Outcomes From Health Information Exchange: Systematic Review and Future Research Needs

Hersh, William R.; Totten, Annette M; Eden, Karen; Devine, Beth; Gorman, Paul N.; Kassakian, Steven Z.; Woods, Susan; Daeges, Monica; Pappas, Miranda; McDonagh, Marian

doi:10.2196/medinform.5215

Cited by 110 publications

(108 citation statements)

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“…While metric lists by organizations like the ONC 31 may not be the last word on measurement, such a compendium provides a starting point for existing approaches already in use. Already there are calls for greater attentiveness to designs, levels of measurement, and conceptual frameworks for outcome evaluations, 21,26 but our findings suggest the research and evaluation community can be more attentive to the glaring need for greater conceptual clarity about HIE in general. Our interviewees' experiences differed on multiple dimensions: state and local; community and enterprise; large and small; with and with academic participation; and with significant public funding and without.…”

Section: Data Qualitymentioning

confidence: 82%

“…13,14,15,16 More recently, research has begun to compare multiple HIEs within or across states to examine process and outcomes. 17,18 However, recent systematic reviews of the literature have been fairly critical, concluding that the existing evidence base for HIE as an effective intervention to change utilization, cost, and quality is insufficient, 19,20,21 and is falling short of expectations around the ability for data stored in HIEs to facilitate population level data.…”

Section: Introductionmentioning

confidence: 99%

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Challenges to Conducting Health Information Exchange Research and Evaluation: Reflections and Recommendations for Examining the Value of HIE

Yeager¹,

Vest²,

Walker³

et al. 2017

eGEMs

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Introduction: Health information exchange (HIE) promises cost and utilization reductions. To date, only a small number of HIE studies have demonstrated benefits to patients, providers, public health, or payers. This may be because evaluations of HIE are methodologically challenging. Indeed, the quality of HIE evaluations is often limited and authors frequently note unmet evaluation objectives. We provide a systematic identification of HIE research challenges that can be used to inform strategies for higher quality scientific evidence. Methods:We conducted qualitative interviews with 23 HIE researchers and leaders of HIE efforts representing experiences with more than 20 HIE efforts. We also conducted a six-person focus group to expand on and confirm individual interview findings. Qualitative analysis followed a grounded theory approach using multiple coders.Results: Participants experienced similar challenges across seven themes (i.e., HIE maturity, data quality, data availability, goal alignment, cooperation, methodology, and policy). Conclusion:Several options may exist to improve HIE research, including developing better conceptual models and methodological approaches to HIE research; formal partnerships between researchers and HIE entities; and establishing a nationwide database of HIE information. Our proposed approaches of promoting data availability, resource sharing, and new partnerships can help to overcome existing barriers and facilitate HIE research.

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Section: Data Qualitymentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Challenges to Conducting Health Information Exchange Research and Evaluation: Reflections and Recommendations for Examining the Value of HIE

Yeager¹,

Vest²,

Walker³

et al. 2017

eGEMs

View full text Add to dashboard Cite

show abstract

“…Another important result of this work was the measurement of data quality metrics to gauge the impact of the eHealth-Interop platform in informational continuity of care, since impact of HIE are yet inadequately studied [44,45].…”

Section: Principal Resultsmentioning

confidence: 99%

An eHealth Platform for the Support of a Brazilian Regional Network of Mental Health Care (eHealth-Interop): Development of an Interoperability Platform for Mental Care Integration (Preprint)

