Ongoing Research

The following are some of the ongoing research projects being conducted by CHIDS Faculty and Fellows.

Medication History Pilot : Impact of the Personal HealthKey™ on Medication Compliance and Knowledge & Attitudes about Treatment, Health, and Other Behavioral Indicators

This project implements a replicable model for a patient to directly download medication history into a portable patient health record to enable improved compliance with medication therapy, provide personalized education, and support patient-provider communications. This is accomplished by establishing a validated process for a pharmacist to authenticate a patient for requesting their medication history information, providing the patient with a PHR application for receiving and managing information, providing patient education, alerts and reminders tied to this information, and supporting the portability and dissemination of this information between patients and their providers using a combination of both a portable USB-enabled device and online portal. This project was initiated in June 2007.

Impact of an Office-Based e-Prescribing System on Prescribing Processes and Outcomes

E-prescribing has been advocated as a 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. CHIDS has received a grant from NIH/AHRQ in collaboration with the Harvard Medical School. CHIDS’ portion of this research project involves the examination of whether the implementation of standards and adoption of e-prescribing improve processes of prescribing for physicians and patients. Members of the research team with expertise in the study of information technology uptake and efficiency will conduct focus groups, case studies, and direct observant of the impact of e-prescribing on office workflow. Understanding whether e-prescribing is acceptable to physicians and improves prescribing processes will provide critical data on the barriers and facilitators to expanding e-prescribing nationwide.

Technology Implementation Sequences and Adoption of EMRs by Ambulatory Care Facilities.

The adoption of EMRs by ambulatory health care facilities, such as physician offices and clinics, is an important component of achieving a nation-wide interoperable health care environment. Using data on over 20,000 ambulatory care facilities across the US, this study examines how the sequence in which information technologies are adopted by the facility influences its likelihood of adopting EMR. This project was started in October 2007. The results of the study will be useful in understanding best practices related to a hospital’s portfolio of HIT applications and how it influences successful EMR adoption.

Feasibility of Using Mobile Technology for Health Assessments in Remote Villages in India.

CHIDS is working closely 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. The goal of this project is to assess the feasibility of using 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. Arogya workers may also perform other functions such as connecting villagers in need with appropriate health care facilities. 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.

Investigating the Design of an Online Rating System 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. Information about physician performance can be provided by a variety of individuals, including nurses and consumers. This project seeks to evaluate a number of modifications in the design of an online social network designed to elicit opinions of nurses about the doctors they work with. It will answer the following research questions: 1) What factors influence a nurse’s willingness to participate?, 2) What factors influence the quality of a nurse’s review of a doctor?, 3) How can nurses be persuaded to provide reviews?

PHR Use by Employees of a Large Multi-National Firm.

The benefits of having a healthy workforce are well-documented: not only do workers with medical problems increase the incidence of absenteeism and negatively affect organizational productivity; they increase the costs of providing healthcare substantially. Electronic Personal Health Records (PHRs) are an important health information technology (HIT) application that offers the potential to significantly affect employee health and wellness. Despite this potential however, we still know very little about what factors influence the adoption and effectiveness of PHR. Current knowledge of PHR impacts is limited to anecdotal evidence and very little is known about issues such as how the technology is being used, who is likely to be a strong advocate, and what the appropriate metrics to assess benefits are. Understanding how and to what extent PHRs result in improved health outcomes is critical in order to develop a compelling business case for investments in PHR technology and to implement the technology successfully. CHIDS has designed a multi-stage study that investigates important questions related to PHR uptake and use. There are three important phases to this study that when completed will collectively provide a comprehensive and multi-dimensional assessment of a PHR initiative. These stages include: 1) Investigation of PHR user characteristics from archival data, 2) Large scale corporate survey, 3) Design enhancements for system.

Ambulatory Safety and Quality: Enabling Patient-Centered Care through Health IT.

The proposed research will clarify the relationship between physicians’ use of Health Information Technology (IT) and patients’ opinions and observations about their healthcare. The research will suggest how patients’ opinions and observations change as their physicians adopt and use Health IT, and how the characteristics of the patients and the physicians, and the capabilities of the Health IT influence that change. The research will consider the full range of Health IT systems, across many ambulatory care settings. The results will provide insight into the conditions under which physicians’ use of Health IT tends to promote patient-centered care.

Consumer Concerns Related to the Privacy of Health Information.

There is evidence to suggest that privacy concerns vary by context: e.g., treatment, payment, research, law enforcement, prescription drug use/benefit, healthcare operations/marketing, bioterrorism, employee health, public health, state government oversight, and RHIOs. This broad based study will examine consumer concerns about various types of health information and their uses. Using the RTI/HISPC exchange scenarios as a framework, we will probe people's attitudes towards privacy. For each of these contexts, we will ask consumers several research questions such as: how do you feel about your information being used for purpose; what would be your concerns (and how might they be mitigated – possibly with incentives); do you see any benefits; how do you feel about your information being used for assessing employee health plans; etc. The study utilizes a multi-phase approach, beginning with focus groups to identify the types of concerns present among consumers, followed by a survey of a nationally representative sample.

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.

EMR System Readiness Index for Physician Practices.

This study investigates various aspects of introducing electronic health record systems (EHRS) into physician practices ranging from perceptions of value to practice-level implications. Specific goals of this project are: 1) to understand the facilitators and inhibitors of EHRS adoption and use in medical practices in the US, 2) to understand the practice-level implications of EHRS adoption and use, 3) to inform policy making about the use of EHR adoption. We use survey data from over 270 practices or varying sizes to isolate the specific factors that are most predictive of EHR adoption.

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.