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CC BY-NC-ND 4.0 · ACI open 2023; 07(02): e49-e60
DOI: 10.1055/s-0043-1772583
Research Article

Directly Integrating Health Information Exchange (HIE) Data with the Electronic Health Record Increases HIE Use by Emergency Department Clinicians

Rebecca L. Rivera   *
1   Clem McDonald Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, Indiana, United States
2   Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States
,
Heidi Hosler   *
1   Clem McDonald Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, Indiana, United States
,
Jeong Hoon Jang
3   Quantitative Risk Management and Department of Applied Statistics, Yonsei University, Seoul, South Korea
,
Jason T. Schaffer
4   Department of Emergency Medicine, Indiana University Health, Indianapolis, Indiana, United States
,
John Price
1   Clem McDonald Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, Indiana, United States
5   Regenstrief Institute Data Core, Regenstrief Institute, Inc., Indianapolis, Indiana, United States
,
Joshua R. Vest
1   Clem McDonald Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, Indiana, United States
6   Department of Health, Policy and Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, United States
,
Titus K. Schleyer
1   Clem McDonald Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, Indiana, United States
2   Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States
› Institutsangaben
Funding This research was made possible by the Lilly Endowment Inc. Physician Scientist Initiative; Indiana University Health and the Indiana Clinical and Translational Sciences Institute, funded in part by grant ULI TR002529 from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Science Award; and the Advances in Medicine (AIM) grant from Cook Medical. Drs. Rivera, Schleyer, Schaffer, Vest, and Jang received funding from the Agency for Healthcare Research and Quality under grant R01HS027185. Dr. Rivera and Ms. Hosler were part of the Indiana Public and Population Health Informatics training program at Fairbanks School of Public Health and Regenstrief Institute, supported by the National Library of Medicine of the National Institutes of Health under award T15LM012502. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, Cook Medical, the Agency for Healthcare Research and Quality, Indiana University, or Regenstrief Institute.
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Abstract

Objectives This article (1) develops a Fast Healthcare Interoperability Resources app, Health Dart, that integrates information from Indiana's community health information exchange (HIE), the Indiana Network for Patient Care (INPC), directly with Cerner, an electronic health record (EHR), and (2) evaluates the effect of Health Dart's implementation on HIE use.

Methods Health Dart was implemented in 14 Indiana University Health emergency departments (EDs) using a stepped-wedge study design. We analyzed rates of INPC use in 286,175 ED encounters between October 1, 2019 and December 31, 2020. Logistic regression was used to model the probability of INPC use given the implementation context, such as user interface (UI) enhancements and the coronavirus disease 2019 pandemic.

Results INPC use increased by 131% across all encounters (from 3.6 to 8.3%; p < 0.001) after Health Dart implementation. INPC use increased by 144% (from 3.6 to 8.8%; p < 0.001) more than 2 months postimplementation. After UI enhancements, postimplementation INPC use increased by 123% (from 3.5 to 7.8%) compared to 181% (from 3.6 to 10.1%; p < 0.001) in postimplementation encounters that occurred before UI enhancements. During the pandemic, postimplementation INPC use increased by 135% (from 3.4 to 8.0%; p < 0.001) compared to 178% (from 3.6 to 10%; p < 0.001) in postimplementation encounters that occurred before the pandemic. Statistical significance was determined using 95% confidence intervals (α = 0.05).

Conclusion Direct integration of HIE information into an EHR substantially increased frequency of HIE use, but the effect was weakened by the UI enhancements and pandemic. HIE information integrated into EHRs in the form of problem-oriented dashboards can potentially make information retrieval more efficient and effective for clinicians.

Keywords

emergency departments - health information exchange - Fast Healthcare Interoperability Resources - FHIR - electronic health record - COVID-19 pandemic

Author Contributions

R.L.R.: conceptualization; formal analysis, funding acquisition, investigation, methodology, project administration, supervision, validation, visualization, writing—review and editing; H.H.: conceptualization, formal analysis, investigation, methodology, project administration, validation, visualization, writing—original draft; J.H.J.: formal analysis, methodology, validation; J.T.S.: funding acquisition, resources, writing—review and editing; J.P.: data curation, resources; J.R.V.: methodology, funding acquisition, formal analysis oversight, writing—review and editing; T.K.S.: conceptualization, funding acquisition, investigation, resources, supervision, validation, visualization, writing—review and editing.


Protection of Human and Animal Subjects

This study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed and approved by the Indiana University Institutional Review Board protocol #1905749709.


* These authors contributed equally to this work.


Supplementary Material



Publikationsverlauf

Eingereicht: 22. Juli 2022

Angenommen: 26. Januar 2023

Artikel online veröffentlicht:
28. September 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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