National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
51 to 75 of 1425 Research Studies DisplayedHassmiller Lich K, O'Leary MC, Nambiar S
Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis.
Researchers used microsimulation to estimate the health and financial effects of insurance expansion and reduction scenarios in North Carolina (NC) for colorectal cancer screening (CRC). The full lifetime of a simulated population of residents age-eligible for CRC screening (aged 50-75) during a 5-year period were simulated. Findings indicate that the estimated cost savings--balancing increased CRC screening/testing costs against decreased cancer treatment costs--were approximately $30 M and $970 M for Medicaid expansion and Medicare-for-all scenarios, respectively, compared to status quo. The researchers concluded that insurance expansion will likely improve CRC screening both overall and in underserved populations while saving money, with the largest savings realized by Medicare.
AHRQ-funded; HS022981.
Citation: Hassmiller Lich K, O'Leary MC, Nambiar S .
Estimating the impact of insurance expansion on colorectal cancer and related costs in North Carolina: a population-level simulation analysis.
Prev Med 2019 Dec;129s:105847. doi: 10.1016/j.ypmed.2019.105847..
Keywords: Health Insurance, Cancer: Colorectal Cancer, Cancer, Healthcare Costs, Screening, Prevention, Medicaid, Medicare, Policy, Access to Care
Tan M, Lipman S, Lee H
Evaluation of electronic medical records on nurses' time allocation during cesarean delivery.
The impact of the electronic medical record (EMR) on nursing workload is not well understood. The objective of this descriptive study was to measure the actual and perceived time that nurses spend on the EMR in the operating room during cesarean births. The investigators found that on average, nurses spent 40% of their intraoperative time on the EMR during cesarean births, and this time burden was distributed across the perioperative period.
AHRQ-funded; HS023506.
Citation: Tan M, Lipman S, Lee H .
Evaluation of electronic medical records on nurses' time allocation during cesarean delivery.
J Patient Saf 2019 Dec;15(4):e82-e85. doi: 10.1097/pts.0000000000000467..
Keywords: Electronic Health Records (EHRs), Labor and Delivery, Provider: Nurse, Health Information Technology (HIT), Provider, Pregnancy
Fuzesi S, Becetti K, Klassen AF
Expectations of breast-conserving therapy: a qualitative study.
The goal of this study was to describe expectations of breast-conserving therapy (BCT) among patients with early breast cancer and aimed to inform preoperative patient education and improve the patient experience through knowledge. The researchers identified themes related to patient expectations of BCT and found that patients had a clear knowledge gap regarding BCT. This data may be used to enhance preoperative discussions aimed at preparing patients for surgery and treatment.
AHRQ-funded; T32HS00066.
Citation: Fuzesi S, Becetti K, Klassen AF .
Expectations of breast-conserving therapy: a qualitative study.
J Patient Rep Outcomes 2019 Dec 27;3(1):73. doi: 10.1186/s41687-019-0167-5..
Keywords: Cancer: Breast Cancer, Cancer, Education: Patient and Caregiver, Surgery
Esfandiari NH, Hughes DT, Reyes-Gastelum D
Factors associated with diagnosis and treatment of thyroid microcarcinomas.
The authors sought to determine diagnostic pathways for microcarcinomas versus larger cancers. Surveying patients from the Georgia and Los Angeles Surveillance, Epidemiology, and End Results (SEER) registries with differentiated thyroid cancer, they found that thyroid microcarcinomas are more likely to be detected by ultrasound and less likely to be associated with surgery scheduled for known thyroid cancer. They concluded that understanding diagnostic pathways allows for targeted interventions to decrease overdiagnosis and overtreatment.
AHRQ-funded; HS024512.
Citation: Esfandiari NH, Hughes DT, Reyes-Gastelum D .
Factors associated with diagnosis and treatment of thyroid microcarcinomas.
J Clin Endocrinol Metab 2019 Dec;104(12):6060-68. doi: 10.1210/jc.2019-01219..
Keywords: Cancer, Diagnostic Safety and Quality
Elkhadragy N, Corelli RL, Russ AL
Faculty perceptions of a tobacco cessation train-the-trainer workshop and experiences with implementation: a qualitative follow-up study.
