The American journal of managed care
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The adoption and use of health information technology (IT) by health systems in ambulatory care can be an important driver of care quality. We examine recent trends in health IT adoption by health system-affiliated ambulatory clinics in the context of the federal government's Meaningful Use and Promoting Interoperability programs. ⋯ The relatively low uptake of health IT functionalities important to care improvement suggests substantial opportunities for further improving adoption of ambulatory health IT even among the current EHR users.
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Observational Study
Predicting hospitalizations from electronic health record data.
Electronic health record (EHR) data have become increasingly available and may help inform clinical prediction. However, predicting hospitalizations among a diverse group of patients remains difficult. We sought to use EHR data to create and internally validate a predictive model for clinical use in predicting hospitalizations. ⋯ Prediction models using EHR-only, claims-only, and combined data had similar predictive value and demonstrated strong discrimination for which patients will be hospitalized in the ensuing 6 months.
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Observational Study
Does machine learning improve prediction of VA primary care reliance?
The Veterans Affairs (VA) Health Care System is among the largest integrated health systems in the United States. Many VA enrollees are dual users of Medicare, and little research has examined methods to most accurately predict which veterans will be mostly reliant on VA services in the future. This study examined whether machine learning methods can better predict future reliance on VA primary care compared with traditional statistical methods. ⋯ The modest gains in performance from the best-performing model, gradient boosting machine, are unlikely to outweigh inherent drawbacks, including computational complexity and limited interpretability compared with traditional logistic regression.
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Electronic consultation, or e-consult, systems improve specialty care access by conveying specialist expertise to primary care clinicians (PCCs) without requiring specialist visits. Our study evaluates organizational factors for e-consult implementation across 5 publicly financed, county-based health systems in California. Each system serves 40,000 to 180,000 culturally and linguistically diverse patients across 4 to 19 primary care locations. ⋯ Successful e-consult implementations in public delivery systems leveraged (1) prior primary care and specialty care clinician relationships and (2) integrated EHR and e-consult platforms. This contrasts with common expectations that new technology will overcome care delivery gaps. Findings add to existing e-consult implementation literature that emphasizes reimbursement and leadership champions.
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Editorial
The health IT special issue: enduring barriers to adoption and innovative predictive methods.
Electronic health record systems have the potential to significantly improve care coordination and, ultimately, clinical care delivery. Still, it is clear that these systems are not silver bullets that will automatically result in better coordination of care and quality.