Internal medicine physician, biomedical Informaticist and researcher, educator, mentor, entrepreneur and author. Address: Scottsdale, Arizona, United States
BACKGROUND Granular information sharing studies rarely use actual patient electronic health recor... more BACKGROUND Granular information sharing studies rarely use actual patient electronic health record (EHR) information. In a previous study, behavioral health patients categorized their own EHR data into sensitive categories (e.g. mental health) and chose which care team members (e.g. pharmacists) should have access to those records. In this study, behavioral health professionals are provided access to the outcomes of a previous patient study to better understand the perspectives of health professionals on patient-controlled granular information sharing. OBJECTIVE Assess behavioral health professionals’: (1) perspectives on understanding and opinions about granular information sharing; (2) accuracy in assessing redacted medical information; (3) reactions to patient rationale for health data categorization, assignment of sensitivity, and sharing choices; and (4) recommendations on how to improve the process of granular health information sharing. METHODS Four two-hour focus groups and a pre- and post-survey were conducted at two integrated health facilities. During the focus groups, outcomes from a previous study on patients’ medical record sharing choices were shared. Thematic analysis and descriptive statistical analyses were conducted. RESULTS Twenty-eight professionals were initially unaware of or provided incorrect definitions of granular information sharing (56.0%). After having access to outcomes from a previous patient study, professionals increased their mixed perspectives (21.4% to 37.1%) on granular information sharing. A majority (81.3%) identified that key medical data had been redacted from the study case. Many (66.1%) stated they did not understand patient rationale for categorization or medical sharing preferences. Finally, participants recommended that a variety of educational approaches be incorporated to inform patients about granular information and health record sharing processes. CONCLUSIONS This study provides detailed insights from behavioral health professionals on patient-controlled granular information sharing. Health professionals accurately identified information gaps resulting from patient-directed data redaction, improved in their overall concept comprehension, underscored the fine line between patient safety and patient rights, and expressed a commitment to help patients appreciate the risks and benefits associated with granular information sharing. Outcomes will inform the development, deployment and evaluation of an electronic consent tool for granular health data sharing.
Research in Social & Administrative Pharmacy, Dec 1, 2011
In 2007, a federal Medicaid Transformation Grant was awarded to design, develop, and deploy a sta... more In 2007, a federal Medicaid Transformation Grant was awarded to design, develop, and deploy a statewide Health Information Exchange and Electronic Health Record in Arizona, United States. To explore the health information technology needs, knowledge, and expectations of Arizona's health care professionals, moderated focus groups were conducted. This article describes the results of the pharmacist focus groups. Focus group activities included a brief presentation, completion of a paper-based survey, and group discussion. The methods included solicitation by invitation, participant selection, meeting content, collaterals, focus group execution, recording, analysis, and discerning comparability among groups. Pharmacy focus group discussions centered on electronic prescribing, including the anticipated advantages: reducing handwriting interpretation errors, improving formulary compliance, improving communication with prescribers, increasing efficiency, and ensuring data accuracy. Disadvantages included: medication errors, inadequate training and knowledge of software applications, and inflated patient expectations. Pharmacists ranked e-prescribing as the highest priority feature of an electronic health system.
Health disparities among Hispanics are associated with poorer health status across multiple healt... more Health disparities among Hispanics are associated with poorer health status across multiple health conditions, greater use of high-acuity services, and lower use of care continuity and preventive services. A new integrated delivery organization (IDO) designed around culturally responsive care aims to reduce health disparities and improve health outcomes among the Hispanic community by deploying a multifeatured approach. The IDO combines the universal administration of a culturally sensitive health risk screening tool, the delivery of culturally appropriate medical, behavioral and spiritual health, and creative support of provider practices with training and informational resources, financial incentives, actionable data, technology, and cultural sensitivity training for providers and staff. The IDO further distinguishes its unique approach by partnering with a university informatics program to establish a local learning health care system destined to enrich the evidence base for culturally appropriate interventions that reduce health disparities. Longitudinal research is currently underway that focuses on the impact of culturally motivated interventions on resource utilization, retention, and quality.
