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We are far from understanding how best to design, implement, and use health information technology (IT). A comprehensive framework, developed by Rippen et al to capture and organize knowledge on the implementation, use, and optimization of health IT, may guide and inform more effective health IT deployment. This study applied Rippen's framework to a focused type of health IT - alerts - through clinical decision support (CDS), an area with a substantial evidence base around many facets of implementation, including the technology, use, and outcomes. We report results from applying this framework for capturing, organizing and standardizing knowledge and related measures around alerts. It is clear there are gaps in information shared and that measures across studies vary significantly. Insights identified using the framework highlight areas for further study and development, directed toward a shared conceptualization and representation of knowledge, and ultimately, a more comprehensive and deeper understanding of health IT.

We modeled the adoption, costs and monetezied benefits of the Department of Veterans Affairs' (VA's) internally developed Laboratory Electronic Data Interchange (LEDI) application from 2001-2007. LEDI provides standards-based electronic exchange of laboratory data and secure transmission of laboratory test orders and results. Once the initial development and installation costs were accounted for, LEDI likely produced value for the VA in savings of laboratory staff time for test ordering and results processing. We estimate that the VA needed to realize 20 percent of projected labor saving to recover its investment in LEDI.

Personal health records (PHRs) are a rapidly growing area of health information technology despite a lack of significant value-based assessment.Here we present an assessment of the potential value of PHR systems, looking at both costs and benefits.We examine provider-tethered, payer-tethered, and third-party PHRs, as well as idealized interoperable PHRs. An analytical model was developed that considered eight PHR application and infrastructure functions. Our analysis projects the initial and annual costs and annual benefits of PHRs to the entire US over the next 10 years.This PHR analysis shows that all forms of PHRs have initial net negative value. However, at the end of 10 years, steady state annual net value ranging from$13 billion to -$29 billion. Interoperable PHRs provide the most value, followed by third-party PHRs and payer-tethered PHRs also showing positive net value. Provider-tethered PHRs constantly demonstrating negative net value.

Personal health records (PHRs) are a rapidly expanding area in medical informatics due to the belief that they may improve healthcare delivery and control costs of care. To truly understand the full potential value of a technology, a cost analysis is critical.However, little evidence exists on the value potential of PHRs, and a cost model for PHRs does not currently exist in the literature.This paper presents a sample cost model for PHR systems, which include PHR infrastructure and applications. We used this model to examine the costs of provider-tethered, payer-tethered, third-party, and interoperable PHRs. Our model projects that on a per-person basis, third-party PHRs will be the most expensive followed by inter operable PHRs, and then provider-tethered PHRs and payer-tethered PHRs are the least expensive. Data interfaces are a major cost driver, thus these findings underscore the need for standards development and use in the implementation ofPHR systems.

Personal Health Records (PHRs) are a rapidly expanding area of medical informatics due to the belief that they may improve health care delivery and control costs of care. The PHRs in use or in development today support a myriad of different functions, and consequently offer different value propositions. A comprehensive value analysis of PHRs has never been conducted; such analysis is needed to identify those PHR functions that yield the greatest value to PHR stakeholders. Here we present a framework that could serve as a foundation for determining the value of PHR functions and thereby help optimize PHR development. While the value framework is specific to the domain of PHRs, the authors have successfully applied the associated evaluation methodology in assessing other health care information technologies.