Summary
Objective: To provide a case report of barriers and promoters to implementing a health information
exchange (HIE) tool that supports patient transfers between hospitals and skilled
nursing facilities.
Methods: A multi-disciplinary team conducted semi-structured telephone and in-person interviews
in a purposive sample of HIE organizational informants and providers in New York City
who implemented HIE to share patient transfer information. The researchers conducted
grounded theory analysis to identify themes of barriers and promoters and took steps
to improve the trustworthiness of the results including vetting from a knowledgeable
study participant.
Results: Between May and October 2011, researchers recruited 18 participants: informaticians,
healthcare administrators, software engineers, and providers from a skilled nursing
facility. Subjects perceived the HIE tool’s development a success in that it brought
together stakeholders who had traditionally not partnered for informatics work, and
that they could successfully share patient transfer information between a hospital
and a skilled nursing facility. Perceived barriers included lack of hospital stakeholder
buy-in and misalignment with clinical workflows that inhibited use of HIE-based patient
transfer data. Participants described barriers and promoters in themes related to
organizational, technical, and user-oriented issues.
The investigation revealed that stakeholders could develop and implement health information
technology that technically enables clinicians in both hospitals and skilled nursing
facilities to exchange real-time information in support of patient transfers. User
level barriers, particularly in the emergency department, should give pause to developers
and implementers who plan to use HIE in support of patient transfers.
Conclusions: Participants’ experiences demonstrate how stakeholders may succeed in developing
and piloting an electronic transfer form that relies on HIE to aggregate, communicate,
and display relevant patient transfer data across health care organizations. Their
experiences also provide insights for others seeking to develop HIE applications to
improve patient transfers between emergency departments and skilled nursing facilities.
Citation: Richardson JE, Malhotra S, Kaushal R. A case report in health information exchange
for inter-organizational patient transfers. Appl Clin Inf 2014; 5: 642–650
http://dx.doi.org/10.4338/ACI-2014-02-CR-0016
Keywords Medical informatics - patient transfer - health information exchange - computer communication
networks - qualitative research
