E. Hammond - Academia.edu (original) (raw)

Papers by E. Hammond

Contemporary Clinical Trials

Journal of the American Medical Informatics Association : JAMIA, Sep 14, 2017

Pragmatic clinical trials (PCTs) are research investigations embedded in health care settings des... more Pragmatic clinical trials (PCTs) are research investigations embedded in health care settings designed to increase the efficiency of research and its relevance to clinical practice. The Health Care Systems Research Collaboratory, initiated by the National Institutes of Health Common Fund in 2010, is a pioneering cooperative aimed at identifying and overcoming operational challenges to pragmatic research. Drawing from our experience, we present 4 broad categories of informatics-related challenges: (1) using clinical data for research, (2) integrating data from heterogeneous systems, (3) using electronic health records to support intervention delivery or health system change, and (4) assessing and improving data capture to define study populations and outcomes. These challenges impact the validity, reliability, and integrity of PCTs. Achieving the full potential of PCTs and a learning health system will require meaningful partnerships between health system leadership and operations, a...

Circulation, 2014

† †Inter-American Society of Cardiology. ‡ ‡American Association for Critical-Care Nurses. § §Asi... more † †Inter-American Society of Cardiology. ‡ ‡American Association for Critical-Care Nurses. § §Asian Pacific Society of Cardiology. ‖‖Integrating the Healthcare Enterprise. ¶ ¶Digital Imaging and Communications in Medicine. ##Society of Thoracic Surgeons. ***Clinical Quality Committee representative during this writing effort. Author Recusals: Writing committee members are required to recuse themselves from voting on sections to which their specific relationship with industry and other entities may apply; see Appendix 1 for recusal information.

Studies in health technology and informatics, Jan 25, 2024

Most agree that the current healthcare system is broken. Fortunately, technology is increasing at... more Most agree that the current healthcare system is broken. Fortunately, technology is increasing at an exponential rate and provides a solution for the future. Digital Health is an integrator concept that has the potential to take advantage of technological advantages. Digital Health converges health, healthcare, research, and everyday life. It includes technologies, platforms, and systems that engage consumers in all aspects of life. It makes health and healthcare be people-centered and personalized. Digital health requires total interoperability-standards, common data elements, and the integration of data from all sources. It demands data sharing. Digital Health brings together a wide range of stakeholders for similar goals using the same resources. Digital Health uses mobile devices and wearable sensors and uses Artificial Intelligence and Machine Learning to handle the vast amount of data Digital Health engages. Finally, Digital Health has the potential to open the gap between the different social and economic classes that must be addressed.

IEEE Journal of Biomedical and Health Informatics

Abstract-- Cardiopulmonary Exercise Testing (CPET) is a unique physiologic medical test used to e... more Abstract-- Cardiopulmonary Exercise Testing (CPET) is a unique physiologic medical test used to evaluate the human response to a progressive maximal exercise stress. Depending on the degree and type of deviation from the normal physiologic response, CPET can help identify a patients specific limitations to exercise to guide clinical care without the need for other expensive and invasive diagnostic tests. However, given the amount and complexity of data obtained from CPET, interpretation and visualization of test results is challenging. CPET data currently requires dedicated training and significant experience for proper clinician interpretation. To make CPET more accessible to clinicians, we investigated a simplified data interpretation and visualization tool using machine learning algorithms. The visualization shows three types of limitations (cardiac, pulmonary and others); values are defined based on the results of three independent random forest classifiers. To display the models scores and make it interpretable to the clinicians, an interactive dashboard with the scores and interpretability plots was developed.

The Seventh Annual Symposium on Computer Applications in Medical Care, 1983. Proceedings.

Journal of the American Medical Informatics Association, 1997

The medical informatics community-vendors and users-have been seeking a common, comprehensive cli... more The medical informatics community-vendors and users-have been seeking a common, comprehensive clinical vocabulary for the past decade. New models for health care and new reporting requirements increase the necessity and desirability of such a vocabulary set. Much of the negotiation time between systems interested in exchanging data is related to matching vocabulary and code sets. Unfortunately, that is only the beginning and ongoing work is required to keep the vocabulary sets synchronized. At the same time, increased emphases on decision support, clinical guidelines, integrated delivery systems, and data reporting for performance evaluation require more precise and understandable vocabulary terms.

