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AHRQ Research Studies Date
Topics
- Ambulatory Care and Surgery (1)
- Care Coordination (1)
- Children/Adolescents (1)
- Chronic Conditions (1)
- Clinician-Patient Communication (1)
- Communication (1)
- Community-Based Practice (1)
- Electronic Health Records (EHRs) (12)
- Emergency Department (2)
- Emergency Medical Services (EMS) (1)
- Healthcare Cost and Utilization Project (HCUP) (1)
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- (-) Health Information Exchange (HIE) (23)
- Health Information Technology (HIT) (18)
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- Patient-Centered Outcomes Research (1)
- Payment (1)
- Policy (1)
- Primary Care (3)
- Provider (2)
- Provider: Clinician (1)
- Provider: Physician (1)
- Public Health (3)
- Public Reporting (1)
- Quality of Care (1)
- Research Methodologies (1)
- Rural Health (1)
- Vulnerable Populations (2)
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
1 to 23 of 23 Research Studies DisplayedNorton JM, Ip A, Ruggiano N
AHRQ Author: Camara DS, Hsiao CJ, Bierman AS
Assessing progress toward the vision of a comprehensive, shared electronic care plan: scoping review.
People with multiple chronic conditions often receive care from a broad array of clinicians across multiple health care settings, making it difficult to share care plans between those facilities and providers. One method for possibly improving care for those individuals is through the development and use of comprehensive, shared, electronic care (e-care) plans. The purpose of the study was to review existing e-care plans and related initiatives that could be utilized to develop a comprehensive, shared e-care plan, and facilitate the National Institutes of Health and Agency for Healthcare Research and Quality joint initiative’s creation of e-care planning tools for people with multiple chronic conditions. The researchers conducted a review of literature from 2015-2020, as well as interviews of expert informants to identify information missing from the literature search. The study identified 7 different interventions for e-care plans and 3 different projects for health care data standards, all of which included elements which could be utilized to further the goals of developing a comprehensive, shared e-care plan. The study concluded that while none of the existing interventions met all the optimal e-care plan criteria for people with multiple chronic conditions, each plan included the infrastructure necessary to progress toward that goal. The researchers reported that gaps must first be addressed, but that a comprehensive, shared e-care plan can improve care coordination across multiple care settings and clinicians.
AHRQ-authored.
Citation: Norton JM, Ip A, Ruggiano N .
Assessing progress toward the vision of a comprehensive, shared electronic care plan: scoping review.
J Med Internet Res 2022 Jun 10;24(6):e36569. doi: 10.2196/36569..
Keywords: Chronic Conditions, Care Coordination, Electronic Health Records (EHRs), Health Information Technology (HIT), Healthcare Delivery, Health Information Exchange (HIE)
Cross DA, Stevens MA, Spivack SB
Survey of information exchange and advanced use of other health information technology in primary care settings: capabilities in and outside of the safety net.
This study’s aim was to estimate advanced use of health information technology (health IT) use in safety net versus nonsafety net primary care practices. The authors explored domains of patient engagement, population health management, and electronic information exchange. They examined organizational characteristics that may differently predict advanced use of IT across these settings. A cross-sectional analysis of a national survey of 1776 physician practices was conducted. Health IT use was found to be common across primary care practices, but advanced use of health IT functionalities ranged from only 30% to 50% use. A lag was found for advanced feature use with safety net practices. However, safety net practices who were members of a health system or practice network had comparable health IT capabilities to those in nonsafety net sites.
AHRQ-funded; HS024075.
Citation: Cross DA, Stevens MA, Spivack SB .
Survey of information exchange and advanced use of other health information technology in primary care settings: capabilities in and outside of the safety net.
Med Care 2022 Feb;60(2):140-48. doi: 10.1097/mlr.0000000000001673.
AHRQ-funded; HS024075..
AHRQ-funded; HS024075..
Keywords: Health Information Exchange (HIE), Health Information Technology (HIT), Primary Care
Apathy NC, Holmgren AJ, Werner RM
Growth in health information exchange with ACO market penetration.