International Journal of Medical Informatics, Jun 1, 2020
BackgroundConsent2Share (C2S) is an open source software created by the Office of the National Co... more BackgroundConsent2Share (C2S) is an open source software created by the Office of the National Coordinator Data Segmentation for Privacy initiative to support electronic health record (EHR) granular segmentation. To date, there are no published formal evaluations of Consent2Share.MethodStructured data (e.g. medications) codified using standard clinical terminologies (e.g. RxNorm) was extracted from the EHR of 36 patients with behavioral health conditions from study sites. EHRs were available through a health information exchange and two sites. The EHR data was already classified into data types (e.g. procedures and services). Both Consent2Share and health providers classified EHR data based on value sets (e.g. mental health) and sensitivity (e.g. not sensitive. Descriptive statistics and Chi-square analysis were used to compare differences between data categorizations.ResultsFrom the resulting 1,080 medical records items, 584 were distinct. Significant differences were found between sensitivity classifications by Consent2Share and providers (χ2 (2, N = 584) = 114.74, p = <0.0001). Sensitivity comparisons led to 56.0% of agreements, 31.2% disagreements, and 12.8% partial agreements. Most (97.8%) disagreements resulted from information classified as not sensitive by Consent2Share, but sensitive by provider (e.g. behavioral health prevention education service). In terms of data types, most disagreements (57.1%) focused on procedures and services information (e.g. ligation of fallopian tube). When considering value sets, most disagreements focused on genetic data (100.0%), followed by sexual and reproductive health (88.9%).ConclusionsThere is a need to further validate Consent2Share before broad use in health care settings. The outcomes from this pilot study will help guide improvements in segmentation logic of tools like Consent2Share and may set the stage for a new generation of personalized consent engines.
The advent of electronic medical records and health information exchanges has facilitated the pos... more The advent of electronic medical records and health information exchanges has facilitated the possibility of patients exercising increasingly granular control over sensitive health information. In principle, patients should be able to control which of their health information is made accessible to which of their healthcare providers. To meet this goal, the architects of any system of granular control of patients' health information face a variety of challenges. In addition to technical, ethical, and prudential considerations, the architects of any effective system must also ensure compliance with applicable legal requirements. The extent of a patient's permissible control depends upon whether governing law prohibits providers from disclosing health information to other providers without a patient's authorization, permits providers to disclose to other providers at the provider's discretion, or requires such disclosure. To inform efforts to design a viable system, this article analyzes U.S. federal and state (Arizona) law in regard to the sharing of the following types of sensitive health information: substance abuse, mental health, genetic, communicable diseases, and sexual and reproductive health.
Little is known about data sharing preferences for care and research of behavioral health patient... more Little is known about data sharing preferences for care and research of behavioral health patients. Eighty-six behavioral health patients (n = 37 Latinos; n = 32 with serious mental illness) completed questionnaires, in either English or Spanish, with items assessing their views on privacy and sensitivity of health record information. Most patients (82.5%) considered mental health information as sensitive. In general, there was a direct correspondence between perceived sensitivity of information and willingness to share with all or some providers. A main motivation for sharing data with providers was improving the patient's own care (77.8%). Most participants (96.5%) indicated they would be extremely to somewhat willing to share their data for research with their care facilities and universities. Follow-up patient interviews are being conducted to further elucidate these findings.