Information technology interventions as a means to meeting healthcare needs are generating a grea... more Information technology interventions as a means to meeting healthcare needs are generating a great deal of interest as healthcare costs increase, society ages, and the healthcare workforce declines. Two focus groups with people 65 years of age and older were conducted to gather information about the use of technology for enabling healthy independent living in older adults.. Methods Two 90 minute focus groups of 8 subjects each were conducted in Kannapolis, NC with subjects 65 years of age and older. The purpose of the focus groups was to better understand how people in this age group view their health and healthcare, the use of technology to facilitate healthcare, their level of independence, and challenges in receiving healthcare. Participants were recruited from people currently enrolled in the MURDOCK Study Community Registry and Biorepository. A moderator led the focus groups following an interview schedule. The sessions were tape recorded and observations were recorded in field...

JAMA Network Open, 2021

IMPORTANCE Electronic health records (EHRs) are considered a potentially significant contributor ... more IMPORTANCE Electronic health records (EHRs) are considered a potentially significant contributor to clinician burnout. OBJECTIVE To describe the association of EHR usage, sex, and work culture with burnout for 3 types of clinicians at an academic medical institution. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of 1310 clinicians at a large tertiary care academic medical center analyzed EHR usage metrics for the month of April 2019 with results from a well-being survey from May 2019. Participants included attending physicians, advanced practice providers (APPs), and house staff from various specialties. Data were analyzed between March 2020 and February 2021. EXPOSURES Clinician demographic characteristics, EHR metadata, and an institution-wide survey. MAIN OUTCOMES AND MEASURES Study metrics included clinician demographic data, burnout score, well-being measures, and EHR usage metadata. RESULTS Of the 1310 clinicians analyzed, 542 (41.4%) were men (mean [SD] age, 47.3 [11.6] years; 448 [82.7%] White clinicians, 52 [9.6%] Asian clinicians, and 21 [3.9%] Black clinicians) and 768 (58.6%) were women (mean [SD] age, 42.6 [10.3] years; 573 [74.6%] White clinicians, 105 [13.7%] Asian clinicians, and 50 [6.5%] Black clinicians). Women reported more burnout (survey score Ն50: women, 423 [52.0%] vs men, 258 [47.6%]; P = .008) overall. No significant differences in EHR usage were found by sex for multiple metrics of time in the EHR, metrics of volume of clinical encounters, or differences in products of clinical care. Multivariate analysis of burnout revealed that work culture domains were significantly associated with self-reported results for commitment (odds ratio [OR],

International Journal of Bio-Medical Computing, 1995

Whereas the preceding IMIA working conferences considered the scope of the Hospital Information S... more Whereas the preceding IMIA working conferences considered the scope of the Hospital Information Systems (HIS) to be restricted to the information systems within the borders of the institution, this conference was of the opinion that functions outside the hospital also need to be included in the definition, i.e. HIS broadens its definition to mean Health Information System. The relationships between the HIS and the Computer-based Patient Record (CPR) were discussed intensively.

The Seventh Annual Symposium on Computer Applications in Medical Care, 1983. Proceedings.

The U n i v e r s i t y o f Iowa Hospitals and C l i n i c s developed and maintains an o n-l i n... more The U n i v e r s i t y o f Iowa Hospitals and C l i n i c s developed and maintains an o n-l i n e I n f e c t i o n Data Management System w i t h i n i t s I B M 370/3081-D dual processor environment. Tabular i n f e c t i o n data

