Biomedical subjects

Daniel P Lorence

Publications and source records attributed to Daniel P Lorence.

At least 19 recordsLinked to original sources

PubMed2006

Racial disparities in health information access: resilience of the Digital Divide.

Policy initiatives of the late 1990s were believed to have largely eliminated the information "Digital Divide." For healthcare consumers, access to information is an essential part of the consumer-centric framework outlined in the recently proposed national health information initiative. This study sought to examine how racial/ethnic characteristics are associated with Internet use and online health information. Using a cross-sectional nationwide study of reported Internet use and information search in 2000 and 2002, we studied a stratified sample of computer users from the Pew Internet and American Life Project surveys. Adjusted estimates of race/ethnicity and income effects on Internet use and search behaviors were derived from generalized estimating equations. Results show wide gaps in the use of computers between Hispanics and Whites (OR = 0.593 [0.440, 0.798]) and between African-Americans and Whites (OR = 0.554 [0.427, 0.720]) in 2000 significantly narrowed in 2002 (OR of Hispanic to white = 1.250 [0.874, 1.789]; OR of African-American to Whites = (0.793 [0.551, 1.141]). Gaps in access to the Internet, however, remained consistent between 2000-2002. Differences in health information seeking between Hispanics and Whites existed in both 2000 and 2002. 56% of White Internet users at some time searched for online health information, whereas 42% of Hispanic Internet users did so in 2000. By 2002, these percentages had increased to 13.4 and 15.8%, respectively. Data highlight the persistence of "Digitally Underserved Groups," despite recent Divide reduction strategies.

Access to Information↗

PubMed2006

Assessing health consumerism on the Web: a demographic profile of information-seeking behaviors.

The growing diversity of the online health information community is increasingly cited as a limiting factor related to the potential of the Internet as an effective health communication channel and information resource. Public-access Internet portals and decreasing costs of personal computers have created a consensus that unequal access to information, or a "Digital Divide," presents a like problem specific to health care consumers. Access to information, however, is an essential part of the consumer-centric framework outlined in the recently proposed U.S. National Health Information Infrastructure (NHII) and Health Architecture initiatives. To date little research has been done to differentiate the types of health information sought on the Web by different subgroups, linking user characteristics and health-seeking behaviors. Data from a study of consumer Web search activity in a post-intervention era serves as a natural experiment, and can identify whether a "digitally underserved group" persists in the United States. Such an environment would serve to exclude traditionally underserved groups from the benefits of the planned national heath information infrastructure. This exploratory technology assessment study seeks to differentiate and delineate specific behaviors, or lack of desired behaviors, across targeted health care subgroups. Doing so allows the design of more effective strategies to promote the use of the Web as a health education and health promotion tool, under the envisioned shared decision-making, consumer-centric health information model.

Adult↗

PubMed2006

Measuring dissimilarity in online health search activities.

There is growing evidence of the use of the Internet to obtain critical health information as well as increased diversity of user groups. While users of web-based information often report their reliance on healthcare providers for validation of information, it has yet to be determined if this is universally true across all types of information or user groups. In some cases consumers may aggregate in places where they trust web information (relative to provider-based information), such as areas of unsettled diagnostic methods or ambiguous treatment protocols. To date little research has been done to identify and differentiate clusters of health consumers and their similarities related to type of information sought. Data from a study of consumer Web search activity in a post-intervention era serves as a natural experiment, and can identify whether clusters of "digitally underserved groups" persist in the US, following national efforts to eliminate barriers to health information access. This exploratory technology assessment study seeks to differentiate and delineate specific information behaviors, across targeted healthcare subgroups. Doing so allows the design of more effective strategies to promote the use of the Web as a health education and health promotion tool, under the envisioned shared decisionmaking, consumer-centric health information model, critical to the proposed US national health information infrastructure.

Attitude to Computers↗

PubMed2006

New technology and old habits: The role of age as a technology chasm.

Familiarity with and use of computers is increasingly cited as a limiting factor related to the potential of the Internet as an effective healthcare resource for the elderly. This study sought to examine differences across age groups in their access to and use of computers and the Internet as a health information resource. We perform multivariate analysis with data from a stratified sample of survey-reported health information-seeking behaviors on the Internet. The results suggest that access to online health information among Internet users varies significantly from the use of computers and Internet. Younger participants showed the highest rates in the use of computer and Internet, and exhibited the lowest rates in the access to online health information. In 2000, 56.7% and 55.9% of medium and older Internet users ever looked for health information on the Web, respectively, whereas 49.4% of young Internet users ever did. By 2002, these fractions had increased by 14.6%, 13.5% and 9.1%, respectively. The comparison of ORs between 2000 and 2002 indicated that the gap is somewhat increased, although the increase was not statistically significant at 0.05 level (the ORs of old to young at2000 = 1.30 [0.933, 1.817]; the ORs at2002 = 1.61 [1.157, 2.255]). Findings show that the gap between old and young seekers users of computers and the Internet for information appears to have widened in recent years, even as advocates of consumer-centric healthcare continue to promote the Internet as a key source of empowerment for the elderly.

