The American journal of managed care
-
Electronic consultation, or e-consult, systems improve specialty care access by conveying specialist expertise to primary care clinicians (PCCs) without requiring specialist visits. Our study evaluates organizational factors for e-consult implementation across 5 publicly financed, county-based health systems in California. Each system serves 40,000 to 180,000 culturally and linguistically diverse patients across 4 to 19 primary care locations. ⋯ Successful e-consult implementations in public delivery systems leveraged (1) prior primary care and specialty care clinician relationships and (2) integrated EHR and e-consult platforms. This contrasts with common expectations that new technology will overcome care delivery gaps. Findings add to existing e-consult implementation literature that emphasizes reimbursement and leadership champions.
-
The learning health system (LHS) has gained traction as a powerful framework for improving the cost and quality of healthcare. The goal of an LHS is to systematically integrate internal data and experience with external evidence so patients receive higher-quality, safer, and more efficient care. ⋯ We also discuss how integrating data on the social determinants and activities to reduce patients' social risk factors could advance the mission of the LHS to enhance patient engagement, improve the delivery of personalized care, and more accurately evaluate the effectiveness of care. Without the collection and integration of data on the social determinants of health, the LHS may fail to reach its full potential to improve health and healthcare.
-
Teams of healthcare providers use health information technology (HIT) to facilitate communication and collaboration. Effective team-based care requires trust, yet we know relatively little about how physicians build and maintain trust with their fellow providers and, further, how HIT affects trust among provider team members. We describe priority areas for advancing our understanding of trust within healthcare teams, which may inform policies and HIT design in efforts to improve clinical decision making, provider satisfaction, quality of care, and patient health outcomes.
-
The adoption and use of health information technology (IT) by health systems in ambulatory care can be an important driver of care quality. We examine recent trends in health IT adoption by health system-affiliated ambulatory clinics in the context of the federal government's Meaningful Use and Promoting Interoperability programs. ⋯ The relatively low uptake of health IT functionalities important to care improvement suggests substantial opportunities for further improving adoption of ambulatory health IT even among the current EHR users.
-
Observational Study
Predicting hospitalizations from electronic health record data.
Electronic health record (EHR) data have become increasingly available and may help inform clinical prediction. However, predicting hospitalizations among a diverse group of patients remains difficult. We sought to use EHR data to create and internally validate a predictive model for clinical use in predicting hospitalizations. ⋯ Prediction models using EHR-only, claims-only, and combined data had similar predictive value and demonstrated strong discrimination for which patients will be hospitalized in the ensuing 6 months.