Researchers conducted a long-term, qualitative follow-up study of faculty participants in the Rx for Change: Clinician-Assisted Tobacco Cessation workshop. All study participants reported implementing components of Rx for Change at their institution. The researchers’ analysis yielded eight major themes pertaining to faculty perceptions and experiences with implementation. They found that participation in the train-the-trainer workshop increased self-reported confidence for teaching tobacco cessation, and faculty valued access to useful, updated tools for teaching. Furthermore, the newly-acquired counseling skills were deemed helpful for treating patients' tobacco use and dependence in clinical practice.
AHRQ- funded; HS022119.
Citation: Elkhadragy N, Corelli RL, Russ AL .
Faculty perceptions of a tobacco cessation train-the-trainer workshop and experiences with implementation: a qualitative follow-up study.
Res Social Adm Pharm 2019 Dec;15(12):1436-45. doi: 10.1016/j.sapharm.2019.01.005..
Keywords: Tobacco Use: Smoking Cessation, Tobacco Use, Education: Continuing Medical Education
Williams CN, Eriksson CO, Kirby A
Hospital mortality and functional outcomes in pediatric neurocritical care.
Pediatric neurocritical care (PNCC) outcomes research is scarce. In this study, the investigators aimed to expand knowledge about outcomes in PNCC by evaluating death and changes in Functional Status Scale (FSS) from baseline among PNCC diagnoses. The investigators concluded that PNCC patients had high rates of death and new disability at discharge, varying significantly between PNCC diagnoses. Multiple domains of disability were affected, underscoring the ongoing multidisciplinary health care needs of survivors.
AHRQ-funded; HS022981.
Citation: Williams CN, Eriksson CO, Kirby A .
Hospital mortality and functional outcomes in pediatric neurocritical care.
Hosp Pediatr 2019 Dec;9(12):958-66. doi: 10.1542/hpeds.2019-0173..
Keywords: Children/Adolescents, Newborns/Infants, Intensive Care Unit (ICU), Critical Care, Neurological Disorders, Mortality, Hospitals, Inpatient Care, Outcomes, Patient-Centered Outcomes Research
Kitsios GD, Yang L, Manatakis DV
Host-response subphenotypes offer prognostic enrichment in patients with or at risk for acute respiratory distress syndrome.
This study examined whether certain plasma biomarkers can be used to help classify mechanically ventilated ICU patients with acute respiratory distress syndrome into hyper- and hypoinflammatory subphenotypes to facilitate more effective targeted therapy. The researchers performed longitudinal measures of 10 plasma biomarkers of host injury and inflammation. They were able to demonstrate that two-class models (hyper- vs hypoinflammatory subphenotypes) fit better than one-class models in patients with acute respiratory distress syndrome or patients at risk for acute respiratory distress (ARFA). Hyperinflammatory classification was associated higher severity of illness, worse clinical outcomes, and persistently elevated biomarkers of host injury and inflammation compared with hypoinflammatory patients.
AHRQ-funded; HS025455.
Citation: Kitsios GD, Yang L, Manatakis DV .
Host-response subphenotypes offer prognostic enrichment in patients with or at risk for acute respiratory distress syndrome.
Crit Care Med 2019 Dec;47(12):1724-34. doi: 10.1097/ccm.0000000000004018..
Keywords: Respiratory Conditions, Critical Care, Intensive Care Unit (ICU), Risk
Bi S, Gunter KE, Lopez FY
Improving shared decision making for Asian American Pacific Islander sexual and gender minorities.
This study examined the challenges Asian American Pacific Islander (AAPI) sexual and gender minorities (SGM) encounter with shared decision making (SDM) with their providers, especially concerning mental health. Focus groups were conducted in San Francisco and interviews were conducted in Chicago and San Francisco. The participants were surveyed about attitudes towards SGM disclosure and preferences about providers. Many participants felt that providers either ignored or overemphasized their identities. Some shared the stigma of SGM identities and effects on mental health in their own families.
AHRQ-funded; HS023050.
Citation: Bi S, Gunter KE, Lopez FY .
Improving shared decision making for Asian American Pacific Islander sexual and gender minorities.
Med Care 2019 Dec;57(12):937-44. doi: 10.1097/mlr.0000000000001212..