Adolescent↗

PubMed2005

The zeitgeist of online health search. Implications for a consumer-centric health system.

BACKGROUND: Health care queries rank among the most frequent topics of information-seeking activity initiated by users of commercial search engines. The quality of information located through existing search engine technology has received little attention, especially when considering the widely varied knowledge levels of internet users. OBJECTIVE: This study sought to create a benchmark technology assessment of online health search trends and practices, with corresponding evaluation of its applicability within the Federal Health Architecture (FHA) plan for a nationwide, interoperable health information infrastructure. DESIGN: Exploratory technology assessment, analyzing focus group participants' views on barriers to effective health information searching, using existing commercial search engine technologies and methods. SETTING AND PARTICIPANTS: Focus group, national leaders in electronic health care (e-health). RESULTS: A variety of web-based assessment tools are available for consumers to be able to identify reliable health websites; however, many may be too difficult for the layperson to use or understand. Existing search technologies are increasingly powerful, although the expanding volume of information on the internet suggests the need for better mediated searching. Search engines provide consumers a means for quickly bypassing information that appears too technical for their individual knowledge level, and at times, searchers often overlook critical information most relevant to their needs. Overall, existing search technologies need to be more interactive, visible, and context-driven, and supported by better technology assessment methodologies, scalability of information, and enhanced access by underserved subgroups. CONCLUSION: Future technology assessments are needed to provide structure for interoperability of health information systems, especially where consumers, providers, and payer systems intersect. State-of-the-art search engine technologies are still not widely available to those who can benefit most from them.

Benchmarking↗

PubMed2005

Incremental adoption of information security in health-care organizations: implications for document management.

The incremental adoption of electronic media in U.S. health care has created increased risk of security and privacy violations in provider organizations. Protective regulatory efforts have been proposed to address ineffective security of patient information, with severe noncompliance penalties. Using data from a nationwide survey of health information managers, this study examines how industry-wide knowledge management trends may influence the degree of security program adoption in health-care organizations. Results suggest that significant nonadoption of mandated security measures continues to occur across the health-care industry. Paper-based systems still prevail, and computerized settings tend to have less security measures. Implications for document management and knowledge policy are discussed.

Computer Security↗

PubMed2005

Clinical knowledge management using computerized patient record systems: is the current infrastructure adequate?

The proliferation of technology in health care, spurred by environmental factors encouraging the adoption of computerized patient records (CPRs), has led to a widely held perception of fully computerized patient information systems as the industry norm. To test the validity of this assumption, using data from a national survey of certified health information managers, we examined the CPR technology adoption rates reported by health information managers, assessing variation across practice settings, regions, and organizational types. Results show that significant nonadoption, and regional variation, exists in the implementation of CPRs. Overall, nonuniform diffusion of computerized health information technology was found, despite national mandates that promote and at times require uniform adoption. A significantly greater number of hospital-based patient records were computerized, compared to clinics and other practice settings. Managers were frequently found to maintain duplicate CPRs and paper-based patient record systems, even after the initial implementation period. Nonuniform regional CPR adoption and redundant paper-based systems were found to be a common practice in medical systems, due in part to cultural factors, mistrust of computerized data, and lack of technology training and knowledge.

Delivery of Health Care↗

PubMed2004

A study of medical and health queries to web search engines.

This paper reports findings from an analysis of medical or health queries to different web search engines. We report results: (i). comparing samples of 10000 web queries taken randomly from 1.2 million query logs from the AlltheWeb.com and Excite.com commercial web search engines in 2001 for medical or health queries, (ii). comparing the 2001 findings from Excite and AlltheWeb.com users with results from a previous analysis of medical and health related queries from the Excite Web search engine for 1997 and 1999, and (iii). medical or health advice-seeking queries beginning with the word 'should'. Findings suggest: (i). a small percentage of web queries are medical or health related, (ii). the top five categories of medical or health queries were: general health, weight issues, reproductive health and puberty, pregnancy/obstetrics, and human relationships, and (iii). over time, the medical and health queries may have declined as a proportion of all web queries, as the use of specialized medical/health websites and e-commerce-related queries has increased. Findings provide insights into medical and health-related web querying and suggests some implications for the use of the general web search engines when seeking medical/health information.

