Publications by authors named "Meryl Bloomrosen"

25 Publications

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Findings from the Health Information Management Section of the 2020 International Medical Informatics Association Yearbook.

Yearb Med Inform 2020 Aug 21;29(1):87-92. Epub 2020 Aug 21.

Graduate Programs in Health Informatics, Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA.

Objectives: To summarize the recent literature and research and present a selection of the best papers published in 2019 in the field of Health Information Management (HIM) and Health Informatics.

Methods: A systematic review of the literature was performed by the two section editors with the help of a medical librarian. The search through bibliographic databases for HIM-related papers was achieved using both MeSH headings and keywords in titles and abstracts. A shortlist of 15 candidate best papers was first selected by section editors before being peer-reviewed by independent external reviewers.

Results: Over half of the 15 papers addressed the issue of data quality in the electronic health record (EHR). In addition to the focus on data quality, there were papers on other topics of long-standing interest to the field of HIM. These topics include privacy, security, and confidentiality of health information, comparability of different coding vocabularies, classifications and terminologies, and the HIM workforce. Finally, there were papers on newer topics for the HIM field, including mobile Health (mHealth), EHR use by public health departments, and usability of different strategies for displaying information in the EHR.

Conclusions: Traditional HIM concerns about HIM practice and workforce as well as issues about data in the EHR including data quality, coding, and privacy and confidentiality continue to be a large part of the HIM research literature. However, newer topics which reflect innovative and emerging technologies, usability assessments, and the application of the EHR outside the traditional clinical setting are starting to appear and more research is needed on these newer areas.
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http://dx.doi.org/10.1055/s-0040-1701999DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442524PMC
August 2020

Findings from the 2019 International Medical Informatics Association Yearbook Section on Health Information Management.

Yearb Med Inform 2019 Aug 16;28(1):65-68. Epub 2019 Aug 16.

Graduate Programs in Health Informatics, Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA.

Objectives: To summarize the recent literature and research and present a selection of the best papers published in 2018 in the field of Health Information Management (HIM) and Health Informatics.

Methods: A systematic review of the literature was performed, with the help of a medical librarian, by the two editors of the HIM section of the International Medical Informatics Association (IMIA) Yearbook. In order to include papers that would address the special theme of the 2019 Yearbook on artificial intelligence (AI) as well as HIM, we searched bibliographic databases for HIM-related papers with an AI focus using both Medical Subject Headings (MeSH) descriptors and keywords in titles and abstracts. A shortlist of 15 candidate best papers was first selected by section editors before being peer-reviewed by independent external reviewers.

Results: While there were a significant number of manuscripts that addressed issues relevant to HIM, there were virtually none with MeSH headings indicating an HIM focus. Manuscripts that were considered related to the HIM field in terms of the practice of health information management as well as the profession included those that examined using machine learning and other AI approaches to identify protected health information in clinical text to aid with de-identification, automated coding approaches to translate free-text into standardized codes, and natural language processing approaches to extract clinical data to assist with populating cancer and other registries.

Conclusions: The papers discussed in the HIM section reflect the special theme of the use of AI in healthcare on issues particularly relevant to the field of HIM. This synopsis discusses these papers and recommends that HIM practitioners be more involved in research and that researchers in AI and related areas recognize the applicability and relevance of their work to the field of HIM.
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http://dx.doi.org/10.1055/s-0039-1677941DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697497PMC
August 2019

Findings from 2017 on Health Information Management

Yearb Med Inform 2018 08 29;27(1):67-73. Epub 2018 Aug 29.

Graduate Programs in Health Informatics, Department of Health Services Administration, University of Alabama at Birmingham, Birmingham, AL, USA.

Objective: To summarize the recent literature and research and present a selection of the best papers published in 2017 in the field of Health Information Management (HIM) and Health Informatics.

