Precision Medicine, AI, and the Future of Personalized Health Care.

The convergence of artificial intelligence (AI) and precision medicine promises to revolutionize health care. Precision medicine methods identify phenotypes of patients with less-common responses to treatment or unique healthcare needs. AI leverages sophisticated computation and inference to generate insights, enables the system to reason and learn, and empowers clinician decision making through augmented intelligence.

Advancing the Science of Healthcare Service Delivery: The NHLBI Corporate Healthcare Leaders' Panel.

There is a growing gap between available science and evidence and the ability of service providers to deliver high-quality care in a cost-effective way to the entire population. We believe that the chasm between knowledge and action is due to a lack of concerted effort among all organizations that deliver health care services across the life span of patients. Broad participation is needed and necessitates a far more explicit and concerted public-private partnership focused on large-scale transformation.

Enhancing Health IT Functionality for Children: The 2015 Children's EHR Format.

Electronic health record (EHR) use throughout the United States has advanced considerably, but functionality to support the optimal care of children has been slower to develop and deploy. A previous team of experts systematically identified gaps in EHR functionality during collaborative work from 2010 to 2013 that produced the Children's EHR Format (Format), funded under the Children's Health Insurance Program Reauthorization Act of 2009, Public Law 111-3. After that, a team of practitioners, software developers, health policy leaders, and other stakeholders examined the Format's exhaustive list of 547 EHR functional requirements in 26 topic areas and found them to be valuable but in need of further refinement and prioritization.

The Business of Trust.

New mobile devices, social networks, analytics, and communications technologies are emerging at an unparalleled rate. As a result, academic health centers will face both new opportunities and formidable challenges. Unlike previous transitions from paper-based systems to networked computer systems, these new technologies are the product of new entrepreneurial and commercial interests driven by consumers.

Consumer-mediated health information exchanges: the 2012 ACMI debate.

The American College of Medical Informatics (ACMI) sponsors periodic debates during the American Medical Informatics Fall Symposium to highlight important informatics issues of broad interest. In 2012, a panel debated the following topic: "Resolved: Health Information Exchange Organizations Should Shift Their Principal Focus to Consumer-Mediated Exchange in Order to Facilitate the Rapid Development of Effective, Scalable, and Sustainable Health Information Infrastructure." Those supporting the proposition emphasized the need for consumer-controlled community repositories of electronic health records (health record banks) to address privacy, stakeholder cooperation, scalability, and sustainability.

Health information exchange reduces repeated diagnostic imaging for back pain.

Study Objective: This study seeks to determine whether health information exchange reduces repeated diagnostic imaging and related costs in emergency back pain evaluation.

Methods: This was a longitudinal data analysis of health information exchange patient-visit data. All repeated emergency department (ED) patient visits for back pain with previous ED diagnostic imaging to a Memphis metropolitan area ED between August 1, 2007, and July 31, 2009, were included.

Healthcare information technology and economics.

At the 2011 American College of Medical Informatics (ACMI) Winter Symposium we studied the overlap between health IT and economics and what leading healthcare delivery organizations are achieving today using IT that might offer paths for the nation to follow for using health IT in healthcare reform. We recognized that health IT by itself can improve health value, but its main contribution to health value may be that it can make possible new care delivery models to achieve much larger value. Health IT is a critically important enabler to fundamental healthcare system changes that may be a way out of our current, severe problem of rising costs and national deficit.

Does health information exchange reduce unnecessary neuroimaging and improve quality of headache care in the emergency department?

Background: Health information exchange (HIE) is advocated as an approach to reduce unnecessary testing and improve quality of emergency department (ED) care, but little evidence supports its use. Headache is a specific condition for which HIE has theoretical benefits.

Objective: To determine whether health information exchange (HIE) reduces potentially unnecessary neuroimaging, increases adherence with evidence-based guidelines, and decreases costs in the emergency department (ED) evaluation of headache.

The financial impact of health information exchange on emergency department care.

Objective: To examine the financial impact health information exchange (HIE) in emergency departments (EDs).

Materials And Methods: We studied all ED encounters over a 13-month period in which HIE data were accessed in all major emergency departments Memphis, Tennessee. HIE access encounter records were matched with similar encounter records without HIE access.