Keywords: Shared Decision Making, Racial and Ethnic Minorities, Vulnerable Populations, Patient and Family Engagement, Patient-Centered Healthcare, Behavioral Health, Social Stigma
Fichtenberg CM, Alley DE, Mistry KB
AHRQ Author: Mistry KB
Improving social needs intervention research: key questions for advancing the field.
This paper summarizes emerging evidence and identifies key areas where more research is needed to advance implementation and policy development. Gaps exist in terms of comparative effectiveness and cost effectiveness of social needs intervention approaches. Increased understanding of mechanisms of action to maximize practitioners' ability to tailor interventions would be a benefit. More research is recommended to guard against unintended consequences and ensure these interventions reduce health inequities. Implementation science research should identify supports and incentives for adoption of effective interventions. Focusing both public and private research efforts on these evidence gaps can help advance identification of interventions that maximize both health equity and healthcare value.
AHRQ-authored; AHRQ-funded; HS026664.
Citation: Fichtenberg CM, Alley DE, Mistry KB .
Improving social needs intervention research: key questions for advancing the field.
Am J Prev Med 2019 Dec;57(6s1):S47-s54. doi: 10.1016/j.amepre.2019.07.018..
Keywords: Evidence-Based Practice, Patient-Centered Outcomes Research, Social Determinants of Health
Predmore Z, Hatef E, Weiner JP
Integrating social and behavioral determinants of health into population health analytics: a conceptual framework and suggested road map.
There is growing recognition that social and behavioral risk factors impact population health outcomes. Interventions that target these risk factors can improve health outcomes. This study presents a review of existing literature and proposes a conceptual framework for the integration of social and behavioral data into population health analytics platforms. The authors describe several use cases for these platforms at the patient, health system, and community levels, and align these use cases with the different types of prevention identified by the Centers for Disease Control and Prevention.
AHRQ-funded; HS000029.
Citation: Predmore Z, Hatef E, Weiner JP .
Integrating social and behavioral determinants of health into population health analytics: a conceptual framework and suggested road map.
Popul Health Manag 2019 Dec;22(6):488-94. doi: 10.1089/pop.2018.0151..
Keywords: Social Determinants of Health, Risk, Research Methodologies
Sun K, Szymonifka J, Tian H
Is traditional Chinese medicine use associated with worse patient-reported outcomes among Chinese American rheumatology patients?
Chinese Americans are a fast-growing immigrant group with more severe rheumatic disease manifestations than whites and often a strong cultural preference for traditional Chinese medicine (TCM). In this study, the investigators aimed to examine TCM use patterns and association with patient-reported outcomes (PRO) among Chinese American rheumatology patients. The investigators concluded that among these Chinese American rheumatology patients, TCM users had worse PRO in many physical and mental health domains.
AHRQ-funded; HS000066.
Citation: Sun K, Szymonifka J, Tian H .
Is traditional Chinese medicine use associated with worse patient-reported outcomes among Chinese American rheumatology patients?
J Rheumatol 2019 Dec;46(12):1634-39. doi: 10.3899/jrheum.181148..
Keywords: Complementary and Alternative Medicine, Racial and Ethnic Minorities, Outcomes
Liu FF, Adrian MC
Is treatment working? Detecting real change in the treatment of child and adolescent depression.
Effectiveness of evidence-based treatments for youth remain modest at best; while practice parameters recommend measurement-based care to enhance youth depression treatment, the literature offers few guidelines on how to use assessment results to inform care decisions or to detect real and clinically meaningful change. The purpose of this study was to produce reliable change indices for two commonly used standardized assessments of youth depression: Patient Health Questionnaire-9 items, Modified for Adolescents (PHQ-9A) and the Short Moods and Feelings Questionnaire (SMFQ).
AHRQ-funded; HS022982.
Citation: Liu FF, Adrian MC .
Is treatment working? Detecting real change in the treatment of child and adolescent depression.
J Am Acad Child Adolesc Psychiatry 2019 Dec;58(12):1157-64. doi: 10.1016/j.jaac.2019.02.011..
Keywords: Children/Adolescents, Depression, Behavioral Health, Evidence-Based Practice, Patient-Centered Outcomes Research
Dolan PT, Afaneh C, Dakin G
Lessons learned from developing a mobile app to assist in patient recovery after weight loss surgery.