Methods: A systematic review of the literature was performed by the two HIM section editors of the International Medical Informatics Association (IMIA) Yearbook with the help of a medical librarian. We searched bibliographic databases for HIM-related papers using both MeSH descriptors and keywords in titles and abstracts. A shortlist of 15 candidate best papers was first selected by section editors before being peer-reviewed by independent external reviewers.

Results: Health Information Exchange was a major theme within candidate best papers. The four papers ultimately selected as 'Best Papers' represent themes that include health information exchange, governance and policy issues, results of health information exchange, and methods of integrating information from multiple sources. Other articles within the candidate best papers include these themes as well as those focusing on authentication and de-identification and usability of information systems.

Conclusions: The papers discussed in the HIM section of IMIA Yearbook reflect the overall theme of the 2018 edition of the Yearbook, i.e., the tension between privacy and access to information. While most of the papers focused on health information exchange, which reflects the "access" side of the equation, most of the others addressed privacy issues. This synopsis discusses these key issues at the intersection of HIM and informatics.
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http://dx.doi.org/10.1055/s-0038-1667072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6115240PMC
August 2018

Patient engagement: challenges and opportunities for physicians.

Ann Allergy Asthma Immunol 2015 Dec 6;115(6):459-62. Epub 2015 Oct 6.

President and CEO, Asthma and Allergy Foundation of America, Landover, Maryland.

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http://dx.doi.org/10.1016/j.anai.2015.09.005DOI Listing
December 2015

Health data use, stewardship, and governance: ongoing gaps and challenges: a report from AMIA's 2012 Health Policy Meeting.

J Am Med Inform Assoc 2014 Mar-Apr;21(2):204-11. Epub 2013 Oct 29.

Department of Bioinformatics, Columbia University, New York, New York, USA.

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.
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http://dx.doi.org/10.1136/amiajnl-2013-002117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3932468PMC
May 2014

Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA.

J Am Med Inform Assoc 2013 Jun 25;20(e1):e2-8. Epub 2013 Jan 25.

Clinical Informatics Research and Development, Partners HealthCare System, Harvard Medical School, Wellesley, Massachusetts 02481, USA.

In response to mounting evidence that use of electronic medical record systems may cause unintended consequences, and even patient harm, the AMIA Board of Directors convened a Task Force on Usability to examine evidence from the literature and make recommendations. This task force was composed of representatives from both academic settings and vendors of electronic health record (EHR) systems. After a careful review of the literature and of vendor experiences with EHR design and implementation, the task force developed 10 recommendations in four areas: (1) human factors health information technology (IT) research, (2) health IT policy, (3) industry recommendations, and (4) recommendations for the clinician end-user of EHR software. These AMIA recommendations are intended to stimulate informed debate, provide a plan to increase understanding of the impact of usability on the effective use of health IT, and lead to safer and higher quality care with the adoption of useful and usable EHR systems.
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http://dx.doi.org/10.1136/amiajnl-2012-001458DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3715367PMC
June 2013

The future state of clinical data capture and documentation: a report from AMIA's 2011 Policy Meeting.

J Am Med Inform Assoc 2013 Jan 8;20(1):134-40. Epub 2012 Sep 8.

Insight Informatics, Manchester, New Hampshire, USA.

Much of what is currently documented in the electronic health record is in response toincreasingly complex and prescriptive medicolegal, reimbursement, and regulatory requirements. These requirements often result in redundant data capture and cumbersome documentation processes. AMIA's 2011 Health Policy Meeting examined key issues in this arena and envisioned changes to help move toward an ideal future state of clinical data capture and documentation. The consensus of the meeting was that, in the move to a technology-enabled healthcare environment, the main purpose of documentation should be to support patient care and improved outcomes for individuals and populations and that documentation for other purposes should be generated as a byproduct of care delivery. This paper summarizes meeting deliberations, and highlights policy recommendations and research priorities. The authors recommend development of a national strategy to review and amend public policies to better support technology-enabled data capture and documentation practices.
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http://dx.doi.org/10.1136/amiajnl-2012-001093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3555335PMC
January 2013

Preventability of adverse drug events involving multiple drugs using publicly available clinical decision support tools.