International Journal of Medical Informatics, 2003

Objectives: To present a summary of the state of the art in Health Information Systems (HIS), as ... more Objectives: To present a summary of the state of the art in Health Information Systems (HIS), as discussed during the Heidelberg HIS Working Group Conference, and to examine possible strategies for continuous improvement of the field. Methods: The state of the art in HIS is briefly described, and the historical trends are examined that emerge from a review of the previous HIS Working Group conferences. To extrapolate from those trends and suggest possible new directions, we consider whether perceived difficulties in the diffusion of HIS systems are simply a product of technological factors, or whether fundamental social factors have been ignored. Results: The experience with HIS environments is 'reasonably good' but not excellent, and true HIS success stories are not common. One of the apparent difficulties is that the typical HIS does not regard communication among clinical users as its core mission, even though repeated studies of information needs and practice patterns show that communication is the leading cost in today's health care environment. It is suggested that progress in the HIS arena will benefit from increased emphasis on the social aspects of health care, and better integration of diverse data to promote the organizational communication and workflow. Improvements could also come from a change to a highly participatory and evolutionary software engineering process, focusing on communication behavior and cooperative work practices. Conclusions: Future HIS development should view provider-provider and provider-patient communication as a core function, and incorporate features such as seamless support and tracking of communication, automatic gathering and presentation of data from multiple sources, data collection in atomic units by the most qualified provider, and integrated management, resource utilization, and tracking. The steps towards HIS that support these features might be smaller than generally suspected, once the appropriate changes in the reference point have been made.

Journal of the American Medical Informatics Association, 2014

In this paper we describe research we are conducting in response to a program announcement solici... more In this paper we describe research we are conducting in response to a program announcement solicited by the Assistant Secretary of Defense for Health Affairs, Defense Health Program. The amount of information in Electronic Health Record (EHR) systems is growing rapidly with the inclusion of disparate forms of data from a number of new sources, i.e. genomics and imaging data. EHR systems will continue to grow as more healthcare data is digitized. As data in EHRs grows, there is increasing interest in understanding what information and knowledge these large data sets represent. Data visualization techniques offer an opportunity to explore and understand large data through novel approaches. Our research seeks to visualize health care data from electronic health records (EHR) and other health related data. Our approach is informed by retrospective data queries using DEDUCE, a query tool developed at Duke University.

Identifying different patterns in longitudinal data (e.g. in laboratory values over time) related... more Identifying different patterns in longitudinal data (e.g. in laboratory values over time) related to a certain disease and associating them with different outcomes can be an important factor in delivering improved patient-specific health care. Visualization is often used to help understand complex temporal patterns, however the effectiveness of many temporal visualization techniques is compromised when dealing with temporal data from large numbers of individuals. We present work in progress on a visualization tool for exploring trajectories in longitudinal clinical data and their relationships to other disease factors. Linked views of multivariate features calculated from the longitudinal data, dynamically aggregated longitudinal data, diagnoses, and demographic data are presented, enabling the user to explore the data and identify potential relationships between temporal patterns, diagnoses, and demographics. We describe the various feature of this tool, demonstrate its application...

Journal of the American Medical Informatics Association, 2001

Much of my professional career has dealt with the creation, implementation, and support of a comp... more Much of my professional career has dealt with the creation, implementation, and support of a computer-based patient record system that became known as The Medical Record, or TMR. In this lecture, I would like to discuss with you some of those experienceswhat we did, what the driving factors were, what worked and what didn't, what lessons we learned, and what implications for medical informatics might be drawn. TMR Context Over its existence, TMR has been implemented in over 40 different sites. It has been implemented in 14 different medical specialties. It has operated in outpatient settings, inpatient settings, intensive care settings, and combinations of these settings. The smallest application was a solo practitioner, and the largest site supported more than 350 providers. The maximum number of patients supported by TMR in one system was approximately 750,000. The Medical Record provides an integrated clinical and accounting functionality. At its peak, it was operational in 15 different sites. At present, TMR is operational in four sites. It is still a character-based system, uses DEC's VMS operating system, and runs on the Alpha computer. The Medical Record was developed in an environment with limited resources-we were pushing the

Health Affairs, 2010

Effective health information systems require timely access to all health data from all sources, i... more Effective health information systems require timely access to all health data from all sources, including sites of direct care. In most parts of the world today, these data most likely come from many different and unconnected systems-but must be organized into a composite whole. We use the word interoperability to capture what is required to accomplish this goal. We discuss five priority areas for achieving interoperability in health care applications (patient identifier, semantic interoperability, data interchange standards, core data sets, and data quality), and we contrast differences in developing and developed countries. Important next steps for health policy makers are to define a vision, develop a strategy, identify leadership, assign responsibilities, and harness resources.

