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Dynamics of Inter-Professional Learning Related to "EHR MedRec" within an SKN System
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Author: Pavani Rangachari, Augusta U.
Author: Karl Rethemeyer, U. at Albany, State U. of New York
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Similar to issues faced in health systems across U.S., AU Health faced a scenario of low physician engagement in, and limited-use of its Electronic Health Record (EHR) Medication Reconciliation (MedRec) technology, which in turn, translated to high rates of medication discrepancies and low accuracy of the patient’s active medication list, during transitions-of-care. In fall 2016, a two-year grant was secured from AHRQ, to pilot-test a Social Knowledge Networking (SKN) system pertaining to “EHR-MedRec,” to enable AU Health to progress from “limited-use” of EHR-MedRec technology, to “meaningful-use.” The aims of this study were to: 1) examine dynamics of inter-professional knowledge exchange and learning related to EHR-MedRec on the SKN system; and 2) explore associations between “SKN-Use” and “Meaningful-Use-(MU)-of-EHR-MedRec,” with the latter being assessed in terms of adherence to best-practices in EHR-MedRec, i.e., practices known to reduce medication discrepancies and promote medication-list accuracy, during transitions-of-care. Over a one-year period, 50 SKN Users (physicians, nurses, and pharmacists from outpatient-and-inpatient-medicine services), participated in discussing issues-related-to EHR-MedRec, moderated by 5 SKN Moderators (senior administrators). Qualitative (thematic) analysis was used to understand dynamics of inter-professional knowledge exchange; and descriptive analysis was used to examine trends in two measures of MU-of-EHR-MedRec that were identified for the study. Inter-professional knowledge exchange related to EHR-MedRec on the SKN, progressed from “problem-statements” to “problem-solving-statements-(the-how-to),” to “IT system-education-(the-what),” to “best-practice-assertions-(the-why),” to “culture-change-assertions-(the-way-to),” to “collective-learning-(aha)-moments,” to lay a foundation for practice change (improvement). These learning dynamics in turn, were associated with distinct improvement trends in both measures of MU-of-EHR-MedRec. The SKN system was a valuable tool in enabling MU-of-EHR-MedRec, by addressing implementation-challenges in the correct sequence i.e., facilitating collective learning of the value of best-practices in EHR MedRec, before IT-training of providers. The study helps identify strategies for the creation of “learning health systems,” to enable successful change implementation in healthcare organizations.
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Paper is No Longer Available Online: Please contact the author(s).
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The Complementarity of Health Information & HIT For Reducing Opioid-Related Mortality and Morbidity
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Author: Lucy Xiaolu Wang, Cornell U.
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HCM Division Best Paper Based on a Dissertation
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William H. Newman Award Nominee
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In response to the opioid crisis, each U.S. state has implemented a prescription drug monitoring program (PMP) to provide health providers with patients’ controlled substance prescription information. I study whether health information technology (IT) complements the availability of patient information in PMPs to reduce opioid-related mortality and morbidity. I construct a novel data set that records state health IT policies that improve PMP data interoperability in cross-system integration and interstate data sharing. Utilizing difference-in-differences methods, I find that health IT policies reduce opioid-related mortality and morbidity. The inpatient morbidity reductions are most substantial in states that created PMPs but never mandated their use. The impacts are also strongest for the most vulnerable groups – middle-age and low- to middle-income patients and are robust when stratified by age, income, location, and insurer type. The total benefits from improved interoperability far exceed the associated costs.
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Paper is No Longer Available Online: Please contact the author(s).
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Exploring System Features of Primary Care Practices that Promote Better Provider Experience
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Author: Lingrui Liu, yale school of public health
Author: Alyna Chien, Boston Children's Hospital and Harvard Medical School
Author: Sara Singer, Stanford U.
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Objective: To investigate system features of primary care practice that improve provider experience of care and work satisfaction in their clinical practices. Study Setting: Nineteen Harvard-affiliated primary care practice sites participated in the Academic Innovations Collaborative (AIC) 2012-2016, which aimed to first establish team-based care and then to improve patient safety. Study Design: We performed qualitative comparative analysis (QCA) to identify formulas of system features necessary or sufficient for enhancing primary care provider experience. Data Collection: In June 2014, practice managers from participating sites completed a survey measuring care process and health information technology (HIT) functionality. A staff survey administered in 2015 measured provider experience of team dynamics, perceptions of safety culture, patient care coordination, and clinical work satisfaction. Principal Findings: Through QCA, we found that highly-functioning teams and perceptions of strong safety culture constitute sufficient conditions for achieving greater clinical work satisfaction among providers. Strong HIT system functionality is not sufficient on its own to achieve the various primary care provider experience outcomes. Conclusions: System features that identify urgent or complex acute illness and that manage collaborations among primary care personnel across institutional settings may be the conditions that best reduce provider burden and enhance their clinical work satisfaction.
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Paper is No Longer Available Online: Please contact the author(s).
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Emergence, Convergence, and Differentiation of Organizational Forms of Health Data Governance
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Author: Jenifer Winter, U. of Hawaii at Manoa
Author: Elizabeth Davidson, U. of Hawaii at Manoa
Author: Crystal Boyce, U. of Hawaii
Author: Victoria Fan, U. of Hawaii
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In this research we are investigating how different organizational forms of data governance develop in response to the opportunities and challenges to aggregate, curate, and utilize digital health data for health systems improvement and market regulation. We are examining (i) how/when do governance arrangements coalesce around specific domains of health data resources as identifiable organizational forms; (ii) what influences how (or whether) these forms develop in a health care market, and (iii) what factors contribute to convergence or divergence in organizational forms across markets? To address these questions, we are conducting an in- depth, multi-level field study of the movement to establish all payer claims database (APCD) organizations in the U.S. healthcare sector. Among states with an APCD there is substantial variety in the data domains, stakeholders, governance goals and structures of the organization, indicating local variation and divergence, as well interstate and national initiatives to encourage convergence along some dimensions. This provides a rich opportunity to study institutional and market factors that contribute to (or inhibit) emergence, convergence, or divergence of health data governance forms and the implications for health care sector management and improvement that may result. Inthis paper we report preliminary findings and analysis of this study.
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Paper is No Longer Available Online: Please contact the author(s).
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