Robert S. Rudin

Promoting Patient-Clinician Conversations to Reduce Cascades of Care

A cascade of care is a seemingly uncontrollable sequence of medical services that is driven by the desire to avoid even the smallest risk of a bad outcome. What drives cascades? And what interventions might mitigate them?

How Smartphone Apps Could Help Keep Health Records Accurate

Electronic health records have helped streamline record keeping but providers aren't always able to reliably pull together records for the same patient from different hospitals, clinics, and doctor's offices. The growing use of smartphones offers a promising opportunity to improve record matching.

The Little Exchange That Could...Transform the U.S. Health Care System

As Congress continues to think about whether and how to support the development of Health Information Exchanges, it should consider the commitment required to bring a mature statewide or national network of HIEs into practice. It should prioritize the evaluation of government-funded HIEs, so that research can help inform and foster return on investment for scarce taxpayer dollars.

How Electronic Health Records Can Lead to Care Coordination

Inadequate care coordination is a major problem in health care delivery, but information technology is emerging as an important tool for enhancing coordination and, ultimately, improving the delivery of care, writes Robert Rudin.

Unraveling the IT Productivity Paradox—Lessons for Health Care

Although health care organizations have favorable characteristics that can maximize IT's benefits, the reengineering of health care delivery is only beginning, write Spencer Jones, Paul Heaton, Robert Rudin, and Eric Schneider.

Journal Article

Effect of a Peer Comparison and Educational Intervention on Medical Test Conversation Quality: A Randomized Clinical Trial

Results of this initial trial suggest that future interventions to improve medical test conversations and reduce test overuse might focus on easing physician adoption barriers and leveraging patient-clinician relationships.

Journal Article

Addressing the Drivers of Medical Test Overuse and Cascades: User-Centered Design to Improve Patient-Doctor Communication

We designed a patient- and provider-facing intervention to improve medical test conversations.

Journal Article

Why APIs? Anticipated Value, Barriers, and Opportunities for Standards-Based Application Programming Interfaces in Healthcare: Perspectives of US Thought Leaders

To better understand the landscape of application programming interface (API) use cases, we interviewed U.S. thought leaders involved in developing and implementing standard-based APIs.

Journal Article

Toward an Asthma Patient-Reported Outcome Measure for Use in Digital Remote Monitoring

The study sought to develop and test a patient-reported outcome measure (PROM) for suitability in digital remote asthma symptom monitoring to identify uncontrolled asthma.

Journal Article

Assessment of Variation in Electronic Health Record Capabilities and Reported Clinical Quality Performance in Ambulatory Care Clinics, 2014–2017

Between 2014 and 2017, clinics with EHRs having greater capabilities had better quality measures than other clinics, but clinics that gained EHR capabilities during this time had smaller increases in quality that were not statistically significant.

Commentary

The Coronavirus Pandemic Highlights Why Family Caregivers Need to Be Integrated into the Health Care Team and Shows Us How to Make It Happen

The authors describe why, in light of COVID-19, it is more critical than ever to integrate family caregivers into patients' health care teams and highlight several solutions for accomplishing this goal.

Journal Article

Barriers to Using Clinical Decision Support in Ambulatory Care: Do Clinics in Health Systems Fare Better?

We quantify the use of clinical decision support (CDS) and the specific barriers reported by ambulatory clinics and examine whether CDS utilization and barriers differed based on clinics' affiliation with health systems.

Journal Article

User-centered Design of a Scalable, Electronic Health Record-Integrated Remote Symptom Monitoring Intervention for Patients with Asthma and Providers in Primary Care

The objective of this article is to determine user and electronic health records (EHR) integration requirements for a scalable remote symptom monitoring intervention for asthma patients and their providers.

Journal Article

Health Information Technology for Ambulatory Care in Health Systems

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.

Journal Article

Optimizing Health IT to Improve Health System Performance: A Work in Progress

We describe activities that health systems are pursuing to better leverage health IT to improve performance, in a qualitative thematic approach.

Journal Article

Digital Health Technologies: Opportunities and Challenges in Rheumatology

Digital health technology offers enormous potential to improve rheumatology care but this potential has so far been largely unrealized.

Journal Article

Trends in the Use of Computerized Physician Order Entry by Health-System Affiliated Ambulatory Clinics in the United States, 2014–2016

Small practice size or not being part of a multi-hospital system are associated with lower use of computerized physician order entry. between 2014 and 2016. Less than optimal use in these environments may be harming patient outcomes.