Am J Health Syst Pharm 2012 Feb;69(3):221-7

Brigham & Women’s Hospital,1620 Tremont Street, Boston, MA 02115, USA.

Purpose: The results of a retrospective evaluation of the frequency and preventability of adverse drug events (ADEs) involving multiple drugs among hospital inpatients are reported.

Methods: Data collected in a previous cohort study of 180 actual ADEs and 552 potential ADEs (PADEs) at six community hospitals in Massachusetts were analyzed to determine the frequency and types of multiple-drug ADEs and the extent to which the ADEs might have been prevented using publicly available clinical decision-support (CDS) knowledge bases. None of the hospitals had a computerized prescriber-order-entry system at the time of data collection (January 2005-August 2006).

Results: A total of 17 ADEs (rate, 1.4 per 100 admissions) and 146 PADEs (rate, 12.2 per 100 admissions) involving multiple drugs were identified. The documented events were related to drug duplication (n = 126), drug-drug interaction (n = 21), additive effects (n = 14), and therapeutic duplication (n = 7) or a combination of those factors. The majority of actual ADEs were due to drug-drug interactions, most commonly involving opioids, benzodiazepines, or cardiac medications; about 75% of the PADEs involved excessive drug doses resulting from order duplication or the prescribing of combination drugs with overlapping ingredients, usually products containing acetaminophen and an opioid. It was determined that 5 (29.4%) of the ADEs and 131 (89.7%) of the PADEs could have been detected through the use of the evaluated CDS tools.

Conclusion: A substantial number of actual ADEs and PADEs in the community hospital setting may be preventable through the use of publicly available CDS knowledge bases.
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http://dx.doi.org/10.2146/ajhp110084DOI Listing
February 2012

The future of health IT innovation and informatics: a report from AMIA's 2010 policy meeting.

J Am Med Inform Assoc 2012 May-Jun;19(3):460-7. Epub 2011 Oct 28.

Knowledge Informatics and Translation, Indiana University School of Medicine, Indianapolis, Indiana, USA.

While much attention has been paid to the short-term impact that widespread adoption of health information technology (health IT) will have on the healthcare system, there is a corresponding need to look at the long-term effects that extant policies may have on health IT system resilience, innovation, and related ethical, social/legal issues. The American Medical Informatics Association's 2010 Health Policy Conference was convened to further the national discourse on the issues surrounding these longer-term considerations. Conference participants self-selected into three broad categories: resilience in healthcare and health IT; ethical, legal, and social challenges; and innovation, adoption, and sustainability. The discussions about problem areas lead to findings focusing on the lack of encouragement for long-term IT innovation that may result from current health IT policies; the potential impact of uneven adoption of health IT based on the exclusions of the current financial incentives; the weaknesses of contingency and risk mitigation planning that threaten system resilience; and evolving standards developed in response to challenges relating to the security, integrity, and availability of electronic health information. This paper discusses these findings and also offers recommendations that address the interwoven topics of innovation, resilience, and adoption. The goal of this paper is to encourage public and private sector organizations that have a role in shaping health information policy to increase attention to developing a national strategy that assures that health IT innovation and resilience are not impeded by shorter-term efforts to implement current approaches emphasizing adoption and meaningful use of electronic health records.
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http://dx.doi.org/10.1136/amiajnl-2011-000522DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341794PMC
August 2012

Development and preliminary evidence for the validity of an instrument assessing implementation of human-factors principles in medication-related decision-support systems--I-MeDeSA.

J Am Med Inform Assoc 2011 Dec 21;18 Suppl 1:i62-72. Epub 2011 Sep 21.

Partners HealthCare System, Wellesley, Massachusetts 02481, USA.

Background: Medication-related decision support can reduce the frequency of preventable adverse drug events. However, the design of current medication alerts often results in alert fatigue and high over-ride rates, thus reducing any potential benefits.