Objectives: Learn how substance use disorder (SUD) treatment organizations view and respond to ch... more Objectives: Learn how substance use disorder (SUD) treatment organizations view and respond to changes in confidentiality and disclosure law following adoption of CARES Act Sec. 3221 and prior to promulgation of revised implementing regulations. Methods: Online survey followed by informal interviews. Representatives of SUD organizations reported their degree of awareness of Sec. 3221 provisions and their organizations' views on amendments to disclosure practices; current and future changes of organizational policies; difficulties anticipated in implementing new rules; and preferences for resources. Results: Forty informant surveys on 30 organizations completed. Participants (62.5 percent) indicated being somewhat knowledgeable about Sec. 3221. Evenly divided positive and concerned views on Sec. 3221 reflect tension between preserving confidentiality of patient records and improving coordination of care. Most (76.7 percent) reported organizational discussions on Sec. 3221. Some (30 percent) identified changes to make in near future. Over a third expected few or no barriers to implementing changes to privacy and disclosure practices, while most (64.7 percent) expected hindrances including complexity and tensions in the law, staff education, cost, technological adjustments, and changes in the ways SUD organizations interact with external organizations and individuals. To overcome barriers noted, participants expressed desire (66.7 percent) for teaching tools such as webinars and templates to follow. Conclusions: SUD treatment organizations began thinking of and planning for proposed changes well before expected implementation of Sec. 3221. Their concerns reflected practicalities of implementation, determining content of law, and wondering about the extent to which it solves problems (improving coordination of care among various providers) or endangered other goals (protecting confidentiality of SUD patient records).
Prescription opioid abuse has become a serious national problem. To respond to the opioid epidemi... more Prescription opioid abuse has become a serious national problem. To respond to the opioid epidemic, states have implemented prescription drug monitoring programs (PDMPs) to monitor and reduce opioid abuse. We conducted a systematic literature review to better understand the PDMP impact on reducing opioid abuse, improving prescriber practices, and how EHR integration has impacted PDMP usability. Lessons learned can help guide federal and state-based efforts to better respond to the opioid crisis.
An integral element of value-based care is care team access to both physical and behavioral healt... more An integral element of value-based care is care team access to both physical and behavioral health data. Data release processes in both environments are governed by federal and state statutes. The requirements for obtaining consent are complex and often confusing. Little is known about the consent processes and practices in the behavioral health setting, specifically how patients and surrogates engage in the process and their interactions with electronic consent tools. This study analyzes the consent processes from the patient perspective at two community behavioral health clinics. Outcomes include description of the processes using electronic consent, workflows and consenter-provider interactions. Conclusions include need to streamline and standardize consent technologies and improve consenter engagement. This study supports the development of an electronic consent tool, My Data Choices (MDC), funded by the National Institute of Mental Health, that offers individuals with behavioral health conditions more control over their medical records.
BACKGROUND Granular information sharing studies rarely use actual patient electronic health recor... more BACKGROUND Granular information sharing studies rarely use actual patient electronic health record (EHR) information. In a previous study, behavioral health patients categorized their own EHR data into sensitive categories (e.g. mental health) and chose which care team members (e.g. pharmacists) should have access to those records. In this study, behavioral health professionals are provided access to the outcomes of a previous patient study to better understand the perspectives of health professionals on patient-controlled granular information sharing. OBJECTIVE Assess behavioral health professionals’: (1) perspectives on understanding and opinions about granular information sharing; (2) accuracy in assessing redacted medical information; (3) reactions to patient rationale for health data categorization, assignment of sensitivity, and sharing choices; and (4) recommendations on how to improve the process of granular health information sharing. METHODS Four two-hour focus groups and a pre- and post-survey were conducted at two integrated health facilities. During the focus groups, outcomes from a previous study on patients’ medical record sharing choices were shared. Thematic analysis and descriptive statistical analyses were conducted. RESULTS Twenty-eight professionals were initially unaware of or provided incorrect definitions of granular information sharing (56.0%). After having access to outcomes from a previous patient study, professionals increased their mixed perspectives (21.4% to 37.1%) on granular information sharing. A majority (81.3%) identified that key medical data had been redacted from the study case. Many (66.1%) stated they did not understand patient rationale for categorization or medical sharing preferences. Finally, participants recommended that a variety of educational approaches be incorporated to inform patients about granular information and health record sharing processes. CONCLUSIONS This study provides detailed insights from behavioral health professionals on patient-controlled granular information sharing. Health professionals accurately identified information gaps resulting from patient-directed data redaction, improved in their overall concept comprehension, underscored the fine line between patient safety and patient rights, and expressed a commitment to help patients appreciate the risks and benefits associated with granular information sharing. Outcomes will inform the development, deployment and evaluation of an electronic consent tool for granular health data sharing.