This study’s objectives were to assess whether hospitals expand the network breadth of their health information exchange (HIE) partners after joining an accountable care organization (ACO) and to analyze whether this HIE network expansion effect varies across markets with differing levels of ACO penetration. The authors used data from the American Hospital Association Annual Survey and Information Technology Supplement to measure nonfederal acute care hospitals from 2014-2017. There was a 30.7% increase in HIE breadth for 0.35 partner types with ACO participation. This effect was larger for hospitals in high-ACO penetration markets (32% increase) and smaller for hospitals in low-ACO penetration markets (24.8% increase).
AHRQ-funded; HS026116.
Citation: Apathy NC, Holmgren AJ, Werner RM .
Growth in health information exchange with ACO market penetration.
Am J Manag Care 2022 Jan;28(1):e7-e13. doi: 10.37765/ajmc.2022.88815..
Keywords: Health Information Exchange (HIE), Electronic Health Records (EHRs), Health Information Technology (HIT)
Vest JR, Freedman S, Unruh MA
Strategic use of health information exchange and market share, payer mix, and operating margins.
The purpose of this study was to identify the impact of hospitals' use of Health information exchange (HIE) capabilities on outcomes that may be sensitive to changes in different contracting arrangements and referral patterns occurring as a result of improved connectivity. The researchers utilized a panel of community hospitals in nine states and explored the relationship between the number of different data types the hospital could exchange via HIE and changes in market share, payer mix, and operating margin. The study found that an increase in HIE capability was related with a 13% increase in a hospital's discharges that were covered by commercial insurers or Medicare. Increasing intraorganizational sharing of information was related with a 9.6% decrease in the percentage of discharges covered by commercial insurers or Medicare. There was no relationship between increasing HIE capability or intraorganizational information sharing and increased market share or operating margin. CONCLUSIONS: Improving information sharing with external organizations may be an approach to support strategic business goals. PRACTICE IMPLICATIONS: Organizations may be served by identifying ways to leverage HIE instead of focusing on intraorganizational exchange capabilities.
AHRQ-funded; HS024717.
Citation: Vest JR, Freedman S, Unruh MA .
Strategic use of health information exchange and market share, payer mix, and operating margins.
Health Care Manage Rev 2022 Jan-Mar; 47(1):28-36. doi: 10.1097/hmr.0000000000000293..
Keywords: Health Information Exchange (HIE), Health Information Technology (HIT), Electronic Health Records (EHRs)
Pylypchuk Y, Meyerhoefer CD, Encinosa W
AHRQ Author: Encinosa W
The role of electronic health record developers in hospital patient sharing.
This study’s objective was to determine whether hospital adoption of a new electronic health record (EHR) developer increases patient sharing with hospitals using the same developer. Data was extracted on patients shared with other hospitals for 2076 US nonfederal acute care hospitals from the 2011 to 2016 CMS Physician Shared Patient Patterns database. The authors calculated the ratio of patients shared with hospitals outside of the focal hospital’s network that use the same EHR developer as the focal hospital. Switching to a new developer increased the ratio of patients shared with other hospitals using the same developer by 4.1-19.3%, depending on model specification. Magnitude of this effect varied by EHR developer and was increasing in developer market share.
AHRQ-authored.
Citation: Pylypchuk Y, Meyerhoefer CD, Encinosa W .
The role of electronic health record developers in hospital patient sharing.
J Am Med Inform Assoc 2022 Jan;29(3):435-42. doi: 10.1093/jamia/ocab263..
Keywords: Electronic Health Records (EHRs), Health Information Exchange (HIE), Health Information Technology (HIT), Hospitals
Cummins MR, Del Fiol G, Crouch BI
Enabling health information exchange at a US poison control center.
This paper discusses the development and implementation of a poison control center (PCC) to participate in a standards-based health information exchange (HIE). This was previously not possible due to software noncompliance with HIE standards, lack of informatics infrastructure, and the need to integrate HIE processes into workflow. The investigators adapted the Health Level Seven Consolidated Clinical Document Architecture (C-CDA) consultation note for the PCC use case. They developed software called SNOWHITE that enables PCC HIE in tandem with a poisoning information center. It was successfully implemented at the Utah PCC starting in February 2017 through October 218.
