Department of Epidemiology Works

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The selection of high-impact health informatics literature: a comparison of results between the content expert and the expert searcher
(http://www-ncbi-nlm-nih-gov.proxy.medlib.iupui.edu/pmc/articles/PMC2706443/, 2009-07) Whipple, Elizabeth C.; McGowan, Julie J.; Dixon, Brian E.; Zafar, Atif
BACKGROUND: The Agency for Healthcare Research and Quality (AHRQ) National Resource Center for Health Information Technology (NRC) created the Health IT Bibliography that contains peer-reviewed articles in eleven different health informatics categories. To create the bibliography, informatics experts identified what they considered the seminal articles in each category. METHODS:Using the same eleven categories, an expert searcher (librarian) compiled a list of the "best" health informatics articles using information seeking and retrieval tools. The two sets of articles were then compared using high citation counts as a measure of value. RESULTS: The expert searcher set (8,230) contained more than 3 times the citations to chosen articles compared to the content expert set (2,382). Of 60 articles, 27% of those articles (n = 16) were included in both sets. The frequently cited journals were similar for both sets, and one-third of the same authors were cited in both sets. DISCUSSION: While citation counts and the timeliness of the articles differed in the two sets, the same authors and same journals were frequently present in both sets. CONCLUSION: A best practice for locating high-quality articles may be collaboration between expert searchers and content experts.
Improving Medication Adherence for Chronic Disease Using Integrated e-Technologies
(2013) Dixon, Brian E.; Jabour, Abdulrahman M.; Phillips, Erin O'Kelly; Marrero, David G.
Diabetes mellitus (DM) is a chronic disease affecting more than 285 people worldwide and the fourth leading cause of death. Increasing evidence suggests that many DM patients have poor adherence with prescribed medication therapies, impacting clinical outcomes. Patients' barriers to medication adherence and the extent to which barriers contribute to poor outcomes, however, are not routinely assessed. We designed a dashboard for an electronic health record system to integrate DM disease and medication data, including patient-reported barriers to adherence. Processes to support routine capture of data from patients are also being explored. The dashboard is being evaluated at multiple ambulatory clinics to examine whether integrated electronic tools can support patient-centered decision-making processes involving complex medication regimens for DM and other chronic diseases.
Linking Health Information Technology to Patient Safety and Quality Outcomes: A Bibliometric Analysis and Review
(http://informahealthcare.com/doi/abs/10.3109/17538157.2012.678451, 2013-01) Whipple, Elizabeth C.; Dixon, Brian E.; McGowan, Julie J.
OBJECTIVE: To assess the scholarly output of grants funded by the Agency for Healthcare Research and Quality (AHRQ) that published knowledge relevant to the impact of health information technologies on patient safety and quality of care outcomes. STUDY DESIGN: We performed a bibliometric analysis of the identified scholarly articles, their journals, and citations. In addition, we performed a qualitative review of the full-text articles and grant documents. DATA COLLECTION/EXTRACTION METHODS: Papers published by AHRQ-funded investigators were retrieved from MEDLINE, journal impact factors were extracted from the 2010 Thompson Reuters Journal Citation Report, citations were retrieved from ISI's Web of Knowledge and Google Scholar. PRINCIPAL FINDINGS: Seventy-two articles met the criteria for review. Most articles addressed one or more of AHRQ's outcome goals and focus priorities. The average impact factor for the journals was 4.005 (range: 0.654-28.899). The articles, and their respective grants, represented a broad range of health information technologies. CONCLUSIONS: This set of AHRQ-funded research projects addressed the goals and priorities of AHRQ, indicating notable contributions to the scientific knowledge base on the impact of information system use in healthcare.
The Landscape of the AHRQ Health Information Technology Portfolio
(2006) Dixon, Brian E.
A major agenda item of the President and Congress is widespread adoption of health information technology (health IT) to improve the quality, safety, and efficiency of health care. This has allowed federal agencies to invest additional money into health IT research. The distribution and potential impact of research dollars spent by one agency supporting this agenda is examined here.
Enhancing the Informatics Evaluation Toolkit with Remote Usability Testing
(2009) Dixon, Brian E.
Developing functional clinical informatics products that are also usable remains a challenge. Despite evidence that usability testing should be incorporated into the lifecycle of health information technologies, rarely does this occur. Challenges include poor standards, a lack of knowledge around usability practices, and the expense involved in rigorous testing with a large number of users. Remote usability testing may be a solution for many of these challenges. Remotely testing an application can greatly enhance the number of users who can iteratively interact with a product, and it can reduce the costs associated with usability testing. A case study presents the experiences with remote usability testing when evaluating a Web site designed for health informatics knowledge dissemination. The lessons can inform others seeking to enhance their evaluation toolkits for clinical informatics products.
