One would think that the enactment of the HIPAA and associated mandates on data security and priv... more One would think that the enactment of the HIPAA and associated mandates on data security and privacy has brought a major shift in the information security management practices across the US healthcare sector. Unfortunately, recent industry reports indicate substantially low level of regulatory compliance, thus raising security concerns to US health IT infrastructure. This research develops a regulatory compliance model by drawing insights from institutional theory literature to identify the key drivers influencing compliance, both institutional and market forces - e.g. mix of state and federal privacy regulations, pressure from compliance leaders in the region, and the consumer demand for privacy among others. The primary contribution of this research lies in the novel application of institutional theory to explain the variability in regulatory compliance prevalent in the US healthcare sector.
Despite many years since the enactment of the Health Insurance Portability and Accountability Act... more Despite many years since the enactment of the Health Insurance Portability and Accountability Act (HIPAA), healthcare providers have been slow to fully comply with the regulatory requirements, especially the privacy and security rules concerning protection of electronic personal health information. Neo-institutional theory, a dominant analytical perspective of organizational behavior, suggests that variability in local markets—both in terms of competition and institutional environment— influence compliance behavior. Drawing from literature on neo-institutional theory, we empirically examine important factors influencing HIPAA compliance in a specific provider segment, home health care. Our analysis of national-level data on home health agencies provides initial evidence of mimetic influence for compliance arising from other home health agencies that have achieved full compliance. We also find normative influence for privacy compliance arising from affiliation to local acute care hos...
Objectives To determine whether health information technology (IT) systems are associated with be... more Objectives To determine whether health information technology (IT) systems are associated with better patient safety in acute care settings. Study Design In a cross-sectional retrospective study, data on hospital patient safety performance for October 2008 to June 2010 were combined with 2007 information technology systems data. The sample included 3002 US non-federal acute care hospitals. Electronic health record (EHR) system was coded as a composite dichotomous variable based on the presence of 10 major clinical and administrative applications that (if in use) could potentially meet stage 1 "meaningful use" objectives. The surgical IT system was measured as a dichotomous variable if a hospital used at least 1 of the perioperative, preoperative, or postoperative information systems. Hospital patient safety performance was measured by risk-standardized estimated rates per 1000 admissions. Statistical analyses were conducted using an estimated dependent variable methodology...
Social networking sites such as Facebook provide a new way to seek and receive social support, a ... more Social networking sites such as Facebook provide a new way to seek and receive social support, a factor widely recognized as important for one's health. However, few studies have used actual conversations from social networking sites to study social support for health related matters. We studied 3,899 Facebook users, among a sample of 33,326 monitored adults, who initiated a conversation that referred to surgery on their Facebook Wall during a six-month period. We explored predictors of social support as measured by number of response posts from "friends." Among our sample, we identified 8,343 Facebook conversation threads with the term "surgery" in the initial post with, on average, 5.7 response posts (SD 6.2). We used a variant of latent semantic analysis to explore the relationship between specific words in the posts that allowed us to develop three thematic categories of words related to family, immediacy of the surgery, and prayer. We used generalized li...
Public health reports (Washington, D.C. : 1974), 1998
Since 1985, community outreach efforts to combat acquired immunodeficiency syndrome (AIDS) among ... more Since 1985, community outreach efforts to combat acquired immunodeficiency syndrome (AIDS) among injecting drug users (IDUs) in the United States have overwhelmingly depended on a provider-client model that relies on staffs of professional outreach workers. We report on a comparison of this traditional outreach model with an innovative social network model, termed "a peer-driven intervention" (PDI). The latter provides IDUs with guidance and structured incentives that permit them to play a much more active role in the outreach process, thereby harnessing peer pressure on behalf of human immunodeficiency virus (HIV) prevention efforts. We compare the performance of a traditional outreach intervention (TOI) and a PDI that were implemented in medium-sized towns in eastern and central Connecticut. Comparisons are based on the number and representativeness of IDUs recruited at each site, the effectiveness of HIV prevention education, compliance rates with AIDS risk reduction re...