JAMIA Open

Objectives To identify factors impacting physician use of information charted by others. Material... more Objectives To identify factors impacting physician use of information charted by others. Materials and methods A 4-round Delphi process was conducted with physicians and non-physicians publishing in the healthcare data quality literature to identify and characterize factors impacting physician use of information charted by others (other people or devices), either within or external to their organization. Factors with high average importance and reliability were categorized according to similarity of topic. Results Thirty-nine factors were ultimately identified as impacting physician use of information charted by others. Five categories of factors included aspects of: the information source, the information itself, the information user, the information system, and aspects of healthcare as an institution. In addition, 4 themes were identified: (1) value of narrative text in providing context, (2) importance of mental models and personal heuristics in deciding whether, and how to use i...

Journal of the American Medical Informatics Association, 2014

Large amounts of personal health data are being collected and made available through existing and... more Large amounts of personal health data are being collected and made available through existing and emerging technological media and tools. While use of these data has significant potential to facilitate research, improve quality of care for individuals and populations, and reduce healthcare costs, many policy-related issues must be addressed before their full value can be realized. These include the need for widely agreed-on data stewardship principles and effective approaches to reduce or eliminate data silos and protect patient privacy. AMIA's 2012 Health Policy Meeting brought together healthcare academics, policy makers, and system stakeholders (including representatives of patient groups) to consider these topics and formulate recommendations. A review of a set of Proposed Principles of Health Data Use led to a set of findings and recommendations, including the assertions that the use of health data should be viewed as a public good and that achieving the broad benefits of this use will require understanding and support from patients.

Contemporary Clinical Trials

Journal of the American Medical Informatics Association : JAMIA, Sep 14, 2017

Pragmatic clinical trials (PCTs) are research investigations embedded in health care settings des... more Pragmatic clinical trials (PCTs) are research investigations embedded in health care settings designed to increase the efficiency of research and its relevance to clinical practice. The Health Care Systems Research Collaboratory, initiated by the National Institutes of Health Common Fund in 2010, is a pioneering cooperative aimed at identifying and overcoming operational challenges to pragmatic research. Drawing from our experience, we present 4 broad categories of informatics-related challenges: (1) using clinical data for research, (2) integrating data from heterogeneous systems, (3) using electronic health records to support intervention delivery or health system change, and (4) assessing and improving data capture to define study populations and outcomes. These challenges impact the validity, reliability, and integrity of PCTs. Achieving the full potential of PCTs and a learning health system will require meaningful partnerships between health system leadership and operations, a...

Circulation, 2014

† †Inter-American Society of Cardiology. ‡ ‡American Association for Critical-Care Nurses. § §Asi... more † †Inter-American Society of Cardiology. ‡ ‡American Association for Critical-Care Nurses. § §Asian Pacific Society of Cardiology. ‖‖Integrating the Healthcare Enterprise. ¶ ¶Digital Imaging and Communications in Medicine. ##Society of Thoracic Surgeons. ***Clinical Quality Committee representative during this writing effort. Author Recusals: Writing committee members are required to recuse themselves from voting on sections to which their specific relationship with industry and other entities may apply; see Appendix 1 for recusal information.

