Abstract:
OBJECTIVE:To determine whether the use of information technology (IT), measured by Meaningful Use capability, is associated with lower rates of inappropriate utilization of imaging services in hospital outpatient settings. RESEARCH DESIGN:A retrospective cross-sectional analysis of 3332 nonfederal U.S. hospitals using data from: Hospital Compare (2011 outpatient imaging efficiency measures), HIMSS Analytics (2009 health IT), and Health Indicator Warehouse (market characteristics). Hospitals were categorized for their health IT infrastructure including EHR Stage-1 capability, and three advanced imaging functionalities/systems including integrated picture archiving and communication system, Web-based image distribution, and clinical decision support (CDS) with physician pathways. Three imaging efficiency measures suggesting inappropriate utilization during 2011 included: percentage of "combined" (with and without contrast) computed tomography (CT) studies out of all CT studies for abdomen and chest respectively, and percentage of magnetic resonance imaging (MRI) studies of lumbar spine without antecedent conservative therapy within 60days. For each measure, three separate regression models (GLM with gamma-log link function, and denominator of imaging measure as exposure) were estimated adjusting for hospital characteristics, market characteristics, and state fixed effects. Additionally, Heckman's Inverse Mills Ratio and propensity for Stage-1 EHR capability were used to account for selection bias. PRINCIPAL FINDINGS:We find support for association of each of the four health IT capabilities with inappropriate utilization rates of one or more imaging modality. Stage-1 EHR capability is associated with lower inappropriate utilization rates for chest CT (incidence rate ratio IRR=0.72, p-value <0.01) and lumbar MRI (IRR=0.87, p-value <0.05). Integrated PACS is associated with lower inappropriate utilization rate of abdomen CT (IRR=0.84, p-value <0.05). Imaging distribution over Web capability is associated with lower inappropriate utilization rates for chest CT (IRR=0.66, p-value <0.05) and lumbar MRI (IRR=0.86, p-value <0.05). CDS with physician pathways is associated with lower inappropriate utilization rates for abdomen CT (IRR=0.87, p-value <0.01) and lumbar MRI (IRR=0.90, p-value <0.05). All other cases showed no association. CONCLUSIONS:The study offers mixed results. Taken together, the results suggest that the use of Stage-1 Meaningful Use capable EHR systems along with advanced imaging related functionalities could have a beneficial impact on reducing some of the inappropriate utilization of outpatient imaging.
journal_name
Int J Med Informjournal_title
International journal of medical informaticsauthors
Appari A,Johnson ME,Anthony DLdoi
10.1016/j.ijmedinf.2017.10.020subject
Has Abstractpub_date
2018-01-01 00:00:00pages
87-95eissn
1386-5056issn
1872-8243pii
S1386-5056(17)30388-Xjournal_volume
109pub_type
杂志文章abstract::Decision trees have been already successfully used in medicine, but as in traditional statistics, some hard real world problems can not be solved successfully using the traditional way of induction. In our experiments we tested various methods for building univariate decision trees in order to find the best induction ...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/s1386-5056(01)00176-9
更新日期:2001-09-01 00:00:00
abstract:INTRODUCTION:Unplanned 30-day hospital readmission account for roughly $17 billion in annual Medicare spending. Many factors contribute to unplanned hospital readmissions and multiple models have been developed over the years to predict them. Most researchers have used insurance claims or administrative data to train a...
journal_title:International journal of medical informatics
pub_type: 杂志文章,meta分析,多中心研究
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更新日期:2015-12-01 00:00:00
abstract:BACKGROUND:The widespread adoption of electronic health records (EHRs) is accelerating the collection of sensitive clinical data. The availability of these data raises privacy concerns, yet sharing the data is essential for public health, longitudinal patient care, and clinical research. METHOD:Following previous work...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2012.11.003
更新日期:2013-01-01 00:00:00
abstract:OBJECTIVE:To explore concrete approaches to socio-technical design of collaborative healthcare information systems and to design a groupware technology for collaborative clinical trial protocol writing. METHOD:We conducted "quick and dirty ethnography" through semi-structured interviews, observational studies, and wor...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2006.05.035
更新日期:2007-06-01 00:00:00
abstract:BACKGROUND:This study assessed current perspectives and expectations for telemedicine by nursing home caregivers and families of nursing home patients in Taipei, Taiwan. METHODS:A total of 116 interviews were conducted with family members (n=37) and caregivers (n=79) using an original, four-part questionnaire devised ...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2009.02.009
更新日期:2009-07-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2009.09.002
更新日期:2010-01-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2003.11.010
更新日期:2004-03-31 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2008.06.015
更新日期:2009-03-01 00:00:00
abstract:BACKGROUND:Building on initial work carried out by the Faculty of Clinical Informatics (FCI) in the UK, the creation of a national competency framework for Clinical Informatics is required for the definition of clinical informaticians' professional attributes and skills. We aimed to systematically review the academic l...
journal_title:International journal of medical informatics
pub_type: 杂志文章,meta分析,评审
doi:10.1016/j.ijmedinf.2020.104237
更新日期:2020-09-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2016.01.009
更新日期:2016-12-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2009.06.002
更新日期:2009-10-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2019.103956
更新日期:2019-11-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/s1386-5056(98)00170-1
更新日期:1999-05-01 00:00:00
abstract::Clinical practice guidelines provide a means to enhance physician performance. This investigation was undertaken in an attempt to understand the nature of impact of guideline use on physician performance. We investigated the impact of (a) algorithmic-based and (b) text-based practice guidelines on clinical decision-ma...
journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/s1386-5056(01)00165-4
更新日期:2001-10-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2020.104235
更新日期:2020-09-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2018.10.007
更新日期:2018-12-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2009.03.006
更新日期:2009-08-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章,评审
doi:10.1016/j.ijmedinf.2019.03.018
更新日期:2019-06-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2007.06.002
更新日期:2007-12-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2007.01.007
更新日期:2007-05-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2012.05.008
更新日期:2013-04-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2012.11.015
更新日期:2013-05-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章,评审
doi:10.1016/j.ijmedinf.2020.104296
更新日期:2020-12-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2006.07.002
更新日期:2007-10-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章,评审
doi:10.1016/S1386-5056(97)01253-7
更新日期:1997-03-01 00:00:00
abstract::This paper describes a new distributed Master of Science degree program stream in health informatics (HI) at the University of Victoria, Canada, aimed at healthcare and information technology professionals working in the health setting. This is a part-time graduate program where students are required to complete 10 co...
journal_title:International journal of medical informatics
pub_type: 杂志文章,评审
doi:10.1016/j.ijmedinf.2007.01.008
更新日期:2007-05-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2016.12.007
更新日期:2017-03-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
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更新日期:2016-08-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
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更新日期:2017-01-01 00:00:00
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journal_title:International journal of medical informatics
pub_type: 杂志文章
doi:10.1016/j.ijmedinf.2020.104363
更新日期:2021-03-01 00:00:00