Methods: The authors previously reviewed human-factors principles for relevance to medication-related decision support alerts. In this study, instrument items were developed for assessing the appropriate implementation of these human-factors principles in drug-drug interaction (DDI) alerts. User feedback regarding nine electronic medical records was considered during the development process. Content validity, construct validity through correlation analysis, and inter-rater reliability were assessed.

Results: The final version of the instrument included 26 items associated with nine human-factors principles. Content validation on three systems resulted in the addition of one principle (Corrective Actions) to the instrument and the elimination of eight items. Additionally, the wording of eight items was altered. Correlation analysis suggests a direct relationship between system age and performance of DDI alerts (p=0.0016). Inter-rater reliability indicated substantial agreement between raters (κ=0.764).

Conclusion: The authors developed and gathered preliminary evidence for the validity of an instrument that measures the appropriate use of human-factors principles in the design and display of DDI alerts. Designers of DDI alerts may use the instrument to improve usability and increase user acceptance of medication alerts, and organizations selecting an electronic medical record may find the instrument helpful in meeting their clinicians' usability needs.
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http://dx.doi.org/10.1136/amiajnl-2011-000362DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3241174PMC
December 2011

Accelerating the deployment of a health information technology and informatics workforce through education, training, research, and evaluation.

Stud Health Technol Inform 2011 ;170:113-21

Vanderbilt University, Nashville, TN, USA.

Supported by stronger and more coordinated US federal funding and policies, driven by goals to deliver care more efficiently, and motivated to provide high quality care for an aging and more diverse population, public-private-sector organisations are redoubling efforts to implement information systems. Thus, there is a critical need to increase and broaden the pool of workers who can help organizations maximise the effectiveness of their investments in technology. There are in the US various current health informatics education and training initiatives and ongoing efforts to accelerate Health IT workforce development.
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December 2011

A proposed vision: the transatlantic observatory for meeting global health policy challenges through information and communications technology-enabled solutions (ARGOS).

Stud Health Technol Inform 2011 ;170:107-11

Vanderbilt University, Nashville, TN, USA.

In 2010 the ARGOS project was funded by the EC (DG RELEX) to contribute to the establishement of a "Transatlantic Observatory for meeting Global Health Policy Challenges through Information and Communication Technology-enabled solutions" to develop and promote common methods for responding to global eHealth challenges in the EU and the US. The European Institute for Health Records (EuroRec) was coordinating the project. The vision is that the Transatlantic Observatory will act as an international platform for dialogue and collaboration on health policy issues and will 1. build international consensus about how to improve the access, efficiency and quality of health services through ICT, 2. promote the importance of interoperability in eHealth, 3. help to define approaches to ensure that health data are easily available where it is needed, 4. identify optimal development paths.
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December 2011

Policy brief on the current status of certification of electronic Health Records in the US and Europe.

Stud Health Technol Inform 2011 ;170:83-106

The EuroRec Institute, Belgium.

If Electronic Health Record systems are to provide an effective contribution to healthcare, a set of benchmarks need to be set to ensure quality control and interoperability of systems. This paper outlines the prevailing status of EHR certification in the US and the EU, compares and contrasts established schemes and poses opportunities for convergence of activity in the domain designed to advance certification endeavours generally. Several EU Member States have in the past proceeded with EHR systems quality labeling and/or certification, but these differ in scope, in legal framework under which they operate, in policies (legislation and financial incentives), in organization, and perhaps most importantly in the quality criteria used for benchmarking. Harmonization, therefore, became a must. Now, through EuroRec (with approaches ranging from self-assessment to third party certification depending on the level of confidence needed) and its Seals, the possibility to achieve this for EHR systems has started in the whole of Europe. The US HITECH Act also attempts to create incentives for all hospitals and eligible providers to adopt and use electronic information. A centerpiece of the Act is to put in place strong financial incentives to adopt and meaningfully use EHRs. The HHS/EHR Certification Programme makes use of ISO/IEC 170XX standards for accreditation, testing and certification. The approved test method addresses the functional and the interoperability requirements defined in the Final Rule criteria and standards. To date six Authorized Testing and Certification Bodies (ATCBs) are testing and certifying products in the US.
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December 2011

Anticipating and addressing the unintended consequences of health IT and policy: a report from the AMIA 2009 Health Policy Meeting.

