Health information exchange (HIE) is an avenue to improving patient care and an important priority under the Meaningful Use requirements. However, we know very little about the usage of HIE systems. Understanding how healthcare professionals actually utilize HIE systems will provide practical insights to system evaluation, help guide system improvement, and help organizations assess performance. We developed a novel way of describing professionals’ HIE usage using the log files from an operational HIE-facilitating organization. The system employed a webpage-style interface. The screen number, types, and variation served to cluster all sessions in to five categories of HIE usage: minimal usage, repetitive searching, clinical information, mixed information, and demographic information. This method reduced the 1,661 different patterns into five recognizable groups for analysis. Overall, most users engaged with the system in a minimal fashion. In terms of user characteristics, minimal usage was highest among physicians and the highest percentage of clinical information usage was among nurses. Usage also differed by organization with repetitive searching most common in settings with scheduled encounters and uncommon in the faster-paced emergency department. Lastly, usage also varied by timing of the patient encounter. Within a single HIE system, discernible types of users behavior existed and varied across jobs, organizations, and time. This approach relied on objective data, can be replicated, and demonstrates the substantial variation in user behaviors like simple measures of adoption or any access. This approach can help leaders and evaluators assess their own and other organizations.
BackgroundChildren may benefit greatly in terms of safety and care coordination from the information sharing promised by health information exchange (HIE). While information exchange capability is a required feature of the certified electronic health record, we known little regarding how this technology is used in general and for pediatric patients specifically.MethodsUsing data from an operational HIE effort in central Texas, we examined the factors associated with actual system usage. The clinical and demographic characteristics of pediatric ED encounters (n = 179,445) were linked to the HIE system user logs. Based on the patterns of HIE system screens accessed by users, we classified each encounter as: no system usage, basic system usage, or novel system usage. Using crossed random effects logistic regression, we modeled the factors associated with basic and novel system usage.ResultsUsers accessed the system for 8.7% of encounters. Increasing patient comorbidity was associated with a 5% higher odds of basic usage and 15% higher odds for novel usage. The odds of basic system usage were lower in the face of time constraints and for patients who had not been to that location in the previous 12 months.ConclusionsHIE systems may be a source to fulfill users' information needs about complex patients. However, time constraints may be a barrier to usage. In addition, results suggest HIE is more likely to be useful to pediatric patients visiting ED repeatedly. This study helps fill an existing gap in the study of technological applications in the care of children and improves knowledge about how HIE systems are utilized.
The Meaningful Use criteria promises to make health information exchange (HIE) much more widespread. However, the usage of the information systems made available by existing HIE efforts tends to be very low. This study sought to examine the factors associated with usage of an operational HIE system during ambulatory care visits to safety-net clinics. Overall the HIE system was accessed for 21% of encounters. However, system access took on two distinct forms. In general, usage was more likely for patients with recent emergency department visits and chronic conditions. This study indicates the organizational commitment to engage in HIE does not necessarily mean that the information systems will be always used. In addition, system usage will take on various forms for different reasons. These results reveal considerations for the development, operation and evaluation of HIE efforts.
Under the provisions of the Health Information Technology for Economic & Clinical Health act providers need to demonstrate their 'meaningful use' of electronic health record systems' health information exchange (HIE) capability. HIE usage is not a simple construct, but the choice of its measurement must attend to the users, context, and objectives of the system being examined. This review examined how usage is reported in the existing literature and also what conceptualizations of usage might best reflect the nature and objectives of HIE. While existing literature on HIE usage included a diverse set of measures, most were theoretically weak, did not attend to the interplay of measure, level of analysis and architectural strategy, and did not reflect how HIE usage affected the actual process of care. Attention to these issues will provide greater insight into the effects of previously inaccessible information on medical decision-making and the process of care.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.