Journal Article

Level of Agreement on Health Information Technology Adoption and Use in Survey Data: A Mixed-Methods Analysis of Ambulatory Clinics in 1 US State

Analyses of HIT survey findings should take into consideration the validity of the data used to develop estimates of prevalence and use.

Journal Article

A Clinically Integrated Mhealth App and Practice Model for Collecting Patient-Reported Outcomes Between Visits for Asthma Patients: Implementation and Feasibility

Implementation of a clinically integrated mHealth app and practice model can achieve high patient retention and adherence to guideline-recommended asthma symptom monitoring, while minimally burdening clinicians.

Journal Article

Common Laboratory Results Frequently Misunderstood by a Sample of Mechanical Turk Users

Use of Mechanical Turk to determine how well patients understand common laboratory test results.

Journal Article

Trends in the Use of Clinical Decision Support by Health System–Affiliated Ambulatory Clinics in the United States, 2014–2016

Use of clinical decision support (CDS) in ambulatory clinics is increasing but remains modest. The CDS function with the greatest use is basic medication screening, which increased from 52% of clinics nationally in 2014 to 61% in 2016.

Journal Article

Advancing a Nationwide Patient Matching Strategy

A nationwide strategy for improved patient matching would enable hospitals, technology developers, and the broader health care ecosystem to better link patients to their records to improve care coordination and reduce costs.

Report

Defining and Evaluating Patient-Empowered Approaches to Improving Record Matching

This study reviews possible patient-empowered approaches to medical record matching and recommends for further development and pilot testing a three-stage solution that uses mobile phones and app-based functionality.

Journal Article

Core Components for a Clinically Integrated mHealth App for Asthma Symptom Monitoring

Smartphone-based health apps - using patient reported outcomes - can help asthma patients monitor symptoms between doctor visits.

Journal Article

Leveraging Telehealth to Bring Volunteer Physicians Into Underserved Communities

Organizations that use telehealth to address safety net clinic needs by recruiting retired or semi-retired doctor volunteers can help improve access to physicians in underserved areas while enriching the professional lives of clinicians.

Journal Article

The Clinical Pharmacy Specialist: Part of the Solution

Efforts to create high-functioning primary care teams should take advantage of the knowledge and skills of clinical pharmacy specialists

Report

Lessons Learned from the MAVEN Project Pilot: Using Physician Volunteers to Increase Access to Care via Telehealth

The Medical Alumni Volunteer Expert Network (MAVEN) Project created a corps of experienced volunteer physicians to provide telehealth consults to providers in safety-net clinics. This evaluation of the program can inform quality-improvement efforts.

Report

Identifying and Coordinating Care for Complex Patients: Findings from the Leading Edge of Analytics and Health Information Technology

Analytics and HIT are currently being used in innovative ways to coordinate care for complex patients, but evidence of their effectiveness is lacking and important foundational work is still needed.

Journal Article

Accelerating Innovation in Health IT

Efforts to accelerate the innovation of health information technology (IT) products need long-term collaboration between developers and users, transformation of care processes in tandem with IT tools, and development of new funding models.

Report

National Patient-Centered Clinical Research Network (PCORnet) Phase I: Final Evaluation Report

PCORnet, the National Patient-Centered Clinical Research Network, seeks to conduct clinical trials and observational research quickly and at low cost. This report contains the results of a formative evaluation of PCORnet's implementation phase.

Report

Resources and Capabilities of the Department of Veterans Affairs to Provide Timely and Accessible Care to Veterans

The Department of Veterans Affairs health care system, with broad resources and capabilities, provides timely and high-quality care to most, but not all, patients. Meeting veterans' needs over the next five years will require additional capacity.

Commentary

Harnessing Private-Sector Innovation to Improve Health Insurance Exchanges

In this paper, analysts consider privately facilitated health insurance exchanges to address some challenges and deepen the impact of health care reform. In this model, the private sector assumes responsibility for peripheral exchange functions.

Report

Improving Hospital Efficiency Through Data-Driven Management: A Case Study of Health First, Florida

This report presents a case study of how one health system addressed resource challenges by using Lean thinking (focusing on process improvement, affecting both structural components and operational processes) enabled by information technology.

Journal Article

Paying for Telemedicine

Telemedicine offers the potential for better care, lower costs, and increased convenience. Expanding existing fee-for-service payment models to include telemedicine may lead to its overuse.

