Health information exchange usage in emergency departments and clinics: the who, what, and why

Johnson, Kevin B.; Unertl, Kim M.; Chen, Qingxia; Lorenzi, Nancy M.; Nian, Hui; Bailey, James E.; Frisse, Mark E.

doi:10.1136/amiajnl-2011-000308

Cited by 105 publications

(113 citation statements)

References 18 publications

(3 reference statements)

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“…In our study, physicians reported workflow challenges due to several factors that have caused disruptions to their workflow such as a slow system response time and multiple logins. Single sign-on or more contextaware system integration are necessary to increase usage of the RHIOs' web-based portals, especially for physicians [20,54]. Interestingly, our interviews also indicated that the more information presented to the users may not always be better.…”

Section: Discussionmentioning

confidence: 87%

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How could health information exchange better meet the needs of care practitioners?

Kierkegaard¹,

Kaushal

Vest

2014

Appl Clin Inform

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SummaryBackground: Health information exchange (HIE) has the potential to improve the quality of healthcare by enabling providers with better access to patient information from multiple sources at the point of care. However, HIE efforts have historically been difficult to establish in the US and the failure rates of organizations created to foster HIE have been high. Objectives: We sought to better understand how RHIO-based HIE systems were used in practice and the challenges care practitioners face using them. The objective of our study were to so investigate how HIE can better meet the needs of care practitioners. Methods: We performed a multiple-case study using qualitative methods in three communities in New York State. We conducted interviews onsite and by telephone with HIE users and non-users and observed the workflows of healthcare professionals at multiple healthcare organizations participating in a local HIE effort in New York State. Results:The empirical data analysis suggests that challenges still remain in increasing provider usage, optimizing HIE implementations and connecting HIE systems across geographic regions. Important determinants of system usage and perceived value includes users experienced level of available information and the fit of use for physician workflows. Conclusions: Challenges still remain in increasing provider adoption, optimizing HIE implementations, and demonstrating value. The inability to find information reduced usage of HIE. Healthcare organizations, HIE facilitating organizations, and states can help support HIE adoption by ensuring patient information is accessible to providers through increasing patient consents, fostering broader participation, and by ensuring systems are usable.

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Section: Discussionmentioning

confidence: 87%

“…Addressing these problem first would help minimize the challenges associated with the poor availability of information in the system and users low levels of search confidence. Such problems often leads to reduced usage of HIE [20]. We propose the following recommendations as to how these challenges can be addressed.…”

Section: Discussionmentioning

confidence: 99%

How could health information exchange better meet the needs of care practitioners?

Kierkegaard¹,

Kaushal

Vest

2014

Appl Clin Inform

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“…The results, if supported by additional research, can drive IT implementation and use at EDs in spite of barriers and challenges reported in the literature (Menachemi, Brooks, Schwalenstocker, & Simpson, 2009). It also hints at potential positive outcomes of using such a system that can be quantified, as opposed to other studies that yielded mixed results concerning benefits of using healthcare IT in general, and EMRs in particular (Furukawa, 2011;Gagnon et al, 2012;Johnson et al, 2011;Kellermann & Jones, 2013). It will thus be quite straightforward to calculate the ROI of such systems if field evaluations of the system yield similar results.…”

Section: Expected Contributionmentioning

confidence: 67%

Simulating the impact of an online digital dashboard in emergency departments on patients length of stay

Mazor

Heart

Even

2016

Journal of Decision Systems

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a Department of industrial engineering and management, Ben-Gurion university of the negev, Beer-sheva, israel; b faculty of Business administration, ono academic college, Kiriat-ono, israel ABSTRACTOvercrowding at EDs is a world known problem which negatively affects the quality of medical care. It is evident, for example, by long patients' waiting times. EDs frequently use average patients' length of stay (LOS) as a performance indicator. Long LOS is commonly correlated with overcrowding. In this research, a prototype of an electronic online digital dashboard, termed operational BI, was developed following the Design Science Research methodology. The system is targeted to be used by the ED staff. Simulation was used to assess if such a system, which displays ED's critical data in a dashboard visualisation, can decrease LOS, thereby ease EDs' overcrowding. Six scenarios were simulated, depicting various use patterns. The results show a potential decrease of 34-44% in average LOS, depending on the use pattern. These are promising results that call for further, realworld examination of the system.

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“…As can be seen, the total time is split almost evenly between reduce and the cryptographic operations for data at level 3 and is dominated by reduce for data at level 2. Johnson et al [18] report approximately 81 accesses per day in a typical HIE. Based on this number, we calculate the total time for auditing all accesses in a day and in a month to be 6.57/5.41 seconds (level 3/level 2) and 3.26/2.68 minutes, respectively.…”

Section: Implementation and Evaluationmentioning

confidence: 99%

“…(ms) [18]). The external audit data has a size of 12 MB, and includes roughly 9,644 entries about patient registration, billing and referral.…”

Section: Implementation and Evaluationmentioning

confidence: 99%

Privacy-preserving audit for broker-based health information exchange

Chun

Jia

et al. 2014

Proceedings of the 4th ACM Conference on Data and Application Security and Privacy

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Developments in health information technology have encouraged the establishment of distributed systems known as Health Information Exchanges (HIEs) to enable the sharing of patient records between institutions. In many cases, the parties running these exchanges wish to limit the amount of information they are responsible for holding because of sensitivities about patient information. Hence, there is an interest in broker-based HIEs that keep limited information in the exchange repositories. However, it is essential to audit these exchanges carefully due to risks of inappropriate data sharing. In this paper, we consider some of the requirements and present a design for auditing broker-based HIEs in a way that controls the information available in audit logs and regulates their release for investigations. Our approach is based on formal rules for audit and the use of Hierarchical Identity-Based Encryption (HIBE) to support staged release of data needed in audits and a balance between automated and manual reviews. We test our methodology via an extension of a standard for auditing HIEs called the Audit Trail and Node Authentication Profile (ATNA) protocol.

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Health information exchange usage in emergency departments and clinics: the who, what, and why

Cited by 105 publications

References 18 publications

How could health information exchange better meet the needs of care practitioners?

How could health information exchange better meet the needs of care practitioners?

Simulating the impact of an online digital dashboard in emergency departments on patients length of stay

Privacy-preserving audit for broker-based health information exchange

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