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

Abstract

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.

Barriers and facilitators to exchanging health information: a systematic review

“…In total, 292 health professionals (non-clinicians) and 402 clinicians in the US were surveyed, interviewed or participated in focus groups sessions. [12, 15-20, 22-24, 28-31] The settings in these studies often included exchange between emergency departments, ambulatory clinics and/or hospitals making stratification by setting difficult. Two additional US-based studies also provided perspective from patients about willingness to have their own data exchanged.…”

“…[16, 18, 21, 23, 25, 26, 28, 29] Eleven studies were rated moderate risk of bias (did not meet 1-2 criteria or did not report the information on the criteria, eAppendix Table B ). [11, 14, 15, 17, 19, 20, 22, 24, 30-32] Two multiple site case studies were considered high risk of bias. [13, 27] One study did not provide sufficient detail to rate the study for risk of bias.…”

“…Four evaluations of the MidSouth e-Health Alliance (MSeHA) provide evidence on barriers and facilitators of use[14, 18, 19, 23] but other studies echoed similar issues. [11, 15-17, 21, 22, 24-26, 28, 29, 32] Barriers and facilitators to use fell under three broad themes: completeness of information, organization and workflow, technology and user needs ( Table 1 ).…”

“…[11, 15, 17, 18, 20, 22, 24, 28-30] Several barriers contributed to incomplete information: patients did not participate because of concerns about privacy[20, 28, 30] or they received care outside of the HIE catchment area;[15] a poor patient matching process. [11, 24] Providers stopped using the query-based system when they could not find patients or new information on patients[15, 18, 20, 24, 29, 30] ( Table 1 ). Incomplete information was found to be a key issue in studies conducted in the US but was not mentioned in studies conducted outside of the US.…”

“…These include addressing concern about privacy with policy and training,[22, 31] careful consideration and design of the consent process,[11, 15, 30] and creation of a process for educating patients. [15, 30] To address patient and provider concern about privacy, organizations should create clear policies and promote understanding about privacy and data sharing among all stakeholders (providers, patients, non-clinician partners) prior to implementation of any data exchange. [31] In planning for electronic health exchange, it is important to decide whether to have an opt-out or opt-in consent process for patients as this effects rates of participation and ultimately, completeness of information.…”