Preventable hospitalizations are common among older adults for reasons that are not well understo... more Preventable hospitalizations are common among older adults for reasons that are not well understood. To determine whether Medicare patients with ambulatory visit patterns indicating higher continuity of care have a lower risk of preventable hospitalization. Retrospective cohort study. Ambulatory visits and hospital admissions. Continuously enrolled fee-for-service Medicare beneficiaries older than 65 years with at least 4 ambulatory visits in 2008. The concentration of patient visits with physicians measured for up to 24 months using the continuity of care score and usual provider continuity score on a scale from 0 to 1. Index occurrence of any 1 of 13 preventable hospital admissions, censoring patients at the end of their 24-month follow-up period if no preventable hospital admissions occurred, or if they died. Of the 3,276,635 eligible patients, 12.6% had a preventable hospitalization during their 2-year observation period, most commonly for congestive heart failure (25%), bacteri...
ABSTRACT Electronic health records (EHRs) are expected to bring a variety of health benefits, inc... more ABSTRACT Electronic health records (EHRs) are expected to bring a variety of health benefits, including reducing disparities in health-care access, but only if they are valued by all patient populations. We used the 2007 Health Information and National Trends Survey to characterize which health-care users report that electronic access to their health records is important for themselves and their providers. Respondents from populations that generally experience health-care disparities (Blacks, Latina/os, and patients with psychological distress) were among the most likely to report that the EHR was very important for themselves. Women were less likely than men to deem the EHR very important for their providers. Findings remained consistent after controlling for respondents’ socioeconomic status, health status, and health care. By identifying the characteristics of current health-care users who see electronic access to records as important for themselves and providers, we can better understand potential barriers as well as motivators to adoption that could contribute to equitable usage across groups or a digital divide.
Journal of the American Medical Informatics Association, 2014
Electronic health record (EHR) systems are linked to improvements in quality of care, yet also pr... more Electronic health record (EHR) systems are linked to improvements in quality of care, yet also privacy and security risks. Results from research studies are mixed about whether patients withhold personal information from their providers to protect against the perceived EHR privacy and security risks. This study seeks to reconcile the mixed findings by focusing on whether accounting for patients' global ratings of care reveals a relationship between EHR provider-use and patient non-disclosure. A nationally representative sample from the 2012 Health Information National Trends Survey was analyzed using bivariate and multivariable logit regressions to examine whether global ratings of care suppress the relationship between EHR provider-use and patient non-disclosure. 13% of respondents reported having ever withheld information from a provider because of privacy/security concerns. Bivariate analysis showed that withholding information was unrelated to whether respondents' providers used an EHR. Multivariable analysis showed that accounting for respondents' global ratings of care revealed a positive relationship between having a provider who uses an EHR and withholding information. After accounting for global ratings of care, findings suggest that patients may non-disclose to providers to protect against the perceived EHR privacy and security risks. Despite evidence that EHRs inhibit patient disclosure, their advantages for promoting quality of care may outweigh the drawbacks. Clinicians should leverage the EHR's value in quality of care and discuss patients' privacy concerns during clinic visits, while policy makers should consider how to address the real and perceived privacy and security risks of EHRs.
Proceedings of the 2012 ACM workshop on Privacy in the electronic society - WPES '12, 2012
ABSTRACT If people are not in control of the collection and sharing of their personal health info... more ABSTRACT If people are not in control of the collection and sharing of their personal health information collected using mobile health (mHealth) devices and applications, privacy concerns could limit their willingness to use and reduce potential benefits provided via mHealth. We investigated users' willingness to share their personal information, collected using mHealth sensing devices, with their family, friends, third parties, and the public. Previous work employed hypothetical scenarios, surveys and interviews to understand ...
