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The 21st Century Cures Act requires that certified health IT products have an application programming interface that allows health data to be accessed and exchanged. The provision could shape the way that physicians and patients experience health care for years to come. Data generated as a by-product of the day-to-day work of delivery systems are a fundamental currency of the 21st Century Cures Act. How efficiently and effectively we use this “real-world” evidence will shape the way medicine is practiced and the way drugs are approved. 1 In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act established an incentive payment program geared toward “meaningful use” of information technology (IT), which ultimately disbursed more than $34 billion for the promotion and purchase of electronic health records (EHRs). That federal investment was complemented by a substantially larger private investment by physicians . . .

AbstractObjectiveTo determine whether electronic health record alerts for acute kidney injury would improve patient outcomes of mortality, dialysis, and progression of acute kidney injury.DesignDouble blinded, multicenter, parallel, randomized controlled trial.SettingSix hospitals (four teaching and two non-teaching) in the Yale New Haven Health System in Connecticut and Rhode Island, US, ranging from small community hospitals to large tertiary care centers.Participants6030 adult inpatients with acute kidney injury, as defined by the Kidney Disease: Improving Global Outcomes (KDIGO) creatinine criteria.InterventionsAn electronic health record based “pop-up” alert for acute kidney injury with an associated acute kidney injury order set upon provider opening of the patient’s medical record.Main outcome measuresA composite of progression of acute kidney injury, receipt of dialysis, or death within 14 days of randomization. Prespecified secondary outcomes included outcomes at each hospital and frequency of various care practices for acute kidney injury.Results6030 patients were randomized over 22 months. The primary outcome occurred in 653 (21.3%) of 3059 patients with an alert and in 622 (20.9%) of 2971 patients receiving usual care (relative risk 1.02, 95% confidence interval 0.93 to 1.13, P=0.67). Analysis by each hospital showed worse outcomes in the two non-teaching hospitals (n=765, 13%), where alerts were associated with a higher risk of the primary outcome (relative risk 1.49, 95% confidence interval 1.12 to 1.98, P=0.006). More deaths occurred at these centers (15.6% in the alert group v 8.6% in the usual care group, P=0.003). Certain acute kidney injury care practices were increased in the alert group but did not appear to mediate these outcomes.ConclusionsAlerts did not reduce the risk of our primary outcome among patients in hospital with acute kidney injury. The heterogeneity of effect across clinical centers should lead to a re-evaluation of existing alerting systems for acute kidney injury.Trial registrationClinicalTrials.gov NCT02753751.

To understand what is new in health information technology (IT), we updated a systematic review of health IT with studies published during 2004-2007. From 4,683 titles, 179 met inclusion criteria. We Identified a proliferation of patient-focused applications although little formal evaluation in this area; more descriptions of commercial electronic health records (EHRs) and health IT systems designed to run independently from EHRs; and proportionately fewer relevant studies from the health IT leaders. Accelerating the adoption of health IT will require greater public-private partnerships, new policies to address the misalignment of financial incentives, and a more robust evidence base regarding IT implementation. [PUBLICATION ABSTRACT]

Perhaps the most profound effect on doctors and patients of the recently enacted stimulus bill will result from its unprecedented $19 billion program to promote the adoption and use of health information technology and electronic health records. Dr. David Blumenthal discusses the federal effort to modernize the information systems of a troubled health care system. The recently enacted stimulus bill — the American Recovery and Reinvestment Act of 2009 (ARRA) — touches almost every aspect of the U.S. economy. Health care is no exception. In fact, the ARRA is historic health care legislation of the type rarely produced by our famously incremental federal government. The law prevents dramatic state cuts in Medicaid, expands funding for preventive health care services and health care research, and helps the unemployed buy health insurance. But perhaps its most profound effect on doctors and patients will result from its unprecedented $19 billion program to promote the adoption and use of . . .

Digital health data are the lifeblood of a continuous learning health system. A steady flow of reliable data is necessary to coordinate and monitor patient care, analyze and improve systems of care, conduct research to develop new products and approaches, assess the effectiveness of medical interventions, and advance population health. The totality of available health data is a crucial resource that should be considered an invaluable public asset in the pursuit of better care, improved health, and lower health care costs. The ability to collect, share, and use digital health data is rapidly evolving. Increasing adoption of electronic health records (EHRs) is being driven by the implementation of the Health Information Technology for Economic and Clinical Health (HITECH) Act, which pays hospitals and individuals incentives if they can demonstrate that they use basic EHRs in 2011. Only a third had access to the basic features necessary to leverage this information for improvement, such as the ability to view laboratory results, maintain problem lists, or manage prescription ordering. In addition to increased data collection, more organizations are sharing digital health data. Data collected to meet federal reporting requirements or for administrative purposes are becoming more accessible. Efforts such as Health.Data.gov provide access to government datasets for the development of insights and software applications with the goal of improving health. Within the private sector, at least one pharmaceutical company is actively exploring release of some of its clinical trial data for research by others. Digital Data Improvement Priorities for Continuous Learning in Health and Health Care: Workshop Summary summarizes discussions at the March 2012 Institute of Medicine (2012) workshop to identify and characterize the current deficiencies in the reliability, availability, and usability of digital health data and consider strategies, priorities, and responsibilities to address such deficiencies.

