Use of push and pull health information exchange technologies by ambulatory care practices and the impact on potentially avoidable health care utilization

项目摘要/摘要 医疗服务提供者通过健康信息交换更好地获取电子患者信息是一个全国性的问题 美国医疗保健系统的政策优先事项和关键基础设施要求。感谢重要的公众 投资，提供者可以使用不同的健康信息交换方法来满足他们的需求 信息需求。一种方法被称为“拉”，它允许提供者在社区范围内查询， 纵向病人记录。第二种方法是“推送”，其中关键信息，如测试结果， 自动交付给供应商。不幸的是，缺乏证据表明这两种措施的有效性 初级保健中的“推”和/或“拉”方法。此外，哪种共享信息的方法最适合 初级保健也是未知的。尽管缺乏证据，但联邦政策鼓励交换病人 信息基于这两种方法是等价的假设。这项提议的目标是 通过厘清“拉”与“推”的关系来解决循证医学中的这些缺陷 初级保健环境中的卫生信息交换使用情况，并通过确定每种方法对 潜在的可避免的和昂贵的卫生保健利用。目标1，确定初级保健提供者是否使用 “推”和“拉”作为健康信息交换的补充或替代方法，利用了一种新的 在电子健康记录系统中跟踪的个人提供者和工作人员行为的数据集 详细介绍了“推”和“拉”健康信息互通使用的措施。这些数据提供了一个完整的、 提供者行为的详细时间序列揭示了每种健康信息交换方法 在病人就诊时使用。目标2，量化“推”和“拉”健康信息交换对 潜在的可避免的医疗保健利用，测试了健康信息交换使用将是 与因门诊护理敏感情况而重新入院和住院的减少有关。这 假说将在一个由240多名门诊患者组成的长达7年的回顾小组中进行验证 医生。实施的不同时间将用来确定“推”和/或“拉”与 包含医生和年份固定效应的回归模型。这种方法允许医生充当 他们自己的控制消除了无法测量的时间不变的混淆。这项拟议的二次数据分析 意义重大，因为美国在可互操作的医疗信息技术上投资了数十亿美元，但 很少有证据表明健康信息交换对利用以及如何在初级保健中使用产生影响 练习一下。这项提议是创新的，因为它将是第一次研究“推”和“拉”健康的影响。 在初级保健中独立和联合提供信息。这种结合超越了现有的研究， 准确反映当前可供医生使用并得到以下支持的健康信息交换方法 卫生信息技术政策。

PROJECT SUMMARY/ABSTRACT Providers' improved access to electronic patient information through health information exchange is a national policy priority and a key infrastructure requirement for the US health care system. Thanks to significant public investments, providers have access to different health information exchange approaches to meet their information needs. One approach is referred to as “pull,” which allows providers to query community-wide, longitudinal patient records. A second approach is “push,” where key information, such as test results, is automatically delivered to providers. Unfortunately, there is a lack of evidence of the effectiveness of either the “push” and/or “pull” approach in primary care. Furthermore, which approach to sharing information best fits into primary care is also unknown. Despite the lack of evidence, federal policy encourages the exchange of patient information based on the assumption that the two approaches are equivalent. The objective of this proposal is to address these shortcomings in the evidence-based by clarifying the relationship between “pull” and “push” health information exchange usage in primary care settings and by determining the impact of each approach on potentially avoidable and costly health care utilization. Aim 1, Determine whether primary care providers use “push” and “pull” as complementary or alternative approaches to health information exchange, leverages a novel dataset of individual provider and staff behavior tracked within an electronic health record system combined with detailed measures of “push” and “pull” health information exchange usage. These data furnish a complete, detailed temporal sequence of providers' behavior revealing how each approach to health information exchange is used during a patient visit. Aim 2, Quantify the effect of “push” and “pull” health information exchange on potentially avoidable health care utilization, tests the hypothesis that health information exchange usage will be associated with reductions in readmissions and hospitalizations for ambulatory care sensitive conditions. This hypothesis will be tested among patients attributed to a 7-year, retrospective panel of more than 240 ambulatory physicians. The differential timing of implementation will be used to identify the effect of “push” and/or “pull” with a regression model that includes physician and year fixed-effects. This approach allows physicians to serve as their own controls eliminating unmeasured time-invariant confounding. This proposed analysis of secondary data is significant because the US has invested billions on interoperable health information technologies, but there is very little evidence of health information exchange's effects on utilization and on how it is used in primary care practice. This proposal is innovative because it will be the first to examine the impact of “push” and “pull” health information independently, and jointly, in primary care. This combination goes beyond existing research to accurately reflect current approaches to health information exchange available to physicians and supported by health information technology policy.