Trust plays an important role in both group cooperation and economic exchange. As new technologie... more Trust plays an important role in both group cooperation and economic exchange. As new technologies emerge for communication and exchange, established mechanisms of trust are disrupted or distorted, which can lead to the breakdown of cooperation or to increasing fraud in exchange. This paper examines whether and how personal privacy information about members of distributed work groups influences individuals' cooperation and privacy behavior in the group. Specifically, we examine whether people use others' privacy ...
2011 IEEE Ninth International Conference on Dependable, Autonomic and Secure Computing, 2011
This project examines the role of ability and reliability in assessments of trustworthiness. Spec... more This project examines the role of ability and reliability in assessments of trustworthiness. Specifically, we use data from the lending website Prosper.com, an online marketplace for "peer-to-peer" lending, where potential borrowers post loan requests, and other individuals bid to loan all or part of the dollar amount requested. We examine how signals of financial ability to repay interact with signals
ABSTRACT Whereas many infectious diseases are spread through casual contact and contagion, HIV tr... more ABSTRACT Whereas many infectious diseases are spread through casual contact and contagion, HIV transmission results from risk behaviors that involve close and often intimate contact. As a result, the transmission of HIV is structured by the social relationships within which these contacts are embedded. Hence, social network analysis is especially suitable for understanding the AIDS epidemic. This paper reports the results of a field experiment that compares a network-based HIV prevention intervention, termed a “Peer-Driven Intervention” (PDI), with the standard form of street-based outreach intervention. The results suggest that the network intervention outperforms the standard approach with respect to number of people accessed, reductions in self-reported levels of HIV risk behavior and cost. Finally, the analysis focuses on the network structure of drug injectors and discusses the implications of these structures for understanding both the spread of HIV through social networks and the design of HIV-prevention interventions. The results show that certain network features, including geographically extensive networks and an abundance of ties across ethnic boundaries, genders, ages and drug preferences, can further the spread of HIV. Ironically, these are also the network features that increase the effectiveness of network-based HIV-prevention interventions. Thus, we show that network interventions work best precisely when they are most needed, that is, when network structures facilitate the spread of HIV.
One would think that the enactment of the HIPAA and associated mandates on data security and priv... more One would think that the enactment of the HIPAA and associated mandates on data security and privacy has brought a major shift in the information security management practices across the US healthcare sector. Unfortunately, recent industry reports indicate substantially low level of regulatory compliance, thus raising security concerns to US health IT infrastructure. This research develops a regulatory compliance model by drawing insights from institutional theory literature to identify the key drivers influencing compliance, both institutional and market forces - e.g. mix of state and federal privacy regulations, pressure from compliance leaders in the region, and the consumer demand for privacy among others. The primary contribution of this research lies in the novel application of institutional theory to explain the variability in regulatory compliance prevalent in the US healthcare sector.
Despite many years since the enactment of the Health Insurance Portability and Accountability Act... more Despite many years since the enactment of the Health Insurance Portability and Accountability Act (HIPAA), healthcare providers have been slow to fully comply with the regulatory requirements, especially the privacy and security rules concerning protection of electronic personal health information. Neo-institutional theory, a dominant analytical perspective of organizational behavior, suggests that variability in local markets—both in terms of competition and institutional environment— influence compliance behavior. Drawing from literature on neo-institutional theory, we empirically examine important factors influencing HIPAA compliance in a specific provider segment, home health care. Our analysis of national-level data on home health agencies provides initial evidence of mimetic influence for compliance arising from other home health agencies that have achieved full compliance. We also find normative influence for privacy compliance arising from affiliation to local acute care hos...
Objectives To determine whether health information technology (IT) systems are associated with be... more Objectives To determine whether health information technology (IT) systems are associated with better patient safety in acute care settings. Study Design In a cross-sectional retrospective study, data on hospital patient safety performance for October 2008 to June 2010 were combined with 2007 information technology systems data. The sample included 3002 US non-federal acute care hospitals. Electronic health record (EHR) system was coded as a composite dichotomous variable based on the presence of 10 major clinical and administrative applications that (if in use) could potentially meet stage 1 "meaningful use" objectives. The surgical IT system was measured as a dichotomous variable if a hospital used at least 1 of the perioperative, preoperative, or postoperative information systems. Hospital patient safety performance was measured by risk-standardized estimated rates per 1000 admissions. Statistical analyses were conducted using an estimated dependent variable methodology...