Electronic records could improve quality and efficiency of health care. National and international bodies propagate this belief worldwide. However, the evidence base concerning the effects and advantages of electronic records is questionable. The outcome of health care systems is influenced by many components, making assertions about specific types of interventions difficult. Moreover, electronic records itself constitute a complex intervention offering several functions with possibly positive as well as negative effects on the outcome of health care systems. The aim of this review is to summarize empirical studies about the value of electronic medical records (EMRs) for hospital care published between 2010 and spring 2019. The authors adopted their method from a series of literature reviews. The literature search was performed on MEDLINE with \"Medical Record System, Computerized\" as the essential keyword. The selection process comprised 2 phases looking for a consent of both authors. Starting with 1345 references, 23 were finally included in the review. The evaluation combined a scoring of the studies' quality, a description of data sources in case of secondary data analyses, and a qualitative assessment of the publications' conclusions concerning the medical record's impact on quality and efficiency of health care. The majority of the studies stemmed from the United States (19/23, 83%). Mostly, the studies used publicly available data (\"secondary data studies\"; 17/23, 74%). A total of 18 studies analyzed the effect of an EMR on the quality of health care (78%), 16 the effect on the efficiency of health care (70%). The primary data studies achieved a mean score of 4.3 (SD 1.37; theoretical maximum 10); the secondary data studies a mean score of 7.1 (SD 1.26; theoretical maximum 9). From the primary data studies, 2 demonstrated a reduction of costs. There was not one study that failed to demonstrate a positive effect on the quality of health care. Overall, 9/16 respective studies showed a reduction of costs (56%); 14/18 studies showed an increase of health care quality (78%); the remaining 4 studies missed explicit information about the proposed positive effect. This review revealed a clear evidence about the value of EMRs. In addition to an awesome majority of economic advantages, the review also showed improvements in quality of care by all respective studies. The use of secondary data studies has prevailed over primary data studies in the meantime. Future work could focus on specific aspects of electronic records to guide their implementation and operation.

To qualify for new federal funds intended to promote the widespread adoption and use of electronic health records, U.S. physician practices must meet the government's \"meaningful use\" benchmarks. Our analysis indicates that among physicians who have electronic health records, between 75-85 percent are already using functions that meet some of the proposed criteria for demonstrating meaningful use. But gaps remain. We provide a new analysis of baseline use of specific electronic health record functions among primary care physicians and medical and surgical specialists. The analysis can help researchers and policy makers measure more accurately the success of ongoing efforts to expand effective use of health information technology. [PUBLICATION ABSTRACT]

In Canada, commercial data brokers are currently able to use deidentified patient data from pharmacies, private drug insurers, the federal government and medical clinics without patient consent. They are able to do this because of a lack of privacy protections for deidentified data. A proposed federal privacy bill, the Consumer Privacy Protection Act (Bill C-11) would have halted disclosure of deidentified data to commercial entities, although the bill left some important issues unresolved. However, the bill died when parliament was dissolved in Aug 2021. Updated legislation should be strengthened to protect patient data and support appropriate uses. Here, Spithoff et al discuss how deidentified patient data are currently being used, potential harms of their use, views of patients and the public about the use of their deidentified data and how legislation can be strengthened to better protect people in Canada.

Online access to all or part of their health records is widely demanded by patients and, where provided in form of patient portals, has been substantially used by at least subgroups of patients, particularly those with chronic disease. However, little is reported regarding the longer-term patient use of patient-accessible electronic health record services, which is important in allocating resources. Renal PatientView (RPV) is an established system that gives patients with chronic kidney disease access to live test results and information about their condition and treatment. It is available in most UK renal units with up to 75% of particular patient groups registered in some centers. We have analyzed patient use out to 4 years and investigated factors associated with more persistent use. Our aim was to investigate RPV use by patients over time from initial registration in order to understand which patients choose to access RPV and the endurance of its appeal for different patient groups. We analyzed an anonymized extract of the database underlying RPV containing information on patient registration and events including patient access and the arrival of new blood test results or letters that patients might wish to view. At the time of the extract, there were 11,352 patients registered on RPV for 0-42 months (median 17). More than half of registrants became persistent users, logging in a median of 2.0 times each month over post-registration intervals of up to 42 months (median 18.9). Provision of assistance with first logon was strongly associated with becoming a persistent user, even at 3 years. Logons by persistent users occurred around the time of consultations/tests, strongly suggestive of patient engagement. While indices indicative of greater deprivation were the strongest determinants of non-participation, they had negligible influence on drop-out rates among established users. In this mature patient portal system, a large proportion of patients made regular use of their online health records over protracted periods. The patterns and timing of use indicate strong patient interest in detailed information such as recent test results and clinic letters. Supporting patients through the first steps of establishing access to their online records is associated with much higher rates of long-term use of RPV and likely would increase use of other electronic health records provided for patients with chronic disease.