Best Paper Selection

Appendix: Content Summaries of Selected Best Papers for the 2024 IMIA Yearbook, Section Health Information Exchange

Aniekwe C, Cuffe K, Audu I, Nalda N, Ibezim B, Nnakwe M, Anazodo T, Dada M, Romano ER, Okoye M, Martin M.

Assessing the effect of electronic health information exchange on the completeness and validity of data for measuring viral load testing turnaround time in Nigeria.

International Journal of Medical Informatics. 2023 Jun 1;174:105059.

doi: 10.1016/j.ijmedinf.2023.105059

This best paper discusses the implementation of health information exchange (HIE) and its impact on data quality within public health program monitoring and surveillance. The study focused on the quality of data available to measure HIV viral load testing turnaround time (TAT) in Nigeria. Researchers measured viral load data validity and completeness before the implementation of HIE, and six months after implementation. The study findings demonstrate improved completeness and timeliness of data. The authors defined data completeness as the percentage of non-missing values and measured this value by specimens and by data elements in the dataset for calculating TAT. The authors collected and analyzed specimen data from 30 healthcare facilities that were tested in three Polymerase Chain Reaction (PCR) labs. To examine data validity, the researchers classified TAT segments with negative values and date fields that were not in International Organization for Standardization (ISO) standard date format as invalid. Validity was measured by specimens and by each TAT segment. The researchers used Pearson's chi-square to assess improvements in validity and completeness post implementation of HIE. The study analyzed 15,226 records of specimens at baseline and 18,022 records of specimens at endline. Findings indicated that data completeness for all specimens recorded increased significantly from 47% before HIE implementation to 67% six months after implementation (p < 0.01). Data validity also increased from 90% before implementation to 91% after implementation (p < 0.01). The authors identified opportunities for improvements as demonstrated by decreases in data validity and completeness and discussed existing gaps in record completeness and validity. The study described their plans and next steps, including reviewing the HIE workflow and updating the source systems to align with this workflow and standardizing data collection across lab systems. Authors noted limitations of the approach including lack of a control group. They point the need to conduct further analysis to understand how automated HIE impacts viral load TAT. Implementation of HIE offers promising benefits to data quality, availability, and improved clinical decision-making. There are potential generalizable implications and opportunities for improving quality of care for people living with HIV/AIDS and addressing public health priorities in other settings and countries.

Sloan-Aagard C, Glenn J, Nañez J, Crawford SB, Currey JC, Hartmann E.

The impact of community health information exchange usage on time to reutilization of hospital services.

The Annals of Family Medicine. 2023 Jan 1;21(1):19-26.

doi: 10.1370/afm.2903.

This study looked at clinician usage of a community health information exchange (HIE) and impact on patient care transitions. The researchers explored the impact on the time until hospital reuse when primary care physicians look up records in the HIE of their patients recently released from the hospital. The researchers conducted a retrospective review of 8,216 hospital inpatients aged over 18 years that were discharged from January 1, 2021 through November 30, 2021 using the Paso del Norte HIE, in El Paso County, Texas. All patients had a primary care physician visit within 30 days after hospital discharge. The authors identified patients that were looked up in the HIE close to that visit. Of the cohort, 2,627 were re-hospitalized and 3,809 visited an emergency department (ED) during the follow-up window. The remaining 1,780 patients were controls. The authors found that lookup in the HIE was significantly associated with reducing the likelihood of visiting the ED by 53% and being re-hospitalized by 61%. Researchers found that lookup in the HIE was associated with an increased median time to use of the ED after inpatient discharge from 99 to 238 patient days. Ethnicity, insurance, gender, and age were also significant predictors of hospital reuse. The authors highlight the benefits HIE use can have on patient outcomes. The study sheds light on lessons learned. For example, they suggest that increased efforts are needed to help ensure that patients have visits with their primary care physicians for their post-hospitalization follow-ups. The authors note the potential impact of health insurance coverage on the pattern of increased length of time between hospital uses. While this study focused on transitions from inpatient hospitalization to primary care physicians, future studies can further explore how to enhance coordination and efficiency of care and transitions of care to other care delivery sites and providers. Additional research could shed light on what data are most useful during transitions and what other outcomes (beyond re-admission) are impacted.