AHRQ-funded; HS021472.
Citation: Cummins MR, Del Fiol G, Crouch BI .
Enabling health information exchange at a US poison control center.
J Am Med Inform Assoc 2020 Jul;27(7):1000-06. doi: 10.1093/jamia/ocaa055..
Keywords: Health Information Exchange (HIE), Health Information Technology (HIT)
Dixon BE, Zhang Z, Amo JN
Improving notifiable disease case reporting through electronic information exchange-facilitated decision support: a controlled before-and-after trial.
This study examined the results of implementing an electronic, prepopulated notifiable disease report form on case reporting rates by ambulatory care clinics to public health authorities. They conducted a 2-year controlled before-and-after trial of a health information exchange (HIE) in Indiana. Data was analyzed from electronic prepopulated reports and paper and fax reports submitted to a local health department for 7 conditions by using a difference-in-differences model. Provider reporting rates for chlamydia and gonorrhea increased significantly during the baseline period. During the intervention period they decreased significantly in control clinics. Completion and timeliness improved for both intervention and control clinics.
AHRQ-funded; HS020909.
Citation: Dixon BE, Zhang Z, Amo JN .
Improving notifiable disease case reporting through electronic information exchange-facilitated decision support: a controlled before-and-after trial.
Public Health Rep 2020 May/Jun;135(3):401-10. doi: 10.1177/0033354920914318..
Keywords: Health Information Exchange (HIE), Health Information Technology (HIT), Electronic Health Records (EHRs), Public Health, Public Reporting, Ambulatory Care and Surgery
Everson J, Butler E
Hospital adoption of multiple health information exchange approaches and information accessibility.
The aim of this study was to determine the change in adoption of 3 types of electronic health information exchange (HIE) in hospitals for 3 types of information exchange: secure messaging, provider portals, and use of an HIE; and to assess if growth in each approach corresponded to an increased ability to access and integrate patient information from outside providers. A sample of 1917 hospitals that responded to the American Hospital Association Information Technology Supplement every year from 2014 to 2016 was used for the analysis. Adoption of each approach increased by 9-15 percentage points over that time. The average number of HIE approaches increased from 1.0 to 1.4. The likelihood of having outside information increased by 10.3 percentage points with adoption of 1 approach, and by 9.5 percentage points with adoption of a second approach.
AHRQ-funded; HS026395.
Citation: Everson J, Butler E .
Hospital adoption of multiple health information exchange approaches and information accessibility.
J Am Med Inform Assoc 2020 Apr 1;27(4):577-83. doi: 10.1093/jamia/ocaa003..
Keywords: Health Information Technology (HIT), Health Information Exchange (HIE), Hospitals
Everson J, Adler-Milstein J
Sharing information electronically with other hospitals is associated with increased sharing of patients.
This study examined whether patient sharing between hospitals increased when they participated in a health information organization (HIO). The researchers used national data on hospital participation in HIOs from the American Hospital Association Information Technology Supplement and data on the volume of Medicare patients shared between pairs of hospitals from 2010 to 2016. They found that there an increase in patient sharing in competitive markets and with larger hospitals. Participation by only one hospital had no impact on patient sharing.
AHRQ-funded; HS026395.
Citation: Everson J, Adler-Milstein J .
Sharing information electronically with other hospitals is associated with increased sharing of patients.
Health Serv Res 2020 Feb;55(1):128-35. doi: 10.1111/1475-6773.13240..
Keywords: Health Information Technology (HIT), Health Information Exchange (HIE), Hospitals
Vest JR, Unruh MA, Casalino LP
The complementary nature of query-based and directed health information exchange in primary care practice.
Many policymakers and advocates assume that directed and query-based health information exchange (HIE) work together to meet organizations' interoperability needs, but this is not grounded in a substantial evidence base. This study sought to clarify the relationship between the usage of these 2 approaches to HIE. The investigators concluded that quantitative and qualitative findings suggested that directed and query-based HIE existed in a complementary manner in ambulatory care settings.
AHRQ-funded; HS024556.
