Browsing by Subject "Data Quality"

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    Electronic Health Record (EHR) Data Quality and Type 2 Diabetes Mellitus Care
    (2022-06) Wiley, Kevin Keith, Jr.; Vest, Joshua; Blackburn, Justin; De Groot, Mary; Menachemi, Nir; Mendonca, Eneida
    Due to frequent utilization, high costs, high prevalence, and negative health outcomes, the care of patients managing type 2 diabetes mellitus (T2DM) remains an important focus for providers, payers, and policymakers. The challenges of care delivery, including care fragmentation, reliance on patient self-management behaviors, adherence to care management plans, and frequent medical visits are well-documented in the literature. T2DM management produces numerous clinical data points in the electronic health record (EHR) including laboratory test values and self-reported behaviors. Recency or absence of these data may limit providers’ ability to make effective treatment decisions for care management. Increasingly, the context in which these data are being generated is changing. Specifically, telehealth usage is increasing. Adoption and use of telehealth for outpatient care is part of a broader trend to provide care at-a-distance, which was further accelerated by the COVID-19 pandemic. Despite unknown implications for patients managing T2DM, providers are increasingly using telehealth tools to complement traditional disease management programs and have adapted documentation practices for virtual care settings. Evidence suggests the quality of data documented during telehealth visits differs from that which is documented during traditional in-person visits. EHR data of differential quality could have cascading negative effects on patient healthcare outcomes. The purpose of this dissertation is to examine whether and to what extent levels of EHR data quality are associated with healthcare outcomes and if EHR data quality is improved by using health information technologies. This dissertation includes three studies: 1) a cross-sectional analysis that quantifies the extent to which EHR data are timely, complete, and uniform among patients managing T2DM with and without a history of telehealth use; 2) a panel analysis to examine associations between primary care laboratory test ages (timeliness) and subsequent inpatient hospitalizations and emergency department admissions; and 3) a panel analysis to examine associations between patient portal use and EHR data timeliness.
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    THE PERCEIVED AND REAL VALUE OF HEALTH INFORMATION EXCHANGE IN PUBLIC HEALTH SURVEILLANCE
    (2011-08-22) Dixon, Brian Edward; Jones, Josette F.; McGowan, Julie J.; Grannis, Shaun J.; Gamache, Roland E.
    Public health agencies protect the health and safety of populations. A key function of public health agencies is surveillance or the ongoing, systematic collection, analysis, interpretation, and dissemination of data about health-related events. Recent public health events, such as the H1N1 outbreak, have triggered increased funding for and attention towards the improvement and sustainability of public health agencies’ capacity for surveillance activities. For example, provisions in the final U.S. Centers for Medicare and Medicaid Services (CMS) “meaningful use” criteria ask that physicians and hospitals report surveillance data to public health agencies using electronic laboratory reporting (ELR) and syndromic surveillance functionalities within electronic health record (EHR) systems. Health information exchange (HIE), organized exchange of clinical and financial health data among a network of trusted entities, may be a path towards achieving meaningful use and enhancing the nation’s public health surveillance infrastructure. Yet the evidence on the value of HIE, especially in the context of public health surveillance, is sparse. In this research, the value of HIE to the process of public health surveillance is explored. Specifically, the study describes the real and perceived completeness and usefulness of HIE in public health surveillance activities. To explore the real value of HIE, the study examined ELR data from two states, comparing raw, unedited data sent from hospitals and laboratories to data enhanced by an HIE. To explore the perceived value of HIE, the study examined public health, infection control, and HIE professionals’ perceptions of public health surveillance data and information flows, comparing traditional flows to HIE-enabled ones. Together these methods, along with the existing literature, triangulate the value that HIE does and can provide public health surveillance processes. The study further describes remaining gaps that future research and development projects should explore. The data collected in the study show that public health surveillance activities vary dramatically, encompassing a wide range of paper and electronic methods for receiving and analyzing population health trends. Few public health agencies currently utilize HIE-enabled processes for performing surveillance activities, relying instead on direct reporting of information from hospitals, physicians, and laboratories. Generally HIE is perceived well among public health and infection control professionals, and many of these professionals feel that HIE can improve surveillance methods and population health. Human and financial resource constraints prevent additional public health agencies from participating in burgeoning HIE initiatives. For those agencies that do participate, real value is being added by HIEs. Specifically, HIEs are improving the completeness and semantic interoperability of ELR messages sent from clinical information systems. New investments, policies, and approaches will be necessary to increase public health utilization of HIEs while improving HIEs’ capacity to deliver greater value to public health surveillance processes.