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Aims As a first step in developing a decision aid to support shared decision-making (SDM) for patients with atrial fibrillation (AF) to evaluate treatment options for rhythm and symptom control, we aimed to measure decision quality and describe decision-making processes among patients and clinicians involved in decision-making around catheter ablation for AF. Methods and results We conducted a cross-sectional, mixed-methods study guided by an SDM model outlining decision antecedents, processes, and outcomes. Patients and clinicians completed semi-structured interviews about decision-making around ablation, feelings of decision conflict and regret, and preferences for the content, delivery, and format of a hypothetical decision aid for ablation. Patients also completed surveys about AF symptoms and aspects of decision quality. Fifteen patients (mean age 71.1 ± 8.6 years; 27% female) and five clinicians were recruited. For most patients, decisional conflict and regret were low, but they also reported low levels of information and agency in the decision-making process. Most clinicians report routinely providing patients with information and encouraging engagement during consultations. Patients reported preferences for an interactive, web-based decision aid that clearly presents evidence regarding outcomes using data, visualizations, videos, and personalized risk assessments, and is available in multiple languages. Conclusion Disconnects between clinician efforts to provide information and bolster agency and patient experiences of decision-making suggest decision aids may be needed to improve decision quality in practice. Reported experiences with current decision-making practices and preferences for decision aid content, format, and delivery can support the user-centred design and development of a decision aid. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives In 2004, New York passed the Health Care Efficiency and Affordability Law for New Yorkers ( HEAL NY) Capital Grants Program, which was the largest state-based investment in health information technology adoption in the United States. We sought to evaluate the effects of this programme on electronic health records (EHR) usage. Methods We undertook a case-control study of health care providers who had signed up with a regional extension centre, some of whom had also received HEAL funding through programmes intended to support EHR adoption. The outcome of interest was achievement of Medicare or Medicaid Meaningful Use and the primary exposure was any link to HEAL NY funding. The association between Meaningful Use status and independent variables was measured using logistic regression models. Results Meaningful Users were more likely to have had a history of HEAL NY funding ( OR = 1.83; 95% CI = 1.59, 2.09). Also, achievement of Meaningful Use was associated with having an EHR before 2011 ( OR = 1.64; 95% CI = 146, 1.83). Among those with EHRs prior to 2011, the odds of achieving Meaningful Use were statistically higher if coupled with HEAL NY funding ( OR = 3.12; 95% CI = 2.50, 3.90). Conclusion Achieving Meaningful Use was associated with a history of HEAL NY funding. However, it was the combination of HEAL NY funding and historic usage of EHRs that was associated with the largest increase in the odds that the provider was a Meaningful User. These findings indicate that state-based incentive programmes can support the effective usage of health information technologies. [ABSTRACT FROM AUTHOR]

Background: Public support will be critical to the success and long-term sustainability of electronic health information exchange (HIE) initiatives currently promoted by federal policy. Purpose: The goal of this study was to assess consumer perceptions of HIE in a state (New York) with a 6-year history of successful HIE organizations. Methods: The Empire State Poll is a random-digit-dial telephone survey of adult New York State residents conducted annually by the Survey Research Institute at Cornell University. In 2011, it contained 77 items. Results: The survey was conducted and data were analyzed in 2011. Eight hundred respondents participated (71% response rate). Large majorities supported HIE among healthcare providers (69%); thought it would improve quality of care (68%); and supported “break the glass” access to HIE data without need for consent in emergencies (90%). Support was lower among people who rated large corporations as less trustworthy. Privacy and security concerns were expressed by 68%. Respondents were supportive whether the architecture involved a physician sending data to another physician, a physician sending data to a patient who could send it to other physicians, or a physician accessing data from other institutions. Conclusions: In New York, public support for HIE is strong. Policy and outreach pertaining to this type of exchange may be most effective if it clarifies the roles and responsibilities of large businesses involved in different aspects of the exchange, and privacy and security controls. Differing architectures received similar levels of support. [Copyright &y& Elsevier]

Background: Electronic patient portals give patients access to information from their electronic health record and the ability to message their providers. These tools are becoming more widely used and are expected to promote patient engagement with health care.Objective: To quantify portal usage and explore potential differences in adoption and use according to patients' socioeconomic and clinical characteristics in a network of federally qualified health centers serving New York City and neighboring counties.Design: Retrospective analysis of data from portal and electronic health records.Participants: 74,368 adult patients seen between April 2008 and April 2010.Main Measures: Odds of receiving an access code to the portal, activating the account, and using the portal more than onceKey Results: Over the 2 years of the study, 16% of patients (n = 11,903) received an access code. Of these, 60% (n = 7138) activated the account, and 49% (n = 5791) used the account two or more times. Patients with chronic conditions were more likely to receive an access code and to become repeat users. In addition, the odds of receiving an access code were significantly higher for whites, women, younger patients, English speakers, and the insured. The odds of repeat portal use, among those with activated accounts, increased with white race, English language, and private insurance or Medicaid compared to no insurance. Racial disparities were small but persisted in models that controlled for language, insurance, and health status.Conclusions: We found good early rates of adoption and use of an electronic patient portal during the first 2 years of its deployment among a predominantly low-income population, especially among patients with chronic diseases. Disparities in access to and usage of the portal were evident but were smaller than those reported recently in other populations. Continued efforts will be needed to ensure that portals are usable for and used by disadvantaged groups so that all patients benefit equally from these technologies. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine patient and provider perspectives on privacy and security considerations in telemedicine during the COVID-19 pandemic. STUDY DESIGN: Qualitative study with patients and providers from primary care practices in 3 National Patient- Centered Clinical Research Network sites in New York, New York; North Carolina; and Florida. METHODS: Semistructured interviews were conducted, audio recorded, transcribed verbatim, and coded using an inductive process. Data related to privacy and information security were analyzed. RESULTS: Sixty-five patients and 21 providers participated. Patients and providers faced technology-related security concerns as well as difficulties ensuring privacy in the transformed shared space of telemedicine. Patients expressed increased comfort doing telemedicine from home but often did not like their providers to offer virtual visits from outside an office setting. Providers initially struggled to find secure and Health Insurance Portability and Accountability Act--compliant platforms and devices to host the software. Whereas some patients preferred familiar platforms such as FaceTime, others recognized potential security concerns. Audio-only encounters sometimes raised patient concerns that they would not be able to confirm the identity of the provider. CONCLUSIONS: Telemedicine led to novel concerns about privacy because patients and providers were often at home or in public spaces, and they shared concerns about software and hardware security. In addition to technological safeguards, our study emphasizes the critical role of physical infrastructure in ensuring privacy and security. As telemedicine continues to evolve, it is important to address and mitigate concerns around privacy and security to ensure high-quality and safe delivery of care to patients in remote settings. [ABSTRACT FROM AUTHOR]