J Am Med Inform Assoc 2011 Jan-Feb;18(1):82-90

AMIA, Bethesda, Maryland 20814, USA.

Federal legislation (Health Information Technology for Economic and Clinical Health (HITECH) Act) has provided funds to support an unprecedented increase in health information technology (HIT) adoption for healthcare provider organizations and professionals throughout the U.S. While recognizing the promise that widespread HIT adoption and meaningful use can bring to efforts to improve the quality, safety, and efficiency of healthcare, the American Medical Informatics Association devoted its 2009 Annual Health Policy Meeting to consideration of unanticipated consequences that could result with the increased implementation of HIT. Conference participants focused on possible unintended and unanticipated, as well as undesirable, consequences of HIT implementation. They employed an input-output model to guide discussion on occurrence of these consequences in four domains: technical, human/cognitive, organizational, and fiscal/policy and regulation. The authors outline the conference's recommendations: (1) an enhanced research agenda to guide study into the causes, manifestations, and mitigation of unintended consequences resulting from HIT implementations; (2) creation of a framework to promote sharing of HIT implementation experiences and the development of best practices that minimize unintended consequences; and (3) recognition of the key role of the Federal Government in providing leadership and oversight in analyzing the effects of HIT-related implementations and policies.
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http://dx.doi.org/10.1136/jamia.2010.007567DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3005876PMC
April 2011

Clinical decision support: progress and opportunities.

J Am Med Inform Assoc 2010 Sep-Oct;17(5):487-92

Department of Public Health Sciences, University of Virginia Health System, Charlottesville, VA, USA.

In 2005, the American Medical Informatics Association undertook a set of activities relating to clinical decision support (CDS), with support from the office of the national coordinator and the Agency for Healthcare Research and Quality. They culminated in the release of the roadmap for national action on CDS in 2006. This article assesses progress toward the short-term goals within the roadmap, and recommends activities to continue to improve CDS adoption throughout the United States. The report finds that considerable progress has been made in the past four years, although significant work remains. Healthcare quality organizations are increasingly recognizing the role of health information technology in improving care, multi-site CDS demonstration projects are under way, and there are growing incentives for adoption. Specific recommendations include: (1) designating a national entity to coordinate CDS work and collaboration; (2) developing approaches to monitor and track CDS adoption and use; (3) defining and funding a CDS research agenda; and (4) updating the CDS 'critical path'.
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http://dx.doi.org/10.1136/jamia.2010.005561DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995690PMC
November 2010

Informatics, evidence-based care, and research; implications for national policy: a report of an American Medical Informatics Association health policy conference.

J Am Med Inform Assoc 2010 Mar-Apr;17(2):115-23

American Medical Informatics Association, Bethesda, Maryland 20814, USA.

There is an increased level of activity in the biomedical and health informatics world (e-prescribing, electronic health records, personal health records) that, in the near future, will yield a wealth of available data that we can exploit meaningfully to strengthen knowledge building and evidence creation, and ultimately improve clinical and preventive care. The American Medical Informatics Association (AMIA) 2008 Health Policy Conference was convened to focus and propel discussions about informatics-enabled evidence-based care, clinical research, and knowledge management. Conference participants explored the potential of informatics tools and technologies to improve the evidence base on which providers and patients can draw to diagnose and treat health problems. The paper presents a model of an evidence continuum that is dynamic, collaborative, and powered by health informatics technologies. The conference's findings are described, and recommendations on terminology harmonization, facilitation of the evidence continuum in a "wired" world, development and dissemination of clinical practice guidelines and other knowledge support strategies, and the role of diverse stakeholders in the generation and adoption of evidence are presented.
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http://dx.doi.org/10.1136/jamia.2009.001370DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000781PMC
June 2010

Best Practices in Clinical Decision Support: the Case of Preventive Care Reminders.