Studies in health technology and informatics, Jan 25, 2024

Most agree that the current healthcare system is broken. Fortunately, technology is increasing at... more Most agree that the current healthcare system is broken. Fortunately, technology is increasing at an exponential rate and provides a solution for the future. Digital Health is an integrator concept that has the potential to take advantage of technological advantages. Digital Health converges health, healthcare, research, and everyday life. It includes technologies, platforms, and systems that engage consumers in all aspects of life. It makes health and healthcare be people-centered and personalized. Digital health requires total interoperability-standards, common data elements, and the integration of data from all sources. It demands data sharing. Digital Health brings together a wide range of stakeholders for similar goals using the same resources. Digital Health uses mobile devices and wearable sensors and uses Artificial Intelligence and Machine Learning to handle the vast amount of data Digital Health engages. Finally, Digital Health has the potential to open the gap between the different social and economic classes that must be addressed.

IEEE Journal of Biomedical and Health Informatics

Abstract-- Cardiopulmonary Exercise Testing (CPET) is a unique physiologic medical test used to e... more Abstract-- Cardiopulmonary Exercise Testing (CPET) is a unique physiologic medical test used to evaluate the human response to a progressive maximal exercise stress. Depending on the degree and type of deviation from the normal physiologic response, CPET can help identify a patients specific limitations to exercise to guide clinical care without the need for other expensive and invasive diagnostic tests. However, given the amount and complexity of data obtained from CPET, interpretation and visualization of test results is challenging. CPET data currently requires dedicated training and significant experience for proper clinician interpretation. To make CPET more accessible to clinicians, we investigated a simplified data interpretation and visualization tool using machine learning algorithms. The visualization shows three types of limitations (cardiac, pulmonary and others); values are defined based on the results of three independent random forest classifiers. To display the models scores and make it interpretable to the clinicians, an interactive dashboard with the scores and interpretability plots was developed.

The Seventh Annual Symposium on Computer Applications in Medical Care, 1983. Proceedings.

Journal of the American Medical Informatics Association, 1997

The medical informatics community-vendors and users-have been seeking a common, comprehensive cli... more The medical informatics community-vendors and users-have been seeking a common, comprehensive clinical vocabulary for the past decade. New models for health care and new reporting requirements increase the necessity and desirability of such a vocabulary set. Much of the negotiation time between systems interested in exchanging data is related to matching vocabulary and code sets. Unfortunately, that is only the beginning and ongoing work is required to keep the vocabulary sets synchronized. At the same time, increased emphases on decision support, clinical guidelines, integrated delivery systems, and data reporting for performance evaluation require more precise and understandable vocabulary terms.

Information technology interventions as a means to meeting healthcare needs are generating a grea... more Information technology interventions as a means to meeting healthcare needs are generating a great deal of interest as healthcare costs increase, society ages, and the healthcare workforce declines. Two focus groups with people 65 years of age and older were conducted to gather information about the use of technology for enabling healthy independent living in older adults.. Methods Two 90 minute focus groups of 8 subjects each were conducted in Kannapolis, NC with subjects 65 years of age and older. The purpose of the focus groups was to better understand how people in this age group view their health and healthcare, the use of technology to facilitate healthcare, their level of independence, and challenges in receiving healthcare. Participants were recruited from people currently enrolled in the MURDOCK Study Community Registry and Biorepository. A moderator led the focus groups following an interview schedule. The sessions were tape recorded and observations were recorded in field...

JAMA Network Open, 2021

IMPORTANCE Electronic health records (EHRs) are considered a potentially significant contributor ... more IMPORTANCE Electronic health records (EHRs) are considered a potentially significant contributor to clinician burnout. OBJECTIVE To describe the association of EHR usage, sex, and work culture with burnout for 3 types of clinicians at an academic medical institution. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of 1310 clinicians at a large tertiary care academic medical center analyzed EHR usage metrics for the month of April 2019 with results from a well-being survey from May 2019. Participants included attending physicians, advanced practice providers (APPs), and house staff from various specialties. Data were analyzed between March 2020 and February 2021. EXPOSURES Clinician demographic characteristics, EHR metadata, and an institution-wide survey. MAIN OUTCOMES AND MEASURES Study metrics included clinician demographic data, burnout score, well-being measures, and EHR usage metadata. RESULTS Of the 1310 clinicians analyzed, 542 (41.4%) were men (mean [SD] age, 47.3 [11.6] years; 448 [82.7%] White clinicians, 52 [9.6%] Asian clinicians, and 21 [3.9%] Black clinicians) and 768 (58.6%) were women (mean [SD] age, 42.6 [10.3] years; 573 [74.6%] White clinicians, 105 [13.7%] Asian clinicians, and 50 [6.5%] Black clinicians). Women reported more burnout (survey score Ն50: women, 423 [52.0%] vs men, 258 [47.6%]; P = .008) overall. No significant differences in EHR usage were found by sex for multiple metrics of time in the EHR, metrics of volume of clinical encounters, or differences in products of clinical care. Multivariate analysis of burnout revealed that work culture domains were significantly associated with self-reported results for commitment (odds ratio [OR],