Research in Social & Administrative Pharmacy, Dec 1, 2011
In 2007, a federal Medicaid Transformation Grant was awarded to design, develop, and deploy a sta... more In 2007, a federal Medicaid Transformation Grant was awarded to design, develop, and deploy a statewide Health Information Exchange and Electronic Health Record in Arizona, United States. To explore the health information technology needs, knowledge, and expectations of Arizona&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s health care professionals, moderated focus groups were conducted. This article describes the results of the pharmacist focus groups. Focus group activities included a brief presentation, completion of a paper-based survey, and group discussion. The methods included solicitation by invitation, participant selection, meeting content, collaterals, focus group execution, recording, analysis, and discerning comparability among groups. Pharmacy focus group discussions centered on electronic prescribing, including the anticipated advantages: reducing handwriting interpretation errors, improving formulary compliance, improving communication with prescribers, increasing efficiency, and ensuring data accuracy. Disadvantages included: medication errors, inadequate training and knowledge of software applications, and inflated patient expectations. Pharmacists ranked e-prescribing as the highest priority feature of an electronic health system.
Health disparities among Hispanics are associated with poorer health status across multiple healt... more Health disparities among Hispanics are associated with poorer health status across multiple health conditions, greater use of high-acuity services, and lower use of care continuity and preventive services. A new integrated delivery organization (IDO) designed around culturally responsive care aims to reduce health disparities and improve health outcomes among the Hispanic community by deploying a multifeatured approach. The IDO combines the universal administration of a culturally sensitive health risk screening tool, the delivery of culturally appropriate medical, behavioral and spiritual health, and creative support of provider practices with training and informational resources, financial incentives, actionable data, technology, and cultural sensitivity training for providers and staff. The IDO further distinguishes its unique approach by partnering with a university informatics program to establish a local learning health care system destined to enrich the evidence base for culturally appropriate interventions that reduce health disparities. Longitudinal research is currently underway that focuses on the impact of culturally motivated interventions on resource utilization, retention, and quality.
International Journal of Medical Informatics, Jun 1, 2020
BackgroundConsent2Share (C2S) is an open source software created by the Office of the National Co... more BackgroundConsent2Share (C2S) is an open source software created by the Office of the National Coordinator Data Segmentation for Privacy initiative to support electronic health record (EHR) granular segmentation. To date, there are no published formal evaluations of Consent2Share.MethodStructured data (e.g. medications) codified using standard clinical terminologies (e.g. RxNorm) was extracted from the EHR of 36 patients with behavioral health conditions from study sites. EHRs were available through a health information exchange and two sites. The EHR data was already classified into data types (e.g. procedures and services). Both Consent2Share and health providers classified EHR data based on value sets (e.g. mental health) and sensitivity (e.g. not sensitive. Descriptive statistics and Chi-square analysis were used to compare differences between data categorizations.ResultsFrom the resulting 1,080 medical records items, 584 were distinct. Significant differences were found between sensitivity classifications by Consent2Share and providers (χ2 (2, N = 584) = 114.74, p = <0.0001). Sensitivity comparisons led to 56.0% of agreements, 31.2% disagreements, and 12.8% partial agreements. Most (97.8%) disagreements resulted from information classified as not sensitive by Consent2Share, but sensitive by provider (e.g. behavioral health prevention education service). In terms of data types, most disagreements (57.1%) focused on procedures and services information (e.g. ligation of fallopian tube). When considering value sets, most disagreements focused on genetic data (100.0%), followed by sexual and reproductive health (88.9%).ConclusionsThere is a need to further validate Consent2Share before broad use in health care settings. The outcomes from this pilot study will help guide improvements in segmentation logic of tools like Consent2Share and may set the stage for a new generation of personalized consent engines.