Citation: Vest JR, Unruh MA, Casalino LP .
The complementary nature of query-based and directed health information exchange in primary care practice.
J Am Med Inform Assoc 2020 Jan;27(1):73-80. doi: 10.1093/jamia/ocz134..
Keywords: Health Information Exchange (HIE), Health Information Technology (HIT), Primary Care
Vest JR, Unruh MA, Freedman S
Health systems' use of enterprise health information exchange vs single electronic health record vendor environments and unplanned readmissions.
Enterprise health information exchange (HIE) and a single electronic health record (EHR) vendor solution are 2 information exchange approaches to improve performance and increase the quality of care. This study sought to determine the association between adoption of enterprise HIE vs a single vendor environment and changes in unplanned readmissions. The investigators concluded that reductions in the probability of an unplanned readmission after a hospital adopts a single vendor environment suggested that HIE technologies can better support the aim of higher quality care.
AHRQ-funded; HS024717.
Citation: Vest JR, Unruh MA, Freedman S .
Health systems' use of enterprise health information exchange vs single electronic health record vendor environments and unplanned readmissions.
J Am Med Inform Assoc 2019 Oct;26(10):989-98. doi: 10.1093/jamia/ocz116..
Keywords: Health Systems, Health Information Exchange (HIE), Electronic Health Records (EHRs), Health Information Technology (HIT), Hospital Readmissions, Hospitals
Vest JR, Unruh MA, Shapiro JS
The associations between query-based and directed health information exchange with potentially avoidable use of health care services.
This study quantified the impact of directed and query-based approaches to health information exchange (HIE) on potentially avoidable use of health care services. Data from Medicare fee-for-service claims was examined from 2008 to 2014 from providers in the Rochester Regional Health Organization (RHIO). There were very small reductions in the probability of ambulatory care sensitive hospitalization with either approach.
AHRQ-funded; HS024556.
Citation: Vest JR, Unruh MA, Shapiro JS .
The associations between query-based and directed health information exchange with potentially avoidable use of health care services.
Health Serv Res 2019 Oct;54(5):981-93. doi: 10.1111/1475-6773.13169..
Keywords: Health Information Exchange (HIE), Health Systems, Health Information Technology (HIT)
Lyles CR, Tieu L, Sarkar U
A randomized trial to train vulnerable primary care patients to use a patient portal.
This study examined the use of patient care portals in primary care practices with vulnerable patients such as those with lower socioeconomic status or limited health literacy (LHL). A randomized control trial was created with 93 English-speaking patients with 1+ chronic diseases. The patients were provided with either an 1) in-person tutorial with a research assistant, or 2) a link to view the videos on their own. A third arm of the trial were control patients with just normal access to get to the portal. There was a higher rate of access (21%) after the trial was over with the two intervention groups as compared with 9% for the usual care patients.
AHRQ-funded; HS022408; HS022561; HS023558.
Citation: Lyles CR, Tieu L, Sarkar U .
A randomized trial to train vulnerable primary care patients to use a patient portal.
J Am Board Fam Med 2019 Mar-Apr;32(2):248-58. doi: 10.3122/jabfm.2019.02.180263..
Keywords: Electronic Health Records (EHRs), Health Information Exchange (HIE), Health Literacy, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care, Vulnerable Populations
Ayer T, Ayvaci MUS, Karaca Z
AHRQ Author: Karaca Z
Production and Operations Management 2019 Mar 2019;28(3):740–58.
Health information exchanges (HIEs) are expected to improve poor information coordination in emergency departments (EDs); however, whether and when HIEs are associated with better operational outcomes remains poorly understood. In this paper, the authors study HIE and length of stay (LOS) relationship using a large dataset from the Healthcare Cost and Utilization Project consisting of about 7.4 million treat‐and‐release visits made to 63 EDs in Massachusetts.
AHRQ-authored.
Citation: Ayer T, Ayvaci MUS, Karaca Z .
Production and Operations Management 2019 Mar 2019;28(3):740–58.
Production and Operations Management 2019 Mar;28(3):740–58..