Miyoshi¹,

Marques²,

Alves³

et al. 2018

Preprint

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BACKGROUND The electronic exchange of health-related data can support different professionals and services to act in a more coordinated and transparent manner and make the management of health service networks more efficient. Although mental health care is one of the areas that can benefit from a secure health information exchange (HIE), as it usually involves long-term and multiprofessional care, there are few published studies on this topic, particularly in low- and middle-income countries. OBJECTIVE The aim of this study was to design, implement, and evaluate an electronic health (eHealth) platform that allows the technical and informational support of a Brazilian regional network of mental health care. This solution was to enable HIE, improve data quality, and identify and monitor patients over time and in different services. METHODS The proposed platform is based on client-server architecture to be deployed on the Web following a Web services communication model. The interoperability information model was based on international and Brazilian health standards. To test platform usage, we have utilized the case of the mental health care network of the XIII Regional Health Department of the São Paulo state, Brazil. Data were extracted from 5 different sources, involving 26 municipalities, and included national demographic data, data from primary health care, data from requests for psychiatric hospitalizations performed by community services, and data obtained from 2 psychiatric hospitals about hospitalizations. Data quality metrics such as accuracy and completeness were evaluated to test the proposed solution. RESULTS The eHealth-Interop integration platform was designed, developed, and tested. It contains a built-in terminology server and a record linkage module to support patients’ identification and deduplication. The proposed interoperability environment was able to integrate information in the mental health care network case with the support of 5 international and national terminologies. In total, 27,353 records containing demographic and clinical data were integrated into eHealth-Interop. Of these records, 34.91% (9548/27,353) were identified as patients who were present in more than 1 data source with different levels of accuracy and completeness. The data quality analysis was performed on 26 demographic attributes for each integrable patient record, totaling 248,248 comparisons. In general, it was possible to achieve an improvement of 18.40% (45,678/248,248) in completeness and 1.10% (2731/248,248) in syntactic accuracy over the test dataset after integration and deduplication. CONCLUSIONS The proposed platform established an eHealth solution to fill the gap in the availability and quality of information within a network of health services to improve the continuity of care and the health services management. It has been successfully applied in the context of mental health care and is flexible to be tested in other areas of care.

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“…Evidence about the benefits of HIE are encouraging [3]. Studies on HIE outcomes have reported modest to moderate reductions in duplicate laboratory and radiology testing [4][5][6], better identification of medication discrepancies and improved medication reconciliation [7].…”

Section: Introductionmentioning

confidence: 99%

Key Factors Affecting Ambulatory Care Providers’ Electronic Exchange of Health Information With Affiliated and Unaffiliated Partners: Web-Based Survey Study (Preprint)

Pendergrass¹,

Ranganathan²

2018

Preprint

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BACKGROUND Despite the potential benefits of electronic health information exchange (HIE) to improve the quality and efficiency of care, HIE use by ambulatory providers remains low. Ambulatory providers can greatly improve the quality of care by electronically exchanging health information with affiliated providers within their health care network as well as with unaffiliated, external providers. OBJECTIVE This study aimed to examine the extent of electronic HIE use by ambulatory clinics with affiliated providers within their health system and with external providers, as well as the key technological, organizational, and environmental factors affecting the extent of HIE use within and outside the health system. METHODS A Web-based survey of 320 ambulatory care providers was conducted in the state of Illinois. The study examined the extent of HIE usage by ambulatory providers with hospitals, clinics, and other facilities within and outside their health care system–encompassing seven kinds of health care data. Ten factors pertaining to technology (IT [information technology] Compatibility, External IT Support, Security & Privacy Safeguards), organization (Workflow Adaptability, Senior Leadership Support, Clinicians Health-IT Knowledge, Staff Health-IT Knowledge), and environment (Government Efforts & Incentives, Partner Readiness, Competitors and Peers) were assessed. A series of multivariate regressions were used to examine predictor effects. RESULTS The 6 regressions produced adjusted R-squared values ranging from 0.44 to 0.63. We found that ambulatory clinics exchanged more health information electronically with affiliated entities within their health system as compared with those outside their health system. Partner readiness emerged as the most significant predictor of HIE usage with all entities. Governmental initiatives for HIE, clinicians’ prior familiarity and knowledge of health IT systems, implementation of appropriate security, and privacy safeguards were also significant predictors. External information technology support and workflow adaptability emerged as key predictors for HIE use outside a clinic’s health system. Differences based on clinic size, ownership, and specialty were also observed. CONCLUSIONS This study provides exploratory insights into HIE use by ambulatory providers within and outside their health care system and differential predictors that impact HIE use. HIE use can be further improved by encouraging large-scale interoperability efforts, improving external IT support, and redesigning adaptable workflows.

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Outcomes From Health Information Exchange: Systematic Review and Future Research Needs

Cited by 110 publications

References 50 publications

Challenges to Conducting Health Information Exchange Research and Evaluation: Reflections and Recommendations for Examining the Value of HIE

Challenges to Conducting Health Information Exchange Research and Evaluation: Reflections and Recommendations for Examining the Value of HIE

An eHealth Platform for the Support of a Brazilian Regional Network of Mental Health Care (eHealth-Interop): Development of an Interoperability Platform for Mental Care Integration (Preprint)

Key Factors Affecting Ambulatory Care Providers’ Electronic Exchange of Health Information With Affiliated and Unaffiliated Partners: Web-Based Survey Study (Preprint)

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