The advent of electronic medical records and health information exchanges has facilitated the pos... more The advent of electronic medical records and health information exchanges has facilitated the possibility of patients exercising increasingly granular control over sensitive health information. In principle, patients should be able to control which of their health information is made accessible to which of their healthcare providers. To meet this goal, the architects of any system of granular control of patients' health information face a variety of challenges. In addition to technical, ethical, and prudential considerations, the architects of any effective system must also ensure compliance with applicable legal requirements. The extent of a patient's permissible control depends upon whether governing law prohibits providers from disclosing health information to other providers without a patient's authorization, permits providers to disclose to other providers at the provider's discretion, or requires such disclosure. To inform efforts to design a viable system, this article analyzes U.S. federal and state (Arizona) law in regard to the sharing of the following types of sensitive health information: substance abuse, mental health, genetic, communicable diseases, and sexual and reproductive health.
Little is known about data sharing preferences for care and research of behavioral health patient... more Little is known about data sharing preferences for care and research of behavioral health patients. Eighty-six behavioral health patients (n = 37 Latinos; n = 32 with serious mental illness) completed questionnaires, in either English or Spanish, with items assessing their views on privacy and sensitivity of health record information. Most patients (82.5%) considered mental health information as sensitive. In general, there was a direct correspondence between perceived sensitivity of information and willingness to share with all or some providers. A main motivation for sharing data with providers was improving the patient's own care (77.8%). Most participants (96.5%) indicated they would be extremely to somewhat willing to share their data for research with their care facilities and universities. Follow-up patient interviews are being conducted to further elucidate these findings.
Objectives: Learn how substance use disorder (SUD) treatment organizations view and respond to ch... more Objectives: Learn how substance use disorder (SUD) treatment organizations view and respond to changes in confidentiality and disclosure law following adoption of CARES Act Sec. 3221 and prior to promulgation of revised implementing regulations. Methods: Online survey followed by informal interviews. Representatives of SUD organizations reported their degree of awareness of Sec. 3221 provisions and their organizations' views on amendments to disclosure practices; current and future changes of organizational policies; difficulties anticipated in implementing new rules; and preferences for resources. Results: Forty informant surveys on 30 organizations completed. Participants (62.5 percent) indicated being somewhat knowledgeable about Sec. 3221. Evenly divided positive and concerned views on Sec. 3221 reflect tension between preserving confidentiality of patient records and improving coordination of care. Most (76.7 percent) reported organizational discussions on Sec. 3221. Some (30 percent) identified changes to make in near future. Over a third expected few or no barriers to implementing changes to privacy and disclosure practices, while most (64.7 percent) expected hindrances including complexity and tensions in the law, staff education, cost, technological adjustments, and changes in the ways SUD organizations interact with external organizations and individuals. To overcome barriers noted, participants expressed desire (66.7 percent) for teaching tools such as webinars and templates to follow. Conclusions: SUD treatment organizations began thinking of and planning for proposed changes well before expected implementation of Sec. 3221. Their concerns reflected practicalities of implementation, determining content of law, and wondering about the extent to which it solves problems (improving coordination of care among various providers) or endangered other goals (protecting confidentiality of SUD patient records).
Prescription opioid abuse has become a serious national problem. To respond to the opioid epidemi... more Prescription opioid abuse has become a serious national problem. To respond to the opioid epidemic, states have implemented prescription drug monitoring programs (PDMPs) to monitor and reduce opioid abuse. We conducted a systematic literature review to better understand the PDMP impact on reducing opioid abuse, improving prescriber practices, and how EHR integration has impacted PDMP usability. Lessons learned can help guide federal and state-based efforts to better respond to the opioid crisis.
An integral element of value-based care is care team access to both physical and behavioral healt... more An integral element of value-based care is care team access to both physical and behavioral health data. Data release processes in both environments are governed by federal and state statutes. The requirements for obtaining consent are complex and often confusing. Little is known about the consent processes and practices in the behavioral health setting, specifically how patients and surrogates engage in the process and their interactions with electronic consent tools. This study analyzes the consent processes from the patient perspective at two community behavioral health clinics. Outcomes include description of the processes using electronic consent, workflows and consenter-provider interactions. Conclusions include need to streamline and standardize consent technologies and improve consenter engagement. This study supports the development of an electronic consent tool, My Data Choices (MDC), funded by the National Institute of Mental Health, that offers individuals with behavioral health conditions more control over their medical records.
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