Appl Clin Inform 2010 ;1(3):331-345

Brigham & Women's Hospital, Boston, MA, USA.

BACKGROUND: Evidence demonstrates that clinical decision support (CDS) is a powerful tool for improving healthcare quality and ensuring patient safety. However, implementing and maintaining effective decision support interventions presents multiple technical and organizational challenges. PURPOSE: To identify best practices for CDS, using the domain of preventive care reminders as an example. METHODS: We assembled a panel of experts in CDS and held a series of facilitated online and in-person discussions. We analyzed the results of these discussions using a grounded theory method to elicit themes and best practices. RESULTS: Eight best practice themes were identified as important: deliver CDS in the most appropriate ways, develop effective governance structures, consider use of incentives, be aware of workflow, keep content current, monitor and evaluate impact, maintain high quality data, and consider sharing content. Keys themes within each of these areas were also described. CONCLUSION: Successful implementation of CDS requires consideration of both technical and socio-technical factors. The themes identified in this study provide guidance on crucial factors that need consideration when CDS is implemented across healthcare settings. These best practice themes may be useful for developers, implementers, and users of decision support.
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http://dx.doi.org/10.4338/ACI-2010-05-RA-0031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3189503PMC
January 2010

The morningside initiative: collaborative development of a knowledge repository to accelerate adoption of clinical decision support.

Open Med Inform J 2010 14;4:278-90. Epub 2010 Dec 14.

Arizona State University, Phoenix, AZ, USA.

The Morningside Initiative is a public-private activity that has evolved from an August, 2007, meeting at the Morningside Inn, in Frederick, MD, sponsored by the Telemedicine and Advanced Technology Research Center (TATRC) of the US Army Medical Research Materiel Command. Participants were subject matter experts in clinical decision support (CDS) and included representatives from the Department of Defense, Veterans Health Administration, Kaiser Permanente, Partners Healthcare System, Henry Ford Health System, Arizona State University, and the American Medical Informatics Association (AMIA). The Morningside Initiative was convened in response to the AMIA Roadmap for National Action on Clinical Decision Support and on the basis of other considerations and experiences of the participants. Its formation was the unanimous recommendation of participants at the 2007 meeting which called for creating a shared repository of executable knowledge for diverse health care organizations and practices, as well as health care system vendors. The rationale is based on the recognition that sharing of clinical knowledge needed for CDS across organizations is currently virtually non-existent, and that, given the considerable investment needed for creating, maintaining and updating authoritative knowledge, which only larger organizations have been able to undertake, this is an impediment to widespread adoption and use of CDS. The Morningside Initiative intends to develop and refine (1) an organizational framework, (2) a technical approach, and (3) CDS content acquisition and management processes for sharing CDS knowledge content, tools, and experience that will scale with growing numbers of participants and can be expanded in scope of content and capabilities. Intermountain Healthcare joined the initial set of participants shortly after its formation. The efforts of the Morningside Initiative are intended to serve as the basis for a series of next steps in a national agenda for CDS. It is based on the belief that sharing of knowledge can be highly effective as is the case in other competitive domains such as genomics. Participants in the Morningside Initiative believe that a coordinated effort between the private and public sectors is needed to accomplish this goal and that a small number of highly visible and respected health care organizations in the public and private sector can lead by example. Ultimately, a future collaborative knowledge sharing organization must have a sustainable long-term business model for financial support.
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http://dx.doi.org/10.2174/1874431101004010278DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3097479PMC
August 2012

Don E. Detmer and the American Medical Informatics Association: an appreciation.

J Am Med Inform Assoc 2009 Jul-Aug;16(4):429-38

American Medical Informatics Association, Bethesda, MD 20814, USA.