International Journal of Bio-Medical Computing, 1995

Whereas the preceding IMIA working conferences considered the scope of the Hospital Information S... more Whereas the preceding IMIA working conferences considered the scope of the Hospital Information Systems (HIS) to be restricted to the information systems within the borders of the institution, this conference was of the opinion that functions outside the hospital also need to be included in the definition, i.e. HIS broadens its definition to mean Health Information System. The relationships between the HIS and the Computer-based Patient Record (CPR) were discussed intensively.

The Seventh Annual Symposium on Computer Applications in Medical Care, 1983. Proceedings.

The U n i v e r s i t y o f Iowa Hospitals and C l i n i c s developed and maintains an o n-l i n... more The U n i v e r s i t y o f Iowa Hospitals and C l i n i c s developed and maintains an o n-l i n e I n f e c t i o n Data Management System w i t h i n i t s I B M 370/3081-D dual processor environment. Tabular i n f e c t i o n data

International Journal of Medical Informatics, 2003

Objectives: To present a summary of the state of the art in Health Information Systems (HIS), as ... more Objectives: To present a summary of the state of the art in Health Information Systems (HIS), as discussed during the Heidelberg HIS Working Group Conference, and to examine possible strategies for continuous improvement of the field. Methods: The state of the art in HIS is briefly described, and the historical trends are examined that emerge from a review of the previous HIS Working Group conferences. To extrapolate from those trends and suggest possible new directions, we consider whether perceived difficulties in the diffusion of HIS systems are simply a product of technological factors, or whether fundamental social factors have been ignored. Results: The experience with HIS environments is 'reasonably good' but not excellent, and true HIS success stories are not common. One of the apparent difficulties is that the typical HIS does not regard communication among clinical users as its core mission, even though repeated studies of information needs and practice patterns show that communication is the leading cost in today's health care environment. It is suggested that progress in the HIS arena will benefit from increased emphasis on the social aspects of health care, and better integration of diverse data to promote the organizational communication and workflow. Improvements could also come from a change to a highly participatory and evolutionary software engineering process, focusing on communication behavior and cooperative work practices. Conclusions: Future HIS development should view provider-provider and provider-patient communication as a core function, and incorporate features such as seamless support and tracking of communication, automatic gathering and presentation of data from multiple sources, data collection in atomic units by the most qualified provider, and integrated management, resource utilization, and tracking. The steps towards HIS that support these features might be smaller than generally suspected, once the appropriate changes in the reference point have been made.

Journal of the American Medical Informatics Association, 2014

In this paper we describe research we are conducting in response to a program announcement solici... more In this paper we describe research we are conducting in response to a program announcement solicited by the Assistant Secretary of Defense for Health Affairs, Defense Health Program. The amount of information in Electronic Health Record (EHR) systems is growing rapidly with the inclusion of disparate forms of data from a number of new sources, i.e. genomics and imaging data. EHR systems will continue to grow as more healthcare data is digitized. As data in EHRs grows, there is increasing interest in understanding what information and knowledge these large data sets represent. Data visualization techniques offer an opportunity to explore and understand large data through novel approaches. Our research seeks to visualize health care data from electronic health records (EHR) and other health related data. Our approach is informed by retrospective data queries using DEDUCE, a query tool developed at Duke University.

