A user needs assessment to inform health information exchange design and implementation

Abstract

BackgroundImportant barriers for widespread use of health information exchange (HIE) are usability and interface issues. However, most HIEs are implemented without performing a needs assessment with the end users, healthcare providers. We performed a user needs assessment for the process of obtaining clinical information from other health care organizations about a hospitalized patient and identified the types of information most valued for medical decision-making.MethodsQuantitative and qualitative analysis were used to evaluate the process to obtain and use outside clinical information (OI) using semi-structured interviews (16 internists), direct observation (750 h), and operational data from the electronic medical records (30,461 hospitalizations) of an internal medicine department in a public, teaching hospital in Tampa, Florida.Results13.7 % of hospitalizations generate at least one request for OI. On average, the process comprised 13 steps, 6 decisions points, and 4 different participants. Physicians estimate that the average time to receive OI is 18 h. Physicians perceived that OI received is not useful 33–66 % of the time because information received is irrelevant or not timely. Technical barriers to OI use included poor accessibility and ineffective information visualization. Common problems with the process were receiving extraneous notes and the need to re-request the information. Drivers for OI use were to trend lab or imaging abnormalities, understand medical history of critically ill or hospital-to-hospital transferred patients, and assess previous echocardiograms and bacterial cultures. About 85 % of the physicians believe HIE would have a positive effect on improving healthcare delivery.ConclusionsAlthough hospitalists are challenged by a complex process to obtain OI, they recognize the value of specific information for enhancing medical decision-making. HIE systems are likely to have increased utilization and effectiveness if specific patient-level clinical information is delivered at the right time to the right users.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-015-0207-x) contains supplementary material, which is available to authorized users.

Assessment of Use and Preferences Regarding Internet-Based Health Care Delivery: Cross-Sectional Questionnaire Study

“…In order to facilitate a safe, timely, efficient, effective, and equitable delivery of internet-based health care, assessment of needs of all stakeholders involved is crucial [19]. Most studies so far have intended to shed light on the provider point of view, mostly on an institutional level, in developed and developing countries ([20], systematic review in [21]), while the recipient point of view has been scarcely examined, mostly in patient cohorts with very specific needs living with chronic conditions [22,23]. Early efforts to implement the electronic health card and corresponding telematic infrastructure are in progress in Germany, and some health insurance companies have established electronic medical records, but German use and preferences regarding internet-based health care delivery has not been assessed.…”

Understanding Gaps Between Daily Living and Clinical Settings in Chronic Disease Management: Qualitative Study

“…Most informatics tool-design models begin with a needs assessment [ 33 , 34 ]. To our knowledge, previous systematic, large-scale, qualitative needs assessments for health IT design have focused on either clinical activities or supporting health-related activities in daily life, not the space or gaps between these areas [ 35 , 36 ].…”

Between “the best way to deliver patient care” and “chaos and low clinical value”: General Practitioners’ and Practice Managers’ views on data sharing

“…[24,28,29] The challenges of development, implementation uptake and sustainability are significant; the findings about outcomes are often disappointing. [2,22,24,27,[30][31][32][33][34][35][36][37][38][39] A recent systematic review [24] suggests that HIE tools are used to a limited extent, typically in between 2% to 10% of patient visits, and that their impact on outcomes is largely unknown beyond HIE "probably reduces emergency department usage and costs in some cases".…”