Building a Production-Ready Infrastructure to Enhance Medication Management: Early Lessons from the Nationwide Health Information Network
(2009-11) Simonaitis, Linas; Dixon, Brian E.; Belsito, Anne; Miller, Theda; Overhage, J. Marc
Poor medication management practices can lead to serious erosion of health care quality and safety. The DHHS Medication Management Use Case outlines methods for the exchange of electronic health information to improve medication management practices. In this case report, the authors describe initial development of Nationwide Health Information Network (NHIN) services to support the Medication Management Use Case. The technical approach and core elements of medication management transactions involved in the NHIN are presented. Early lessons suggest the pathway to improvements in quality and safety are achievable, yet there are challenges for the medical informatics community to address through future research and development activities.
Electronic Laboratory Data Quality and the Value of a Health Information Exchange to Support Public Health Reporting Processes
(2011-10) Dixon, Brian E.; McGowan, Julie J; Grannis, Shaun J
There is increasing interest in leveraging electronic health data across disparate sources for a variety of uses. A fallacy often held by data consumers is that clinical data quality is homogeneous across sources. We examined one attribute of data quality, completeness, in the context of electronic laboratory reporting of notifiable disease information. We evaluated 7.5 million laboratory reports from clinical information systems for their completeness with respect to data needed for public health reporting processes. We also examined the impact of health information exchange (HIE) enhancement methods that attempt to improve completeness. The laboratory data were heterogeneous in their completeness. Fields identifying the patient and test results were usually complete. Fields containing patient demographics, patient contact information, and provider contact information were suboptimal. Data processed by the HIE were often more complete, suggesting that HIEs can support improvements to existing public health reporting processes.
Measuring the impact of a health information exchange intervention on provider-based notifiable disease reporting using mixed methods: a study protocol
(2013-10) Dixon, Brian E.; Grannis, Shaun J; Revere, Debra
Background Health information exchange (HIE) is the electronic sharing of data and information between clinical care and public health entities. Previous research has shown that using HIE to electronically report laboratory results to public health can improve surveillance practice, yet there has been little utilization of HIE for improving provider-based disease reporting. This article describes a study protocol that uses mixed methods to evaluate an intervention to electronically pre-populate provider-based notifiable disease case reporting forms with clinical, laboratory and patient data available through an operational HIE. The evaluation seeks to: (1) identify barriers and facilitators to implementation, adoption and utilization of the intervention; (2) measure impacts on workflow, provider awareness, and end-user satisfaction; and (3) describe the contextual factors that impact the effectiveness of the intervention within heterogeneous clinical settings and the HIE. Methods/Design The intervention will be implemented over a staggered schedule in one of the largest and oldest HIE infrastructures in the U.S., the Indiana Network for Patient Care. Evaluation will be conducted utilizing a concurrent design mixed methods framework in which qualitative methods are embedded within the quantitative methods. Quantitative data will include reporting rates, timeliness and burden and report completeness and accuracy, analyzed using interrupted time-series and other pre-post comparisons. Qualitative data regarding pre-post provider perceptions of report completeness, accuracy, and timeliness, reporting burden, data quality, benefits, utility, adoption, utilization and impact on reporting workflow will be collected using semi-structured interviews and open-ended survey items. Data will be triangulated to find convergence or agreement by cross-validating results to produce a contextualized portrayal of the facilitators and barriers to implementation and use of the intervention. Discussion By applying mixed research methods and measuring context, facilitators and barriers, and individual, organizational and data quality factors that may impact adoption and utilization of the intervention, we will document whether and how the intervention streamlines provider-based manual reporting workflows, lowers barriers to reporting, increases data completeness, improves reporting timeliness and captures a greater portion of communicable disease burden in the community.
Development and Assessment of a Public Health Alert Delivered through a Community Health Information Exchange
(2010-10) Gamache, Roland; Stevens, Kevin C; Merriwether, Rico; Dixon, Brian E.; Grannis, Shaun
Timely communication of information to health care providers during a public health event can improve overall response to such events. However, current methods for sending information to providers are inefficient and costly. Local health departments have traditionally used labor-intensive, mail-based processes to send public health alerts to the provider community. This article describes a novel approach for delivering public health alerts to providers by leveraging an electronic clinical messaging system within the context of a health information exchange. Alerts included notifications related to the 2009 H1N1 flu epidemic, a syphilis outbreak, and local rabies exposure. We describe the process for sending electronic public health alerts and the estimated impact on efficiency and cost effectiveness.
Impact of Selective Mapping Strategies on Automated Laboratory Result Notification to Public Health Authorities
(2012-11) Gamache, Roland E; Dixon, Brian E.; Grannis, Shaun; Vreeman, Daniel J
Automated electronic laboratory reporting (ELR) for public health has many potential advantages, but requires mapping local laboratory test codes to a standard vocabulary such as LOINC. Mapping only the most frequently reported tests provides one way to prioritize the effort and mitigate the resource burden. We evaluated the implications of selective mapping on ELR for public health by comparing reportable conditions from an operational ELR system with the codes in the LOINC Top 2000. Laboratory result codes in the LOINC Top 2000 accounted for 65.3% of the reportable condition volume. However, by also including the 129 most frequent LOINC codes that identified reportable conditions in our system but were not present in the LOINC Top 2000, this set would cover 98% of the reportable condition volume. Our study highlights the ways that our approach to implementing vocabulary standards impacts secondary data uses such as public health reporting.

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