The essential role of reconfiguration capabilities in the implementation of HIV-related health information exchanges
ABSTRACT To understand the dynamic capabilities that enabled the six demonstration projects of the Information Technology Networks of Care Initiative to implement health information exchanges (HIEs) tailored to their local HIV epidemics and regional care systems.
We conducted 111 semi-structured interviews with project staff and information technology (IT) specialists associated with the demonstration projects, staff from community-based organizations and public health agencies collaborating in the design and implementation of the HIEs, and providers who used each HIE. The dynamic capability framework guided analyses. In the context of a HIE, the framework's components include information systems (the actual technological exchange systems and capacity to update them), absorptive capacity (the ability to implement an operating HIE), reconfiguration capacity (the ability to adapt workflows and clinical practices in response to a HIE), and organizational size and human resources (characteristics likely to affect a clinic's ability to respond).
Across the projects, we found evidence for the importance of three dynamic capabilities: information systems, reconfiguration capacity, and organizational size and human resources. However, of these three, reconfiguration capacity was the most salient. Implementation outcomes at all six of the projects were shaped substantially by the degree of attention dedicated to reworking procedures and practices so that HIE usage became routine.
Electronic information exchange offers the promise of improved coordination of care. However, implementation of HIEs goes beyond programing and hardware installation challenges, and requires close attention to the needs of the HIEs end-users. Providers need to discern value from a HIE because their active participation is essential to ensuring that clinic and agency practices and procedures are reconfigured to incorporate new systems into daily work processes.
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ABSTRACT: Care process monitoring is needed to provide performance management reporting to measure how quality of care goals are being met for a specific care process. There are special challenges faced when monitoring community care processes, especially if one wants to manage performance for community care across an entire geographic region. In this paper, we evaluate an application meta-model for defining a care process monitoring application (CPMA) previously developed for monitoring care processes in a hospital, to determine its effectiveness for addressing community care processes. A case study developed in collaboration with a regional health authority is used.Procedia Computer Science 12/2014; 37. DOI:10.1016/j.procs.2014.08.070
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ABSTRACT: Health information systems (HISs) offer great potential for supporting healthcare delivey, particularly collaborative care delivery that is provided across multiple settings and providers. To date many HISs have focused on digitzing data or processes on a departmental or healthcare provider basis. This approach has resulted in unintended consequences due to different types of interoperability issues. New approaches are needed to design integrated HISs to support collaborative care delivery. There is also a need for studies that articulate interoperability needs for HISs and how to evaluate different aspects (i.e., data, process and technical) of interoperability. This paper uses a three year case study of the design of the Palliative Care Information System (PAL-IS) to study system design and interoperability considerations for a collaborative HIS. We describe the two phases in which PAL-IS was designed and also identify criteria for evaluating interoperability of collaborative HISs.2014 5th International Conference on Information and Communication Systems (ICICS); 04/2014
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ABSTRACT: Although health information exchanges (HIE) have existed since their introduction by President Bush in his 2004 State of the Union Address, and despite monetary incentives earmarked in 2009 by the health information technology for economic and clinical health (HITECH) Act, adoption of HIE has been sparse in the United States. Research has been conducted to explore the concept of HIE and its benefit to patients, but viable business plans for their existence are rare, and so far, no research has been conducted on the dynamic nature of barriers over time. The aim of this study is to map the barriers mentioned in the literature to illustrate the effect, if any, of barriers discussed with respect to the HITECH Act from 2009 to the early months of 2014. We conducted a systematic literature review from CINAHL, PubMed, and Google Scholar. The search criteria primarily focused on studies. Each article was read by at least two of the authors, and a final set was established for evaluation (n=28). The 28 articles identified 16 barriers. Cost and efficiency/workflow were identified 15% and 13% of all instances of barriers mentioned in literature, respectively. The years 2010 and 2011 were the most plentiful years when barriers were discussed, with 75% and 69% of all barriers listed, respectively. The frequency of barriers mentioned in literature demonstrates the mindfulness of users, developers, and both local and national government. The broad conclusion is that public policy masks the effects of some barriers, while revealing others. However, a deleterious effect can be inferred when the public funds are exhausted. Public policy will need to lever incentives to overcome many of the barriers such as cost and impediments to competition. Process improvement managers need to optimize the efficiency of current practices at the point of care. Developers will need to work with users to ensure tools that use HIE resources work into existing workflows.