Keywords: Emergency Department, Healthcare Cost and Utilization Project (HCUP), Health Information Exchange (HIE), Health Information Technology (HIT)
Lin SC, Hollingsworth JM, Adler-Milstein J
Alternative payment models and hospital engagement in health information exchange.
The purpose of this study was to assess whether hospital participation in alternative payment models (APMs) was associated with greater engagement in health information exchange (HIE) along 4 dimensions: volume of patients for whom information is exchanged, diversity of information types, breadth of partner types, and depth of technical approach. Findings suggest that APM participation was associated with greater HIE diversity, breadth, and depth that value-based payment may be spurring improvements in HIE infrastructure; however, the finding that APM participation is associated with lower HIE volume suggests that there may be incentive to focus HIE investments on a limited number of partners.
AHRQ-funded; HS024525; HS024728.
Citation: Lin SC, Hollingsworth JM, Adler-Milstein J .
Alternative payment models and hospital engagement in health information exchange.
Am J Manag Care 2019 Jan 1;25(1):e1-e6..
Keywords: Payment, Health Information Exchange (HIE), Hospitals
Elysee G, Herrin J, Horwitz LI
An observational study of the relationship between meaningful use-based electronic health information exchange, interoperability, and medication reconciliation capabilities.
Stagnation in hospitals' adoption of data integration functionalities coupled with reduction in the number of operational health information exchanges could become a significant impediment to hospitals' adoption of 3 critical capabilities: electronic health information exchange, interoperability, and medication reconciliation, in which electronic systems are used to assist with resolving medication discrepancies and improving patient safety. This observational study examines the relationship between meaningful use-based electronic health information exchange, interoperability, and medication reconciliation capabilities.
AHRQ-funded; HS022882.
Citation: Elysee G, Herrin J, Horwitz LI .
An observational study of the relationship between meaningful use-based electronic health information exchange, interoperability, and medication reconciliation capabilities.
Medicine 2017 Oct;96(41):e8274. doi: 10.1097/MD.0000000000008274..
Keywords: Electronic Health Records (EHRs), Health Information Exchange (HIE), Health Information Technology (HIT), Hospitals, Medication
Grande SW, Castaldo MG, Carpenter-Song E
A digital advocate? Reactions of rural people who experience homelessness to the idea of recording clinical encounters.
This study examines the reactions of homeless people to the idea of using a smartphone to record their own clinical encounter, either covertly or with permission from their physician. The researchers conducted semi-structured interviews with individuals at a temporary housing shelter in Northern New England. The study found that while many rural, disadvantaged individuals felt marginalized by the wide social distance between themselves and their clinicians, recording technology may serve as an advocate by holding both patients and doctors accountable and by permitting the burden of clinical proof to be shared.
AHRQ-funded; HS021695.
Citation: Grande SW, Castaldo MG, Carpenter-Song E .
A digital advocate? Reactions of rural people who experience homelessness to the idea of recording clinical encounters.
Health Expect 2017 Aug;20(4):618-25. doi: 10.1111/hex.12492..
Keywords: Health Information Exchange (HIE), Clinician-Patient Communication, Rural Health, Vulnerable Populations
Dixon BE, Zhang Z, Lai PTS
Completeness and timeliness of notifiable disease reporting: a comparison of laboratory and provider reports submitted to a large county health department.
This study analyzed patterns of reporting as well as data completeness and timeliness for traditional, passive reporting of notifiable disease by two distinct sources of information: hospital and clinic staff versus clinical laboratory staff. Laboratory reports were received, on average, 2.2 days after diagnosis versus a week for provider reports.
AHRQ-funded; HS020909.
Citation: Dixon BE, Zhang Z, Lai PTS .
Completeness and timeliness of notifiable disease reporting: a comparison of laboratory and provider reports submitted to a large county health department.
BMC Med Inform Decis Mak 2017 Jun 23;17(1):87. doi: 10.1186/s12911-017-0491-8.
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Keywords: Public Health, Health Information Technology (HIT), Health Information Exchange (HIE), Provider
Bush RA, Kuelbs C, Ryu J
Structured data entry in the electronic medical record: perspectives of pediatric specialty physicians and surgeons.
