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.
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.
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Health Information Exchange, Medical Home
and Care Coordination
Promoting Sustainable HIE: Health Information Exchange
Evaluation Framework and DC RHIO Assessment
2011 HIMSS Presentation |
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.
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
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
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.
HIT Impacts, Comparative Effectiveness and Outcomes
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 at www.rhsmith.umd.edu/chids
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
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
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
HIT and Consumers
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 at
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
Healthcare Quality 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
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.
Evaluating the Food and Drug Administration Public-Private Partnerships
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