Europe↗

PubMed2004

Semantics and the medical web: a review of barriers and breakthroughs in effective healthcare query.

This paper provides an overview of the research into current medical vocabularies and their impact on searching the Web for health information. The Web provides growing opportunities for laypersons to gain knowledge about specific health conditions, though research to date has been incomplete. Many studies have examined aspects of controlled medical vocabularies. Other studies have examined aspects of medical Web searching vocabularies. In this context, there is a growing need to examine more closely laypersons' Web queries using controlled medical vocabularies that were designed to serve the needs of medical professionals. It may be the case that the average consumer of Web health services is not able to use correct medical terminology, and may not be able to choose analogous or synonymous terms from a search result list. Our review suggests a growing need for studies to examine the current applicability of controlled medical vocabularies as well as alternatives to semantic query by Web search engine users.

Humans↗

PubMed2003

Benchmarking variation in coding accuracy across the United States.

The objective of this study was to measure the consistency of coded medical data through information managers' reports of the overall coding error level in patients' medical records. Using a cross-sectional design, we examined the reported percent of records containing coding errors significant enough to change a diagnostic related group (DRG). Results indicate about 87 percent, 9 percent, and 5 percent of respondents reported that significant coding errors existed in less than 5 percent, 6-10 percent, and greater than 10 percent of the medical records in their institutions, respectively. Significant variation was found in the accuracy and consistency of coding practice and associated data quality across key demographic and organizational variables. Significantly large error rates in coded data exist in some organizations. Given variations across key demographic characteristics, providers may tend to distrust all coded data, when aggregated. As the United States moves toward an evidence-based medicine environment, the use of current patient data classification methods may be of limited value without increased attention to coding practices.

Benchmarking↗

PubMed2003

Disparity in coding concordance: do physicians and coders agree?

Increasing demands for large-scale comparative analysis of health care costs has led to a similar demand for consistently classified data. Evidence-based medicine demands evidence that can be trusted. This study sought to assess managers' observed levels of agreement with physician code selections when classifying patient data. Using a non-sampled research design of both mailed and telephone surveys, we employ a nationwide cross-section of over 16,000 accredited US medical record managers. As a main outcome measure, we evaluate reported levels of agreement between physician and information manager code selections made when classifying patient data. Results indicate about 19 percent of respondents report that coder-physician classification disagreement occurred on more than 5 percent of all patient encounters. In some cases, disagreement occurred in 20 percent or more instances of code selection. This phenomenon shows significant variation across key demographic and market indicators. With the growing practice of measuring coded data quality as an outcome of health care financial performance, along with adoption of electronic classification and patient record systems, the accuracy of coded data is likely to remain uncertain in the absence of more consistent classification and coding practices.

Data Collection↗

PubMed2003

Identifying barriers to billing compliance.

Programs designed toward the control of health care fraud are leading to increasingly aggressive enforcement and prosecutorial efforts by federal regulators, related to over-reimbursement for service providers. Greater penalties for fraudulent practices have been touted as an effective deterrent to practices that encourage, or fail to prevent, incorrect claims for reimbursement. In such a context, this study sought to examine the extent of compliance management barriers through a national survey of all accredited US health information managers, examining likely barriers to payment of health care claims. Using data from a series of surveys on the stated compliance actions of more than 16,000 health care managers, we find that the publication and dissemination of compliance enforcement regulations had a significant effect on the reduction of fraud. Results further suggest that significant non-adoption of proper billing compliance measures continues to occur, despite the existence of counter-fraud prosecution risk designed to enforce proper compliance. Finally, we identify benchmarks of compliance management and show how they vary across demographic, practice setting, and market characteristics. We find significant variation in influence across practice settings and managed care markets. While greater publicity related to proper billing procedures generally leads to greater compliance awareness, this trend may have created pockets of "institutional non-compliance," which result in an increase in the prevalence of non-compliant management actions. As a more general proposition, we find that it is not sufficient to consider compliance actions independent of institutional or industry-wide influences.

Data Collection↗

PubMed2002

Regional variation in medical systems data: influences on upcoding.

Attempts to minimize over-reimbursement to health care providers have resulted in highly publicized prosecution of health care providers and provider organizations. Such prosecution has led many to propose that upcoding influences exerted upon health care information managers would largely disappear, both within and external to the provider organization. This study seeks to examine the degree of both intra- and extraorganizational influences on reimbursement optimizing practices through a national survey of accredited health information managers. Results suggest that significant upcoding influence continues to occur within organizations, despite the risk of severe counterfraud penalties designed to eliminate such practices. We examine variation in intra- and extraorganizational optimizing influences, finding such influence was found to exist both within and external to the provider organization. We also examine how optimization influences vary across demographic, practice setting, and market characteristics. We find significant variation in influence across practice settings and managed care markets. Ramifications for reimbursement assessment are discussed.