Health information exchange usage in emergency departments and clinics: the who, what, and why.

Objective: Health information exchange (HIE) systems are being developed across the nation. Understanding approaches taken by existing successful exchanges can help new exchange efforts determine goals and plan implementations. The goal of this study was to explore characteristics of use and users of a successful regional HIE.

User perspectives on the usability of a regional health information exchange.

Objective: We assessed the usability of a health information exchange (HIE) in a densely populated metropolitan region. This grant-funded HIE had been deployed rapidly to address the imminent needs of the patient population and the need to draw wider participation from regional entities.

Design: We conducted a cross-sectional survey of individuals given access to the HIE at participating organizations and examined some of the usability and usage factors related to the technology acceptance model.

Development and use of a medication history service associated with a health information exchange: architecture and preliminary findings.

We describe our early experience with use in emergency department settings of a standards-based medication history service integrated into a health information exchange (HIE). The service sends queries from one Exchange's emergency department interface both to a local ambulatory care system and to the medication hub services provided by a second HIE. This second HIE in turn sends requests to SureScripts and returns histories for incorporation into the first Exchange's clinical interface.

Health information exchange in Memphis: impact on the physician-patient relationship.

Health information exchanges represent one way of making medical information available to practitioners across institutional boundaries. One health information exchange in Memphis Tennessee has been operational since May of 2006 and provides information supporting care for over 1.2 million individuals.

Health information technology: one step at a time.

The development, implementation, and management of health care information technologies are prominent components of the American Recovery and Reinvestment Act of 2009. How these technologies will affect our health care system will depend on the collective choices made in the months ahead. Focusing on a limited set of near-term objectives will build trust, confer near-term benefit, and create the building blocks required to harness the altruistic and entrepreneurial motivations most likely to create future health care delivery systems.

Reducing HIE costs through real-time data feed visualizations.

Reliable and cost-effective health information exchanges require real-time monitoring of data sources, especially during implementation and deployment. MidSouth eHealth Alliance developers created a tool for real-time visualization of data feed logs which summarizes activity over multiple time windows and across different components, sources, and event types. This representation allows maintainers to differentiate between expected patterns and events that require rapid intervention to ensure reliable data handling, supporting efficient monitoring of and response to anomalous activity.

The MidSouth eHealth Alliance: use and impact in the first year.

The MidSouth e-Health Alliance is a health information exchange that has been in use in the Memphis, Tennessee region since May, 2006. This health information exchange took two years to develop from the time it was initially conceived. Following on the work done by the Indianapolis project, the MidSouth e-Health Alliance focused initially on implementations in emergency departments throughout this region.

A regional health information exchange: architecture and implementation.

The MidSouth eHealth Alliances health information exchange in Memphis, Tennessee provides access to data on almost 1 million individuals. The effort is the product of a comprehensive, integrated approach to technology and policy that emphasizes patient-centered use, low-cost, flexibility, and rigorous privacy and confidentiality policies and practices It is used in emergency departments and other major clinical settings. This paper provides a high-level overview of the system and its use.

Mapping laboratory test codes to LOINC for a regional health information exchange.

Fully mapping laboratory tests to LOINC greatly increases functionality within a regional data exchange, but it is a costly process. As an inexpensive approach, we defined 53 "clinically significant" labs to map within the Memphis, Tennessee RHIO. These tests comprised a small percentage of unique test codes but a large percentage of laboratory message volume.

Estimated financial savings associated with health information exchange and ambulatory care referral.

Data and financial models based on an operational health information exchange suggest that health care delivery costs can be reduced by making clinical data available at the time of care in urban emergency departments. Reductions are the result of decreases in laboratory and radiographic tests, fewer admissions for observation, and lower overall emergency department costs. The likelihood of reducing these costs depends on the extent to which clinicians alter their workflow and take into account information available through the exchange from other institutions prior to initiating a treatment plan.

The United Hospital Fund meeting on evaluating health information exchange.

Health information exchange (HIE) projects are sweeping the nation, with hopes that they will lead to high quality, efficient care, yet the literature on their measured benefits remains sparse. To the degree that the field adopts a common set of evaluation strategies, duplicate work can be reduced and meta-analysis will be easier. The United Hospital Fund sponsored a meeting to address HIE evaluation.