Research Briefings

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 PDF]
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 PDF]
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 PDF]
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 [Download PDF]
Keeping Up with the Jones’: Influence from Peer Hospitals on EMR Diffusion
Corey 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 Links
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 Technology-Mediated Communities
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 [Download PDF]
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.