Don E. Detmer has served as President and Chief Executive Officer of the American Medical Informatics Association (AMIA) for the past five years, helping to set a course for the organization and demonstrating remarkable leadership as AMIA has evolved into a vibrant and influential professional association. On the occasion of Dr. Detmer's retirement, we fondly reflect on his professional life and his many contributions to biomedical informatics and, more generally, to health care in the U.S. and globally.
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http://dx.doi.org/10.1197/jamia.M3238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2705244PMC
September 2009

How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings.

BMC Med Inform Decis Mak 2009 Feb 23;9:15. Epub 2009 Feb 23.

Vanderbilt University Medical Center, The Informatics Center, Nashville, TN, USA.

Background: Adoption of EHRs by U.S. ambulatory practices has been slow despite the perceived benefits of their use. Most evaluations of EHR implementations in the literature apply to large practice settings. While there are similarities relating to EHR implementation in large and small practice settings, the authors argue that scale is an important differentiator. Focusing on small ambulatory practices, this paper outlines the benefits and barriers to EHR use in this setting, and provides a "field guide" for these practices to facilitate successful EHR implementation.

Discussion: The benefits of EHRs in ambulatory practices include improved patient care and office efficiency, and potential financial benefits. Barriers to EHRs include costs; lack of standardization of EHR products and the design of vendor systems for large practice environments; resistance to change; initial difficulty of system use leading to productivity reduction; and perceived accrual of benefits to society and payers rather than providers. The authors stress the need for developing a flexible change management strategy when introducing EHRs that is relevant to the small practice environment; the strategy should acknowledge the importance of relationship management and the role of individual staff members in helping the entire staff to manage change. Practice staff must create an actionable vision outlining realistic goals for the implementation, and all staff must buy into the project. The authors detail the process of implementing EHRs through several stages: decision, selection, pre-implementation, implementation, and post-implementation. They stress the importance of identifying a champion to serve as an advocate of the value of EHRs and provide direction and encouragement for the project. Other key activities include assessing and redesigning workflow; understanding financial issues; conducting training that is well-timed and meets the needs of practice staff; and evaluating the implementation process.

Summary: The EHR implementation experience depends on a variety of factors including the technology, training, leadership, the change management process, and the individual character of each ambulatory practice environment. Sound processes must support both technical and personnel-related organizational components. Additional research is needed to further refine recommendations for the small physician practice and the nuances of specific medical specialties.
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http://dx.doi.org/10.1186/1472-6947-9-15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2662829PMC
February 2009

Integrated personal health records: transformative tools for consumer-centric care.

BMC Med Inform Decis Mak 2008 Oct 6;8:45. Epub 2008 Oct 6.

AMIA, Bethesda, Maryland, USA.

Background: Integrated personal health records (PHRs) offer significant potential to stimulate transformational changes in health care delivery and self-care by patients. In 2006, an invitational roundtable sponsored by Kaiser Permanente Institute, the American Medical Informatics Association, and the Agency for Healthcare Research and Quality was held to identify the transformative potential of PHRs, as well as barriers to realizing this potential and a framework for action to move them closer to the health care mainstream. This paper highlights and builds on the insights shared during the roundtable.

Discussion: While there is a spectrum of dominant PHR models, (standalone, tethered, integrated), the authors state that only the integrated model has true transformative potential to strengthen consumers' ability to manage their own health care. Integrated PHRs improve the quality, completeness, depth, and accessibility of health information provided by patients; enable facile communication between patients and providers; provide access to health knowledge for patients; ensure portability of medical records and other personal health information; and incorporate auto-population of content. Numerous factors impede widespread adoption of integrated PHRs: obstacles in the health care system/culture; issues of consumer confidence and trust; lack of technical standards for interoperability; lack of HIT infrastructure; the digital divide; uncertain value realization/ROI; and uncertain market demand. Recent efforts have led to progress on standards for integrated PHRs, and government agencies and private companies are offering different models to consumers, but substantial obstacles remain to be addressed. Immediate steps to advance integrated PHRs should include sharing existing knowledge and expanding knowledge about them, building on existing efforts, and continuing dialogue among public and private sector stakeholders.