Social networking sites such as Facebook provide a new way to seek and receive social support, a ... more Social networking sites such as Facebook provide a new way to seek and receive social support, a factor widely recognized as important for one's health. However, few studies have used actual conversations from social networking sites to study social support for health related matters. We studied 3,899 Facebook users, among a sample of 33,326 monitored adults, who initiated a conversation that referred to surgery on their Facebook Wall during a six-month period. We explored predictors of social support as measured by number of response posts from "friends." Among our sample, we identified 8,343 Facebook conversation threads with the term "surgery" in the initial post with, on average, 5.7 response posts (SD 6.2). We used a variant of latent semantic analysis to explore the relationship between specific words in the posts that allowed us to develop three thematic categories of words related to family, immediacy of the surgery, and prayer. We used generalized li...
Public health reports (Washington, D.C. : 1974), 1998
Since 1985, community outreach efforts to combat acquired immunodeficiency syndrome (AIDS) among ... more Since 1985, community outreach efforts to combat acquired immunodeficiency syndrome (AIDS) among injecting drug users (IDUs) in the United States have overwhelmingly depended on a provider-client model that relies on staffs of professional outreach workers. We report on a comparison of this traditional outreach model with an innovative social network model, termed "a peer-driven intervention" (PDI). The latter provides IDUs with guidance and structured incentives that permit them to play a much more active role in the outreach process, thereby harnessing peer pressure on behalf of human immunodeficiency virus (HIV) prevention efforts. We compare the performance of a traditional outreach intervention (TOI) and a PDI that were implemented in medium-sized towns in eastern and central Connecticut. Comparisons are based on the number and representativeness of IDUs recruited at each site, the effectiveness of HIV prevention education, compliance rates with AIDS risk reduction re...
Preventable hospitalizations are common among older adults for reasons that are not well understo... more Preventable hospitalizations are common among older adults for reasons that are not well understood. To determine whether Medicare patients with ambulatory visit patterns indicating higher continuity of care have a lower risk of preventable hospitalization. Retrospective cohort study. Ambulatory visits and hospital admissions. Continuously enrolled fee-for-service Medicare beneficiaries older than 65 years with at least 4 ambulatory visits in 2008. The concentration of patient visits with physicians measured for up to 24 months using the continuity of care score and usual provider continuity score on a scale from 0 to 1. Index occurrence of any 1 of 13 preventable hospital admissions, censoring patients at the end of their 24-month follow-up period if no preventable hospital admissions occurred, or if they died. Of the 3,276,635 eligible patients, 12.6% had a preventable hospitalization during their 2-year observation period, most commonly for congestive heart failure (25%), bacteri...
ABSTRACT Electronic health records (EHRs) are expected to bring a variety of health benefits, inc... more ABSTRACT Electronic health records (EHRs) are expected to bring a variety of health benefits, including reducing disparities in health-care access, but only if they are valued by all patient populations. We used the 2007 Health Information and National Trends Survey to characterize which health-care users report that electronic access to their health records is important for themselves and their providers. Respondents from populations that generally experience health-care disparities (Blacks, Latina/os, and patients with psychological distress) were among the most likely to report that the EHR was very important for themselves. Women were less likely than men to deem the EHR very important for their providers. Findings remained consistent after controlling for respondents’ socioeconomic status, health status, and health care. By identifying the characteristics of current health-care users who see electronic access to records as important for themselves and providers, we can better understand potential barriers as well as motivators to adoption that could contribute to equitable usage across groups or a digital divide.