This study examines the outcomes of patients recovering from weight loss surgery using a newly developed mobile app to help them recover successfully. The enrolled patients used the app for 30 days from July 2017 to October 2018. As the app was being used, it was updated. Ten patients were enrolled in the trial period with four using the initial version and six with the updated version. All patients were satisfied with the app and liked the notifications of updates. In the trial version only one patient completed at least 70% of the surveys, but five completed the surveys for the updated version. Next steps for the researchers is to conduct a pilot study with a larger set of patients.
AHRQ-funded; HS000066.
Citation: Dolan PT, Afaneh C, Dakin G .
Lessons learned from developing a mobile app to assist in patient recovery after weight loss surgery.
J Surg Res 2019 Dec;244:402-08. doi: 10.1016/j.jss.2019.06.063..
Keywords: Obesity: Weight Management, Obesity, Surgery, Telehealth, Health Information Technology (HIT)
Patel SA, Araujo T, Rodriguez LP
Long peripheral catheters: a retrospective review of major complications.
The risk of infectious and noninfectious complications associated with long peripheral catheters (LPCs) is unknown. In this retrospective study of 539 catheters, the investigators did a retrospective review of major complications. Among other discoveries, they found LPCs were often placed for the indications of difficult access and long-term antibiotics.
AHRQ-funded; HS025891.
Citation: Patel SA, Araujo T, Rodriguez LP .
Long peripheral catheters: a retrospective review of major complications.
J Hosp Med 2019 Dec;14(12):758-60. doi: 10.12788/jhm.3313..
Keywords: Healthcare-Associated Infections (HAIs), Adverse Events, Patient Safety, Central Line-Associated Bloodstream Infections (CLABSI), Blood Clots, Infectious Diseases, Risk
Mafi JN, May FP, Kahn KL
Low-value proton pump inhibitor prescriptions among older adults at a large academic health system.
Researchers sought to characterize the prevalence of potentially low-value proton pump inhibitor (PPI) prescriptions among older adults to inform a quality improvement intervention. Subjects were patients, aged 65 years or older, receiving primary care at a large academic health system in 2018. The researchers found that one in eight older adults were prescribed a PPI, and over one-third of prescriptions were potentially low-value. They conclude that, with most potentially low-value prescribing concentrated among a small subset of primary care physicians, interventions targeting them and/or applying EHR-based automatic stopping rules may protect older adults from harm.
AHRQ-funded; HS024067.
Citation: Mafi JN, May FP, Kahn KL .
Low-value proton pump inhibitor prescriptions among older adults at a large academic health system.
J Am Geriatr Soc 2019 Dec;67(12):2600-05. doi: 10.1111/jgs.16117..
Keywords: Elderly, Medication, Quality Improvement, Quality of Care, Primary Care
Byhoff E, Taylor LA
Massachusetts community-based organization perspectives on Medicaid redesign.
The purpose of the study was to investigate how community-based organizations perceive Medicaid policy changes to address the social determinants of health. Forty-six key informant interviews were conducted, representing 44 community-based organizations across Massachusetts. Findings showed that changes to Medicaid policy can catalyze interest in partnership between healthcare organizations and community-based organizations. Recommendations included having policymakers and healthcare leadership ensure that community-based organizations are part of strategy development and social service program implementation.
AHRQ-funded; HS026664.
Citation: Byhoff E, Taylor LA .
Massachusetts community-based organization perspectives on Medicaid redesign.
Am J Prev Med 2019 Dec;57(6 Suppl 1):S74-s81. doi: 10.1016/j.amepre.2019.07.017..
Keywords: Medicaid, Social Determinants of Health, Policy, Health Insurance
Singh H, Graber ML, Hofer TP
Measures to improve diagnostic safety in clinical practice.
In this paper, the investigators discuss how the need to develop measures to improve diagnostic performance could move forward at a time when the scientific foundation needed to inform measurement is still evolving. They highlight challenges and opportunities for developing potential measures of "diagnostic safety" related to clinical diagnostic errors and associated preventable diagnostic harm. In doing so, they propose a starter set of measurement concepts for initial consideration that seem reasonably related to diagnostic safety and call for these to be studied and further refined.