Abstracting and Indexing↗

PubMed2002

EPR adoption and dual record maintenance in the U.S.: assessing variation in medical systems infrastructure.

The growing adoption of evidence-based medicine in the United States is acting to cause fundamental changes in the delivery of healthcare management services. With the increasing incorporation of electronic patient records (EPRs) into the day-to-day practice of medicine, it necessitates greater dependence on adequate functioning of such resources, as they become more frequently used as a clinical complement in the practice of medicine. Assessing the patterns of adoption of EPRs is likewise of increasing importance, with the recent imposition of uniform government data collection and management requirements. The medium of data storage and maintenance within many organizations is a critical factor in the ultimate delivery of service, with a like need for an integrated, designated medium for the management of data becoming paramount. This study examines, on a nationwide basis, variation in reported adoption of EPRs within U.S. healthcare organizations, and the related maintenance of dual electronic/paper record systems.

Database Management Systems↗

PubMed2002

Variation in coding influence across the USA. Risk and reward in reimbursement optimization.

Recent anti-fraud enforcement policies across the US health-care system have led to widespread speculation about the effectiveness of increased penalties for overcharging practices adopted by health-care service organizations. Severe penalties, including imprisonment, suggest that fraudulent billing, and related misclassification of services provided to patients, would be greatly reduced or eliminated as a result of increased government investigation and reprisal. This study sought to measure the extent to which health information managers reported being influenced by superiors to manipulate coding and classification of patient data. Findings from a nationwide survey of managers suggest that such practices are still pervasive, despite recent counter-fraud legislation and highly visible prosecution of fraudulent behaviors. Examining variation in influences exerted from both within and external to specific service delivery settings, results suggest that pressure to alter classification codes occurred both within and external to the provider setting. We also examine how optimization influences vary across demographic, practice setting, and market characteristics, and find significant variation in influence across practice settings and market types. Implications for reimbursement programs and evidence-based health care are discussed.

Behavior Control↗

PubMed2002

Assessing managed care market variation in reports of coding accuracy.

The implementation of larger, faster and more comprehensive databases in healthcare delivery settings is an emerging outgrowth of evidence-based medicine. This study seeks to assess, at a national level, the degree of uniformity across markets in utilization and management of coded medical information. Implications for managers and policymakers, related to comparative managed care data benchmarks, are reviewed.

Benchmarking↗

PubMedDate not supplied

Information in medical decision making: how consistent is our management?

BACKGROUND: The use of outcomes data in clinical environments requires a correspondingly greater variety of information used in decision making, the measurement of quality, and clinical performance. As information becomes integral in the decision-making process, trustworthy decision support data are required. METHODS: Using data from a national census of certified health information managers, variation in automated data quality management practices was examined. RESULTS: Relatively low overall adoption of automated data management exists in health care organizations, with significant geographic and practice setting variation. Nonuniform regional adoption of computerized data management exists, despite national mandates that promote and in some cases require uniform adoption. Overall, a significant number of respondents (42.7%) indicated that they had not adopted policies and procedures to direct the timeliness of data capture, with 57.3% having adopted such practices. CONCLUSIONS: The inconsistency of patient data policy suggests that provider organizations do not use uniform information management methods, despite growing federal mandates to do so.

Administrative Personnel↗

PubMedDate not supplied

Manager's reports of variation in coding accuracy across U.S. oncology centers.

Advances in high-speed data processing capabilities, and the increasing reliance on information systems in comparative data assessment, are creating greater dependence on information systems, with a related need for more timely assessment of coding quality. Assessing the accuracy of coded and classified data becomes critical as the implementation of government compliance management requirements, along with the growing adoption of evidence-based medicine in error detection, serve to challenge healthcare researchers to consider the quality of coded data in management assessments. The implementation of larger, faster and more comprehensive databases in healthcare delivery settings is one response to this changing environment, but at a national level there will need to be some degree of uniformity in their utilization and management, if researchers are expected to rely on comparative benchmarks to fully assess organizational performance. In a nationwide survey of health information managers we found about 81 percent of respondents reported that significant coding errors existed in 5 percent or less of the records in their institutions. About 11 percent of respondents, however, reported that the coding errors existed in six to ten percent of their records. Regional and practice setting variation in reported coding error ranged widely, occurring across organizations as well as area locations. Related impact on comparative data-driven management assessment is discussed.

Abstracting and Indexing↗