The impact of electronic health records on diagnosis.

Diagnostic error may be the largest unaddressed patient safety concern in the United States, responsible for an estimated 40,000-80,000 deaths annually. With the electronic health record (EHR) now in near universal use, the goal of this narrative review is to synthesize evidence and opinion regarding the impact of the EHR and health care information technology (health IT) on the diagnostic process and its outcomes. We consider the many ways in which the EHR and health IT facilitate diagnosis and improve the diagnostic process, and conversely the major ways in which it is problematic, including the unintended consequences that contribute to diagnostic error and sometimes patient deaths.

The Department of Veterans Affairs' (VA) implementation of the Virtual Lifetime Electronic Record (VLER): findings and lessons learned from Health Information Exchange at 12 sites.

Purpose: We describe the Department of Veterans Affairs' (VA) Virtual Lifetime Health Electronic Record (VLER) pilot phase in 12 communities to exchange health information with private sector health care organizations and the Department of Defense (DoD), key findings, lessons, and implications for advancing Health Information Exchanges (HIE), nationally.

Methods: A mixed methods approach was used to monitor and evaluate the status of VLER Health Exchange pilot phase implementation from December 2009 through October 2012. Selected accomplishments, contributions, challenges, and early lessons that are relevant to the growth of nationwide HIE are discussed.

Data Quality and Interoperability Challenges for eHealth Exchange Participants: Observations from the Department of Veterans Affairs' Virtual Lifetime Electronic Record Health Pilot Phase.

Authors studied the United States (U.S.) Department of Veterans Affairs' (VA) Virtual Lifetime Electronic Record (VLER) Health pilot phase relative to two attributes of data quality - the adoption of eHealth Exchange data standards, and clinical content exchanged.

Applying an organizational framework for health information technology to alerts.

We are far from understanding how best to design, implement, and use health information technology (IT). A comprehensive framework, developed by Rippen et al to capture and organize knowledge on the implementation, use, and optimization of health IT, may guide and inform more effective health IT deployment. This study applied Rippen's framework to a focused type of health IT - alerts - through clinical decision support (CDS), an area with a substantial evidence base around many facets of implementation, including the technology, use, and outcomes.

Organizational framework for health information technology.

Purpose: We do not yet know how best to design, implement, and use health information technology (IT). A comprehensive framework that captures knowledge on the implementation, use, and optimization of health IT will help guide more effective approaches in the future.

Methods: The authors conducted a targeted review of existing literature on health IT implementation and use, including health IT-related theories and models.

Assessing the value of laboratory electronic data interchange in the department of veterans affairs.

We modeled the adoption, costs and monetezied benefits of the Department of Veterans Affairs' (VA's) internally developed Laboratory Electronic Data Interchange (LEDI) application from 2001-2007. LEDI provides standards-based electronic exchange of laboratory data and secure transmission of laboratory test orders and results. Once the initial development and installation costs were accounted for, LEDI likely produced value for the VA in savings of laboratory staff time for test ordering and results processing.

The value from investments in health information technology at the U.S. Department of Veterans Affairs.

We compare health information technology (IT) in the Department of Veterans Affairs (VA) to norms in the private sector, and we estimate the costs and benefits of selected VA health IT systems. The VA spent proportionately more on IT than the private health care sector spent, but it achieved higher levels of IT adoption and quality of care. The potential value of the VA's health IT investments is estimated at $3.

Measuring the impact of a public health data training program.

In spring and fall of 2000, 109 community health professionals participated in "Public Health Data: Our Silent Partner," a training program developed by the Centers for Disease Control and Prevention (CDC). The two-day training was offered four times in different locations in New York State in response to local health departments and community partners identifying a need for data analysis training. Participants completed evaluations during the training, and they were surveyed within a year of completing the training.

The process to develop a meaningful community health assessment in New York State.

Conducting and producing a meaningful Community Health Assessment (CHA) is an important and essential public health service and a mandatory biennial activity for New York State's (NYS) Local Health Departments. The Assessment Initiative project has allowed the NYS Department of Health to better understand and identify strategies to strengthen CHAs and to develop training, education, and technical assistance programs. The Assessment Initiative project has benefited from participation, coordination, and sharing of resources and expertise with other community health improvement initiatives in NYS, including those that emphasize collaborative approaches to health improvement, workforce development, and expanding access to data.