AHRQ-funded; HS022087.
Citation: Singh H, Graber ML, Hofer TP .
Measures to improve diagnostic safety in clinical practice.
J Patient Saf 2019 Dec;15(4):311-16. doi: 10.1097/pts.0000000000000338.
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Keywords: Patient Safety, Diagnostic Safety and Quality, Healthcare Delivery, Quality Improvement, Quality of Care, Medical Errors, Adverse Events
Vu JV, Gunaseelan V, Dimick JB
Mechanisms of age and race differences in receiving minimally invasive inguinal hernia repair.
Black patients and older adults are less likely to receive minimally invasive hernia repair. In this study, the investigators explored the association between race, age, and surgeon utilization of minimally invasive surgery (MIS) with the likelihood of receiving MIS inguinal hernia repair. The investigators concluded that race differences were explained by surgeon MIS utilization, implicating access to MIS-performing surgeon as a mediator. Conversely, age disparity was independent of MIS utilization, even after adjusting for comorbidities, indicating some degree of provider bias against performing MIS repair in older patients.
AHRQ-funded; HS025778.
Citation: Vu JV, Gunaseelan V, Dimick JB .
Mechanisms of age and race differences in receiving minimally invasive inguinal hernia repair.
Surg Endosc 2019 Dec;33(12):4032-37. doi: 10.1007/s00464-019-06695-0..
Keywords: Racial and Ethnic Minorities, Surgery, Elderly, Access to Care, Healthcare Utilization
Ailabouni NJ, Marcum ZA, Schmader KE
Medication use quality and safety in older adults: 2018 update.
This study identified four key articles from 2018 that address medication use quality and safety for older adults. The first study highlighted a cluster-randomized trial that utilized a pharmacist-led education-based intervention delivered to both patients and doctors to deprescribe four types of inappropriate medications. The second study from the UK examined the association between anticholinergic exposure, overall and by medication class, and dementia risk in 40,770 older adults. The third study was a Swedish longitudinal cohort study examining the association between antihypertensive medications and incident dementia. The fourth and last study was a randomized, double-blind, placebo-controlled trial and examined the effect of daily low-dose aspirin for primary prevention of cardiac events and hemorrhage in 19,144 community-dwelling older adults.
AHRQ-funded; HS022982.
Citation: Ailabouni NJ, Marcum ZA, Schmader KE .
Medication use quality and safety in older adults: 2018 update.
J Am Geriatr Soc 2019 Dec;67(12):2458-62. doi: 10.1111/jgs.16243..
Keywords: Elderly, Medication, Medication: Safety, Patient Safety, Quality of Care, Provider: Pharmacist, Provider
Parikh K, Perry K, Pantor C
Multidisciplinary engagement increases medications in-hand for patients hospitalized with asthma.
Asthma exacerbations in children are a leading cause of missed school days and health care use. Patients discharged from the hospital often do not fill discharge prescriptions and are at risk for future exacerbations. In this study, a multidisciplinary team aimed to increase the percentage of patients discharged from the hospital after an asthma exacerbation with their medications in-hand from 15% to 80%.
AHRQ-funded; HS024554.
Citation: Parikh K, Perry K, Pantor C .
Multidisciplinary engagement increases medications in-hand for patients hospitalized with asthma.
Pediatrics 2019 Dec;144(6). doi: 10.1542/peds.2019-0674..
Keywords: Children/Adolescents, Asthma, Medication, Patient Adherence/Compliance, Teams, Hospital Discharge, Transitions of Care
Yang AD, Quinn CM, Hewitt DB
National evaluation of needlestick events and reporting among surgical residents.
Needlestick injuries pose significant health hazards; however, the nationwide frequency of needlesticks and reporting practices among surgical residents are unknown. The objectives of this study were to examine the rate and circumstances of self-reported needlestick events in US surgery residents, assess factors associated with needlestick injuries, evaluate reporting practices, and identify reporting barriers.
AHRQ-funded; HS000078.
Citation: Yang AD, Quinn CM, Hewitt DB .
National evaluation of needlestick events and reporting among surgical residents.
J Am Coll Surg 2019 Dec;229(6):609-20. doi: 10.1016/j.jamcollsurg.2019.09.001..
