Difference between revisions of "Evaluating health information exchange"

Revision as of 13:42, 4 May 2008

Evaluating public health uses of health information exchange, Jason S. Shapiro, Journal of Biomedical Informatics 40 (2007) S46-S49

Shapiro states that while the potential public health benefits of health information exchange (HIE) are clear there is little supporting evidence in the current literature. He notes that while there are several health use cases for HIE only a few have been implemented and even fewer have been evaluated.

The author lists six potential public health use cases for HIE (as described by Mostashari et al.)

1. Mandated reporting of laboratory diagnoses

Shapiro contends mandated reports would be timely and complete if direct electronic reporting to state health departments via HIEs occurred. He proposes using the volume of relevant data (expressed as the ratio of relevant data reported to all relevant data in a laboratories database) as the primary evaluation measure. He also proposes pre- and post-implementation studies of efficiency, completeness and timeliness.

2. Mandated reporting of physician-based diagnoses

Shapiro argues that HIEs would increase mandated physician reporting by automatic screening of data such as ICD-9 diagnostic codes, CPT codes and medications. However he acknowledges that the data so obtained would then have to be manually reviewed to exclude erroneous or non-relevant cases. He argues that with maturation of HIE systems more advanced informatics would lead to improved system recall.

Unlike the first use case he does not see recall as a viable evaluation because of the cost and time constraints of determining all relevant data in the database. He advocates using precision (which would look at the number of erroneous or non-relevant cases that are included.)

3. Public health investigation

Shapiro points out that in this use case the patient who has a reportable disease is already known and the health investigator need only access the HIE for additional information needed for the investigation rather than using more time consuming methods (making phone calls, travelling or obtaining paper records.) The ease with which this can be accomplished is dependent on the particular HIE (question of full electronic access vs. simple results retrieval.) Shapiro recommends using qualitative or semi-qualitative studies such as surveys, semi-structured interviews or observational techniques for evaluation.

4. Disease based non-reportable laboratory data

HIEs will help centralize data and improve accessibility for health departments helping to guide public heath messages and rule out harmless epidemiological causes.

5. Antibiotic-resistant organism surveillance

Culture resistant patterns would be transmitted through the HIE system to the health department and this information could then be used to construct community-wide antibiograms or notify clinicians about patients previously diagnosed with infections caused by an antibiotic resistant organism. Shapiro recommends evaluating rates of local resistance patterns as well as of nosocomial infections pre- and post- implementation.

6. Population-level quality monitoring

HIEs would be used to monitor secondary and tertiary prevention of chronic diseases, e.g., rates of hemoglobin A1C levels for diabetes control. Quality metrics pre- and post- implementation could then be used to monitor preventive care.

Comments: Overall a good discussion of public health uses of HIE. However, I found approaches to evaluation in disease-based non-reportable data to be the least robust of all the use cases discussed. Also the evaluation of mandated reporting of physician-based diagnoses suggested by Shapiro involves manual review which would be time consuming.

L. Bernard-Pantin