Identifying different patterns in longitudinal data (e.g. in laboratory values over time) related... more Identifying different patterns in longitudinal data (e.g. in laboratory values over time) related to a certain disease and associating them with different outcomes can be an important factor in delivering improved patient-specific health care. Visualization is often used to help understand complex temporal patterns, however the effectiveness of many temporal visualization techniques is compromised when dealing with temporal data from large numbers of individuals. We present work in progress on a visualization tool for exploring trajectories in longitudinal clinical data and their relationships to other disease factors. Linked views of multivariate features calculated from the longitudinal data, dynamically aggregated longitudinal data, diagnoses, and demographic data are presented, enabling the user to explore the data and identify potential relationships between temporal patterns, diagnoses, and demographics. We describe the various feature of this tool, demonstrate its application...

Journal of the American Medical Informatics Association, 2001

Much of my professional career has dealt with the creation, implementation, and support of a comp... more Much of my professional career has dealt with the creation, implementation, and support of a computer-based patient record system that became known as The Medical Record, or TMR. In this lecture, I would like to discuss with you some of those experienceswhat we did, what the driving factors were, what worked and what didn't, what lessons we learned, and what implications for medical informatics might be drawn. TMR Context Over its existence, TMR has been implemented in over 40 different sites. It has been implemented in 14 different medical specialties. It has operated in outpatient settings, inpatient settings, intensive care settings, and combinations of these settings. The smallest application was a solo practitioner, and the largest site supported more than 350 providers. The maximum number of patients supported by TMR in one system was approximately 750,000. The Medical Record provides an integrated clinical and accounting functionality. At its peak, it was operational in 15 different sites. At present, TMR is operational in four sites. It is still a character-based system, uses DEC's VMS operating system, and runs on the Alpha computer. The Medical Record was developed in an environment with limited resources-we were pushing the

Health Affairs, 2010

Effective health information systems require timely access to all health data from all sources, i... more Effective health information systems require timely access to all health data from all sources, including sites of direct care. In most parts of the world today, these data most likely come from many different and unconnected systems-but must be organized into a composite whole. We use the word interoperability to capture what is required to accomplish this goal. We discuss five priority areas for achieving interoperability in health care applications (patient identifier, semantic interoperability, data interchange standards, core data sets, and data quality), and we contrast differences in developing and developed countries. Important next steps for health policy makers are to define a vision, develop a strategy, identify leadership, assign responsibilities, and harness resources.

JAMIA Open

Objectives To identify factors impacting physician use of information charted by others. Material... more Objectives To identify factors impacting physician use of information charted by others. Materials and methods A 4-round Delphi process was conducted with physicians and non-physicians publishing in the healthcare data quality literature to identify and characterize factors impacting physician use of information charted by others (other people or devices), either within or external to their organization. Factors with high average importance and reliability were categorized according to similarity of topic. Results Thirty-nine factors were ultimately identified as impacting physician use of information charted by others. Five categories of factors included aspects of: the information source, the information itself, the information user, the information system, and aspects of healthcare as an institution. In addition, 4 themes were identified: (1) value of narrative text in providing context, (2) importance of mental models and personal heuristics in deciding whether, and how to use i...

Journal of the American Medical Informatics Association, 2014

Large amounts of personal health data are being collected and made available through existing and... more Large amounts of personal health data are being collected and made available through existing and emerging technological media and tools. While use of these data has significant potential to facilitate research, improve quality of care for individuals and populations, and reduce healthcare costs, many policy-related issues must be addressed before their full value can be realized. These include the need for widely agreed-on data stewardship principles and effective approaches to reduce or eliminate data silos and protect patient privacy. AMIA's 2012 Health Policy Meeting brought together healthcare academics, policy makers, and system stakeholders (including representatives of patient groups) to consider these topics and formulate recommendations. A review of a set of Proposed Principles of Health Data Use led to a set of findings and recommendations, including the assertions that the use of health data should be viewed as a public good and that achieving the broad benefits of this use will require understanding and support from patients.