Summary: Integrated PHRs promote active, ongoing patient collaboration in care delivery and decision making. With some exceptions, however, the integrated PHR model is still a theoretical framework for consumer-centric health care. The authors pose questions that need to be answered so that the field can move forward to realize the potential of integrated PHRs. How can integrated PHRs be moved from concept to practical application? Would a coordinating body expedite this progress? How can existing initiatives and policy levers serve as catalysts to advance integrated PHRs?
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http://dx.doi.org/10.1186/1472-6947-8-45DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2596104PMC
October 2008

Advancing the framework: use of health data--a report of a working conference of the American Medical Informatics Association.

J Am Med Inform Assoc 2008 Nov-Dec;15(6):715-22. Epub 2008 Aug 28.

American Medical Informatics Association, Bethesda, Maryland 20814, USA.

The fields of health informatics and biomedical research increasingly depend on the availability of aggregated health data. Yet, despite over fifteen years of policy work on health data issues, the United States (U.S.) lacks coherent policy to guide users striving to navigate the ethical, political, technical, and economic challenges associated with health data use. In 2007, building on more than a decade of previous work, the American Medical Informatics Association (AMIA) convened a panel of experts to stimulate discussion about and action on a national framework for health data use. This initiative is being carried out in the context of rapidly accelerating advances in the fields of health informatics and biomedical research, many of which are dependent on the availability of aggregated health data. Use of these data poses complex challenges that must be addressed by public policy. This paper highlights the results of the meeting, presents data stewardship as a key building block in the national framework, and outlines stewardship principles for the management of health information. The authors also introduce a taxonomy developed to focus definitions and terminology in the evolving field of health data applications. Finally, they identify areas for further policy analysis and recommend that public and private sector organizations elevate consideration of a national framework on the uses of health data to a top priority.
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http://dx.doi.org/10.1197/jamia.M2905DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2585531PMC
December 2008

Toward a national framework for the secondary use of health data: an American Medical Informatics Association White Paper.

J Am Med Inform Assoc 2007 Jan-Feb;14(1):1-9. Epub 2006 Oct 31.

American Medical Informatics Association, 4915 St. Elmo Avenue, Suite 401, Bethesda, MD 20814, USA.

Secondary use of health data applies personal health information (PHI) for uses outside of direct health care delivery. It includes such activities as analysis, research, quality and safety measurement, public health, payment, provider certification or accreditation, marketing, and other business applications, including strictly commercial activities. Secondary use of health data can enhance health care experiences for individuals, expand knowledge about disease and appropriate treatments, strengthen understanding about effectiveness and efficiency of health care systems, support public health and security goals, and aid businesses in meeting customers' needs. Yet, complex ethical, political, technical, and social issues surround the secondary use of health data. While not new, these issues play increasingly critical and complex roles given current public and private sector activities not only expanding health data volume, but also improving access to data. Lack of coherent policies and standard "good practices" for secondary use of health data impedes efforts to strengthen the U.S. health care system. The nation requires a framework for the secondary use of health data with a robust infrastructure of policies, standards, and best practices. Such a framework can guide and facilitate widespread collection, storage, aggregation, linkage, and transmission of health data. The framework will provide appropriate protections for legitimate secondary use.
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http://dx.doi.org/10.1197/jamia.M2273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2329823PMC
March 2007

The language of health data exchange.

J AHIMA 2006 Apr;77(4):34-7; quiz 39-40

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April 2006

E-HIM: from vision to reality.

Authors:
Meryl Bloomrosen

J AHIMA 2005 Oct;76(9):36-41

eHealth Initiative Foundation, Washington DC, USA.

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October 2005