A 35-item questionnaire based on Unified Theory of Acceptance and Use of Technology, was used to measure attitudes, facilitation, and potential incentives for adopting for clinical documentation among 25 pediatric specialty physicians and surgeons. Pediatric surgeons were significantly less positive than specialty physicians about effects on Performance and the effect of Social Influence but in more agreement that use of forms was voluntary.
AHRQ-funded; HS022404.
Citation: Bush RA, Kuelbs C, Ryu J .
Structured data entry in the electronic medical record: perspectives of pediatric specialty physicians and surgeons.
J Med Syst 2017 May;41(5):75. doi: 10.1007/s10916-017-0716-5.
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Keywords: Electronic Health Records (EHRs), Children/Adolescents, Health Information Exchange (HIE)
Kim KK, Sankar P, Wilson MD
Factors affecting willingness to share electronic health data among California consumers.
The objective of the study is to explore factors that affect consumers' willingness to share electronic health information for healthcare and research. It concluded that consumers' choices about electronically sharing health information are affected by their attitudes toward EHRs as well as beliefs about research benefit and individual control.
AHRQ-funded; HS019913.
Citation: Kim KK, Sankar P, Wilson MD .
Factors affecting willingness to share electronic health data among California consumers.
BMC Med Ethics 2017 Apr 4;18(1):25. doi: 10.1186/s12910-017-0185-x.
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Keywords: Communication, Electronic Health Records (EHRs), Health Information Exchange (HIE), Health Information Technology (HIT), Research Methodologies
Vest JR
Geography of community health information organization activity in the United States: implications for the effectiveness of health information exchange.
This study describes the extent of reported community health information organization (HIO) coverage in the United States and explores the practical and policy implications of overlaps and gaps in HIO service areas. Its findings suggests that community HIOs may be inefficiently distributed. Parts of the United States have multiple, overlapping HIOs, while others do not have any providing health information exchange services.
AHRQ-funded; HS020304.
Citation: Vest JR .
Geography of community health information organization activity in the United States: implications for the effectiveness of health information exchange.
Health Care Manage Rev 2017 Apr/Jun;42(2):132-41. doi: 10.1097/hmr.0000000000000103.
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Keywords: Community-Based Practice, Health Information Exchange (HIE), Health Information Technology (HIT), Policy
Everson J, Kocher KE, Adler-Milstein J
Health information exchange associated with improved emergency department care through faster accessing of patient information from outside organizations.
This study assessed whether electronic health information exchange (HIE) is associated with improved emergency department (ED) care processes and utilization through more timely clinician viewing of information from outside organizations. It concluded that the relationship between HIE and improved care processes and reduced utilization in the ED is mediated by faster accessing of information from outside organizations.
AHRQ-funded; HS024160.
Citation: Everson J, Kocher KE, Adler-Milstein J .
Health information exchange associated with improved emergency department care through faster accessing of patient information from outside organizations.
J Am Med Inform Assoc 2017 Apr 1;24(e1):e103-e10. doi: 10.1093/jamia/ocw116.
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Keywords: Electronic Health Records (EHRs), Emergency Department, Emergency Medical Services (EMS), Quality of Care, Health Information Exchange (HIE)
Revere D, Hills RH, Dixon BE
Notifiable condition reporting practices: implications for public health agency participation in a health information exchange.
The researchers sought to better understand the barriers to and burden of notifiable condition reporting from the perspectives of clinic physicians, interviews with clinic reporters, and interviews with public health workers involved in reporting workflow. A strong recommendation generated by their findings is that, given their central role in reporting, clinic reporters are a significant target audience for public health outreach and education that aims to alleviate perceived reporting burden and improve reporting knowledge.
AHRQ-funded; HS020909.
Citation: Revere D, Hills RH, Dixon BE .
Notifiable condition reporting practices: implications for public health agency participation in a health information exchange.
BMC Public Health 2017 Mar 11;17(1):247. doi: 10.1186/s12889-017-4156-4.
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Keywords: Health Information Exchange (HIE), Public Health, Infectious Diseases, Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Physician, Provider: Clinician, Provider