CHIDS research briefings are produced and circulated quarterly to partners and
stakeholders. They summarize research results for executive audiences. Please
click on the issue and volume number to download the specific research briefing.
If you need printed copies for distribution, please contact us. Hard copies are
available a nominal fee of $5 per copy.
Spring 2009 Vol. 4, Issue 1A [Download
Privacy Risks, Emotion, and Consumers’ Willingness to Share Personal Health Information
Catherine Anderson and Ritu Agarwal
The decision related to allowing Personal Health Information (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. We conducted a study to examine
consumers’ willingness to disclose personal health information (PHI) so that it may be digitized and potentially shared
with others. We collected data from a nationally representative sample of over 1000 consumers. This research brief
discusses the key findings of the study.
Winter 2008 Vol. 3, Issue 1B [Download
Quantifying the Economic Impact of Communication
Inefficiencies in US Hospitals
Ritu Agarwal, Daniel Sands and Jorge Diaz-Schneider
This research reports findings from a multi-stage study to develop models for quantifying the economic burden of poor
communications in hospitals in the US. We develop a conceptual model of the outcomes of poor communications isolating four
dimensions, efficiency of core operations, effectiveness of core operations, quality of work life, and service quality.
Our quantitative analysis revealed that US hospitals lose over $12b annually as a result of poor communications. A major
proportion of this loss is due to increase in hospital length of stay, followed by wasted physician and wasted nurse time.
The loss for a 500 bed hospital is estimated at approximately $4 million annually. This study suggests that improving the
quality of communications requires both technological solutions and a detailed clinical process understanding.
Summer 2008 Vol. 3, Issue 1C [Download
Pay-for-Performance Landscape Assessment: “Value-based purchasing: Reimbursement & Recognition
Based on Processes and Outcomes”
P. Kenyon Crowley
The United States is facing a number of problems with its health system, including the poor utilization of healthcare dollars per
output, the poor management of chronic conditions, and the poor use of best practices or evidence-based medicine in the delivery of
care. Existing incentive systems do not reflect the relative value of health care services in important aspects of quality, such
as clinical quality, patient-centeredness, and efficiency. Nor do current payment systems recognize or reward outcomes and care
coordination. There is a limited focus on prevention and the treatment of chronic conditions as patients move across various care
settings. Pay-for-performance (“P4P”), also called “Value-based Purchasing” and “Pay-for-Quality”, is viewed by many as a practical
approach to improving the quality of patient care, whereby incentive systems are aligned with desired treatments, processes and outputs.
The purpose of this research paper is to explore the current P4P landscape and provide insight into the key trends and issues shaping the
P4P agenda with content suitable for both the healthcare novice and health industry professional. Several leading stakeholders are
profiled and recommendations for promoting P4P adoption are provided.
Summer 2007 Vol.2, Issue 2A
Keeping Up with the Jones’: Influence from Peer Hospitals on EMR Diffusion
M. Angst and Ritu Agarwal
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.
Summer 2007 Vol.2, Issue 1B [Download PDF]
The Missing Link: Electronic Health Record Adoption by Physician Practices
Catherine Anderson, Abhay Mishra, Ritu Agarwal, Corey M. Angst and Steve Labkoff
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.
Summer 2007 Vol.2,
Issue 1A [Download PDF]
Using Annotations from Controlled Vocabularies to Find Patterns in Life Science
Louiqa Raschid, Woei-Jyh Lee, Padmini Srinivasan, Daniel L. Rubin and Nigam Shah
The Life Science Link methodology provides users with a set of tools to explore
the rich Web of interconnected and annotated objects in multiple repositories,
and to identify meaningful patterns. These instances represent a background
dataset of knowledge. We then identify those associations of pairs of CV terms
that are potentially significant and may lead to new knowledge. We develop an
approach to determine a confidence level and support in the associations between
the pairs of CV terms.
Fall 2006 Vol.1, Issue 2B [Download PDF]
State-Level HIT Activity and Themes
Corey M. Angst, Anuj Desai and Jennifer Wulff
This focuses on state level health information technology (HIT)
activities. It examines: (1) how active individual states are in the HIT domain,
(2) specific themes in HIT activity, and (3) states that are influential in, or
catalysts for HIT adoption. We found increasing state-level HIT activity and
earmarked funding and resources to support their efforts. Several states emerged
as leaders, offering innovative plans for implementing electronic health records
(EHRs) and demonstrating political leadership for these initiatives.
Fall 2006 Vol.1,
Issue 2A [Download PDF]
Early Findings on Personal Health Records and Individual Use
Corey M. Angst and Ritu Agarwal
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.
Fall 2006 Vol.1, Issue 1B [Download PDF]
With Help From Strangers: Social Support and Smoking Cessation in
Jessie Ma and Ritu Agarwal
This study draws 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.
Fall 2006 Vol.1, Issue 1A
Electronic Health Records: Will privacy concerns hinder adoption?
Corey M. Angst and Ritu Agarwal
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.