Journal Article

Usage and Effect of Health Information Exchange: A Systematic Review

Health information exchange (HIE) is increasing in the United States, and it is incentivized by government policies. The authors systematically review and evaluate evidence of the use and effect of HIE on clinical care.

Report

Patient Safety in the Commonwealth of Massachusetts: Current Status and Opportunities for Improvement

In a RAND study about the landscape of patient safety in Massachusetts, researchers interviewed expert observers (patients, health care leaders, and others) about progress to date and future opportunities to produce safer patient care.

Research Brief

Continuity of Care and the Cost of Treating Chronic Disease

Modest improvements in continuity of care correlate with sizable reductions in service use, complications, and costs for Medicare patients with congestive heart failure, chronic obstructive pulmonary disease, and type 2 diabetes mellitus.

Report

Promoting Patient Safety Through Effective Health Information Technology Risk Management

The research team worked with 11 hospitals and ambulatory practices to evaluate a process improvement strategy and tools developed to help health care organizations diagnose, monitor, and mitigate health information technology-related safety risks.

Journal Article

Continuity and the Costs of Care for Chronic Disease

Modest differences in care continuity for Medicare beneficiaries are associated with sizable differences in costs, use, and complications.

Journal Article

The Value of Health Information Technology: Filling the Knowledge Gap

Despite rapid growth in the rate of adoption of health information technology, and in the volume of evaluation studies, the existing knowledge base for the value of health IT is not advancing at a similar rate.

Journal Article

Health Information Technology: An Updated Systematic Review with a Focus on Meaningful Use

Incentives offered by the U.S. government have spurred marked increases in use of health information technology (IT).

Journal Article

Let the Left Hand Know What the Right Is Doing: A Vision for Care Coordination and Electronic Health Records

Using a simple framework, we describe a vision of information technology capabilities that could substantially improve four care coordination activities: identifying collaborators, contacting collaborators, collaborating, and monitoring.

Journal Article

Health Information Technology Adoption Measurement Framework: Overall Guidance for HCIA Awardees

The Centers for Medicare & Medicaid Services (CMS)/Center for Medicare and Medicaid Innovation (CMMI) requested that RAND assist their HCIA Awardees in developing health information technology (HIT) adoption measures.

Journal Article

Measuring Care Continuity: A Comparison of Claims-Based Methods

Assessing care continuity is important in evaluating the impact of health care reform and changes to health care delivery.

Journal Article

Unraveling the IT Productivity Paradox -- Lessons for Health Care

Productivity gains that can be achieved by widely adopting health information technology are likely to come from the reengineering of health care and may require new measurement tools to accurately gauge their impact.

Journal Article

Simulation Suggests That Medical Group Mergers Won't Undermine the Potential Utility of Health Information Exchanges

Federal and state agencies are investing substantial resources in the creation of community health information exchanges, which are consortia that enable independent health care organizations to exchange clinical data.

Journal Article

Care Transitions as Opportunities for Clinicians to Use Data Exchange Service: How Often Do They Occur?

The electronic exchange of health information among healthcare providers has the potential to produce enormous clinical benefits and financial savings, although realizing that potential will be challenging.

Journal Article

Why Clinicians Use or Don't Use Health Information Exchange

The ED is one important place where an HIE may have an impact on patient care because many emergency patients are unfamiliar to ED facilities and important clinical information is often missing.

Journal Article

What Affects Clinicians' Usage of Health Information Exchange?

Clinicians, EHR and HIE product vendors and trainers should work toward integrating HIE into clinical workflows.

Journal Article

The Litmus Test for Health Information Exchange Success: Will Small Practices Participate?

The movement to establish widespread health information exchange (HIE) in the United States has thus far shown mixed results.

Journal Article

Assessing the Value of Laboratory Electronic Data Interchange in the Department of Veterans Affairs

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.

Journal Article

Liability Coverage for Regional Health Information Organizations: Lessons from the AHRQ-funded State Regional Demonstration Projects in Health Information Technology and Other Community Efforts

This report will share findings from the field on how eight regional health information organizations (RHIOs) have navigated various issues and challenges associated with liability insurance for health information exchange (HIE).

Journal Article

Understanding the Decisions and Values of Stakeholders in Health Information Exchanges: Experiences from Massachusetts

The authors studied how health information exchange systems are established by examining the decisions of key stakeholders participating in a health information exchange pilot project in 3 Massachusetts communities.