purpose of this study is to establish a foundation and action agenda for a deeper understanding and integration of patients’ personal health information management practices into the design of patient-centered health IT. The research adopts a multi-disciplinary perspective on personal information management in general and personal health information management in particular. We survey the peer-reviewed and grey literature on strategies and tools for personal health information management and identity gaps in understanding. We provide recommendations for future research that can be instrumental in moving the agenda for promoting greater adoption of health information management tools by consumers forward. Personal Health Information Management and the Design of Consumer Health Information Technology,” Technical Report, Agency for Healthcare Research and Quality, Publication No. 09-0075-EF, June 2009.

The Willingness of Individuals to Disclose Personal Genetic Information

There has been considerable progress in medicine following the mapping of the human genome ten years ago. Future progress is closely tied to the availability of robust genetic databanks. To the extent that society needs volunteers to populate these data banks, an understanding of the information disclosure decision is critical. We study the willingness of individuals to disclose personal genetic information, focusing on the effects of (1) the purpose for which information is sought, (2) the soliciting institution, and (3) individual characteristics (such as perception of risks and benefits). Our findings have important implications for (1) stimulating voluntary disclosure, (2) avoiding statistical bias due to selection effects, and (3) designing institutions for genomics research. Working paper available.

The Complex Privacy Calculus for Personal Health Information (PHI)

The decision related to allowing PHI to be digitized is not a simple one. It is likely that individuals differ in their perceptions of the privacy risks and benefits related to sharing their electronic health information depending on the specific context in which they are asked to disclose the information. The healthcare setting is characterized by multiple types of health information (e.g. mental health, HIV/AIDS status) which are afforded different levels of protection due to their sensitive nature. Further, the healthcare value chain has multiple players with a need to access and use PHI, and the individual has varied degrees and methods of interaction with these organizations. Finally, a key contextual consideration is the purpose for which information will be used. How do individuals make choices in such a complex contextual milieu? To answer this question we draw from Communication Privacy Management (CPM) theory which, in conjunction with the healthcare context, provides insight into potential risk factors which influence an individual’s level of concern and trust (i.e. the privacy calculus). Research briefing available for download. Accepted for publication in Information Systems Research.

Mobile Technology for Health Assessments in Remote Villages in India.

CHIDS is working with the Arogya Foundation of India, a not-for-profit organization with the goal of promoting the advancement of rural health care and enabling villages to become self-dependent in health, to assess the use of a mobile device for logging and transmitting health assessments in remote villages. The collection of this health data has national, if not international, implications for the study of health trends and providing early interventions. Arogya operates through a cadre of field workers (Arogya Sevikas) who collect data related to the health status of the rural community within which they work. The data collected by Arogya workers is currently stored in paper-based forms and is largely utilized at the local level. The project will seek to also understand how the local level data can be synthesized and used for disease surveillance purposes. Project report available here.

Early Findings on Personal Health Records and Individual Use

In this study, we explore an emergent IT application – the electronic personal health record (PHR) that arguably, offers the same potential for revolutionary, discontinuous change in the healthcare sector. We conducted an exploratory empirical study to understand the characteristics of individuals who are early adopters of PHR software. We also sought to understand what type of value individuals perceive in the PHR, and the drivers of their usage intentions. We found three distinct perceived components of value: (1) compliance, (2) connectedness, and (3) convenience. We also found that different demographic and medical condition variables influence the type of value a user sees in a PHR. Finally, our results show that future intentions to use a PHR are driven by perceptions that the PHR provides compliance and improves a patient’s relationship and connectedness with their healthcare provider. Research briefing available for download.

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Healthcare Quality, Transparency and Health 2.0

Determinants of On-Line Quality Disclosure by California Hospitals.

Disclosing hospital quality information to the general public in an accessible fashion is an important first step in creating consumers who are more informed about health care choices. Although quality information has been collected by governmental and quasi governmental agencies for over a decade, public access to this information has typically been somewhat cumbersome. Recently the state of California launched a voluntary initiative where hospitals can choose to provide a series of quality indicators on a user-friendly website. Of the 367 hospitals in California, over 40% have opted not to participate in this initiative, called the California Hospital Assessment and Reporting Taskforce, or CHART. In this research we pose the question “why do some hospitals choose to voluntarily disclose their quality performance online?” We model the hospital’s decision to opt-in as a function of financial, institutional, quality, technological and market factors.

Investigating Online Rating Systems for Doctors.

The widespread availability of quality and performance information related to both hospitals and physicians is a striking trend in today’s healthcare environment. We study the extent to which online physician ratings correlate with quality ratings from other sources such as information collected by health plans. We also study how the availability of online ratings influences consumer behavior, and provide recommendations on how doctors can protect their on-line reputations.

Social Value Creation in Online Health Communities

The striking growth of online communities in recent years suggests that they have considerable promise for generating economic and social welfare. While research has begun to document the economic outcomes of online community participation, conceptualizing and quantifying the social value created in these collectives persists as a challenge. This study proposes that online communities focused on health create social value by bridging the rural-urban regional divide. Using a unique dataset from a rare disease community, we provide one of the first empirical analyses of social value creation. We apply stochastic network models and text mining techniques to uncover support patterns between users and the underlying social structure of the community, and investigate the specific patterns of informational, experiential, and emotional support that occur.

Evaluating the Food and Drug Administration Public-Private Partnerships Program

The FDA Public-Private Partnerships Program is dedicated to leading the creation, implementation and management of strategic collaborations that leverage expertise and resources from FDA and other organizations to protect and promote public health. Public-Private Partnerships (PPPs) represent an economically compelling way for FDA and stakeholders to leverage combined resources and know-how, collaboratively and under aligned missions, for the benefit of public health. Federal programs, including the FDA PPP Program, must have performance metrics and meaningful outcomes that demonstrate a return on the taxpayer’s investments. Many of the traditional performance metrics and outcome measures cannot fully quantify the results of creative programs—several of which are unprecedented in scope, timelines and deliverables—and new methods to capture information and measure progress are needed. CHIDS is working with the FDA to evaluate the PPP Program and develop a framework and set of supporting information management processes. The research deliverables will assist in the ongoing governance and management of the PPP Program as well as in the development of future PPPs.

Social Support and Smoking Cessation in Technology-Mediated Communities.

We draw upon prior research in social support and social learning to hypothesize that smoking cessation outcomes can be predicted by the structural social support (i.e., quantity) and functional social support (i.e., quality) provided to the individual in the online community. We measure structural social support by the individual’s tenure in the community and the size of their social network, i.e., the number of community members they interact with. Functional social support is assessed by information need fulfillment, group identification, and identity consonance. Empirical findings from a study of participants on Quitnet.com provide support for the valuable and powerful effects of social support from other online community members, i.e., virtual “strangers”. Implications for the design of online communities for social support related to wellness are discussed. Research briefing available for download

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