Journal of the American Medical Informatics Association, 2014
Electronic health record (EHR) systems are linked to improvements in quality of care, yet also pr... more Electronic health record (EHR) systems are linked to improvements in quality of care, yet also privacy and security risks. Results from research studies are mixed about whether patients withhold personal information from their providers to protect against the perceived EHR privacy and security risks. This study seeks to reconcile the mixed findings by focusing on whether accounting for patients' global ratings of care reveals a relationship between EHR provider-use and patient non-disclosure. A nationally representative sample from the 2012 Health Information National Trends Survey was analyzed using bivariate and multivariable logit regressions to examine whether global ratings of care suppress the relationship between EHR provider-use and patient non-disclosure. 13% of respondents reported having ever withheld information from a provider because of privacy/security concerns. Bivariate analysis showed that withholding information was unrelated to whether respondents' providers used an EHR. Multivariable analysis showed that accounting for respondents' global ratings of care revealed a positive relationship between having a provider who uses an EHR and withholding information. After accounting for global ratings of care, findings suggest that patients may non-disclose to providers to protect against the perceived EHR privacy and security risks. Despite evidence that EHRs inhibit patient disclosure, their advantages for promoting quality of care may outweigh the drawbacks. Clinicians should leverage the EHR's value in quality of care and discuss patients' privacy concerns during clinic visits, while policy makers should consider how to address the real and perceived privacy and security risks of EHRs.
Proceedings of the 2012 ACM workshop on Privacy in the electronic society - WPES '12, 2012
ABSTRACT If people are not in control of the collection and sharing of their personal health info... more ABSTRACT If people are not in control of the collection and sharing of their personal health information collected using mobile health (mHealth) devices and applications, privacy concerns could limit their willingness to use and reduce potential benefits provided via mHealth. We investigated users' willingness to share their personal information, collected using mHealth sensing devices, with their family, friends, third parties, and the public. Previous work employed hypothetical scenarios, surveys and interviews to understand ...
Trust plays an important role in both group cooperation and economic exchange. As new technologie... more Trust plays an important role in both group cooperation and economic exchange. As new technologies emerge for communication and exchange, established mechanisms of trust are disrupted or distorted, which can lead to the breakdown of cooperation or to increasing fraud in exchange. This paper examines whether and how personal privacy information about members of distributed work groups influences individuals' cooperation and privacy behavior in the group. Specifically, we examine whether people use others' privacy ...
2011 IEEE Ninth International Conference on Dependable, Autonomic and Secure Computing, 2011
This project examines the role of ability and reliability in assessments of trustworthiness. Spec... more This project examines the role of ability and reliability in assessments of trustworthiness. Specifically, we use data from the lending website Prosper.com, an online marketplace for "peer-to-peer" lending, where potential borrowers post loan requests, and other individuals bid to loan all or part of the dollar amount requested. We examine how signals of financial ability to repay interact with signals
ABSTRACT Whereas many infectious diseases are spread through casual contact and contagion, HIV tr... more ABSTRACT Whereas many infectious diseases are spread through casual contact and contagion, HIV transmission results from risk behaviors that involve close and often intimate contact. As a result, the transmission of HIV is structured by the social relationships within which these contacts are embedded. Hence, social network analysis is especially suitable for understanding the AIDS epidemic. This paper reports the results of a field experiment that compares a network-based HIV prevention intervention, termed a “Peer-Driven Intervention” (PDI), with the standard form of street-based outreach intervention. The results suggest that the network intervention outperforms the standard approach with respect to number of people accessed, reductions in self-reported levels of HIV risk behavior and cost. Finally, the analysis focuses on the network structure of drug injectors and discusses the implications of these structures for understanding both the spread of HIV through social networks and the design of HIV-prevention interventions. The results show that certain network features, including geographically extensive networks and an abundance of ties across ethnic boundaries, genders, ages and drug preferences, can further the spread of HIV. Ironically, these are also the network features that increase the effectiveness of network-based HIV-prevention interventions. Thus, we show that network interventions work best precisely when they are most needed, that is, when network structures facilitate the spread of HIV.
Uploads
Papers by Denise Anthony