Keywords: Education: Continuing Medical Education, Surgery, Injuries and Wounds, Provider
Tam CA, Dauw CA, Ghani KR
New persistent opioid use after outpatient ureteroscopy for upper tract stone treatment.
The purpose of this study was to measure the incidence of persistent opioid use following ureteroscopy (URS). Over 100 Americans die every day from opioid overdose. Recent studies suggest that many opioid addictions surface after surgery. The investigators concluded that nearly 1 in 16 opioid-naive patients developed new persistent opioid use after URS. New persistent opioid use was associated with the amount of opioid prescribed at the time of URS. The authors suggest that, given these findings, urologists should re-evaluate their post-URS opioid prescribing patterns.
AHRQ-funded; HS024525; HS024728.
Citation: Tam CA, Dauw CA, Ghani KR .
New persistent opioid use after outpatient ureteroscopy for upper tract stone treatment.
Urology 2019 Dec;134:103-08. doi: 10.1016/j.urology.2019.08.042..
Keywords: Opioids, Medication, Substance Abuse, Surgery, Practice Patterns
Reuter B, Shaw J, Hanson J
Nutritional assessment in inpatients with cirrhosis can be improved after training and is associated with lower readmissions.
Malnutrition is widely prevalent in cirrhosis patients, which can worsen sarcopenia, hepatic encephalopathy (HE), and overall prognosis. In this study, investigators aimed to define the frequency of nutritional assessments of patients with cirrhosis in retrospective and prospective (after educational training) cohorts and to evaluate prospective changes along with their effects on 90-day readmissions. The authors concluded that nutritional consultation rates in inpatients with cirrhosis could be significantly improved after educational intervention and were associated with lower 90-day readmission rates.
AHRQ-funded; HS025412.
Citation: Reuter B, Shaw J, Hanson J .
Nutritional assessment in inpatients with cirrhosis can be improved after training and is associated with lower readmissions.
Liver Transpl 2019 Dec;25(12):1790-99. doi: 10.1002/lt.25602..
Keywords: Nutrition, Inpatient Care, Hospital Readmissions, Education: Patient and Caregiver
Riley AR, Walker BL, Wilson AC
Parents' consumer preferences for early childhood behavioral intervention in primary care.
In this study, the investigators sought to better understand parents' preferences for the content and delivery method of behavioral health guidance in pediatric primary care and to determine the relationship of those preferences with demographic characteristics, child behavior problems, and parenting style. The investigators found that most parents were interested in behavioral guidance as part of primary care, but their preferences for the content and delivery of that guidance varied by known socioeconomic, child, and parenting risk factors.
AHRQ-funded; HS022981.
Citation: Riley AR, Walker BL, Wilson AC .
Parents' consumer preferences for early childhood behavioral intervention in primary care.
J Dev Behav Pediatr 2019 Dec;40(9):669-78. doi: 10.1097/dbp.0000000000000736..
Keywords: Children/Adolescents, Primary Care, Behavioral Health, Caregiving, Healthcare Delivery
De Marchis EH, Hessler D, Fichtenberg C
Part I: A quantitative study of social risk screening acceptability in patients and caregivers.
This study evaluated patient and caregiver acceptability of social risk screening. Adult patients and the adult caregivers of pediatric patients were recruited from primary care clinics and emergency departments across nine states for a survey; survey items included the Center for Medicare and Medicaid Innovation Accountable Health Communities' social risk screening tool and questions about the appropriateness of screening and including social risk data in electronic health records. Results showed that a strong majority of surveyed patients and caregivers found social risk screening to be appropriate. Most also felt comfortable including social risk data in electronic health records. The researchers conclude that lack of patient acceptability is unlikely to be a major implementation barrier.
AHRQ-funded; HS026664.
Citation: De Marchis EH, Hessler D, Fichtenberg C .
Part I: A quantitative study of social risk screening acceptability in patients and caregivers.
Am J Prev Med 2019 Dec;57(6 Suppl 1):S25-s37. doi: 10.1016/j.amepre.2019.07.010..
Keywords: Children/Adolescents, Caregiving, Screening, Social Determinants of Health, Electronic Health Records (EHRs), Health Information Technology (HIT)