Adoption of Health Information Exchange by Emergency Physicians at Three Urban Academic Medical Centers
02 February 2011
accepted: 18 May 2011
16 December 2017 (online)
Objectives: Emergency physicians are trained to make decisions quickly and with limited patient information. Health Information Exchange (HIE) has the potential to improve emergency care by bringing relevant patient data from non-affiliated organizations to the bedside. NYCLIX (New York CLinical Information eXchange) offers HIE functionality among multiple New York metropolitan area provider organizations and has pilot users in several member emergency departments (EDs).
Methods: We conducted semi-structured interviews at three participating EDs with emergency physicians trained to use NYCLIX. Among “users” with > 1 login, responses to questions regarding typical usage scenarios, successful retrieval of data, and areas for improving the interface were recorded. Among “non-users” with ≤1 login, questions about NYCLIX accessibility and utility were asked. Both groups were asked to recall items from prior training regarding data sources and availability.
Results: Eighteen NYCLIX pilot users, all board certified emergency physicians, were interviewed. Of the 14 physicians with more than one login, half estimated successful retrieval of HIE data affecting patient care. Four non-users (one login or less) cited forgotten login information as a major reason for non-use. Though both groups made errors, users were more likely to recall true NYCLIX member sites and data elements than non-users. Improvements suggested as likely to facilitate usage included a single automated login to both the ED information system (EDIS) and HIE, and automatic notification of HIE data availability in the EDIS All respondents reported satisfaction with their training.
Conclusions: Integrating HIE into existing ED workflows remains a challenge, though a substantial fraction of users report changes in management based on HIE data. Though interviewees believed their training was adequate, significant errors in their understanding of available NYCLIX data elements and participating sites persist.
- 1 Clancy CM. Keynote address: Closing the research-to-practice gap in emergency medicine. Acad Emerg Med 2007; 14 (11) 932-935.
- 2 Kohn LT, Corrigan JM, Donaldson MS. Committee on Quality of Health Care in America, Institute of Medicine editors. To err is human: building a safer health system. Washington, DC, USA: National Academies Press; 1999
- 3 Vaidya S, Shapiro JS, Kuperman G. Unique patients and crossover rates in a health information exchange in New York City. AMIA Annu Symp Proc 2010.
- 4 Finnell JT, Overhage JM, Dexter PR, Perkins SM, Lane KA, McDonald CJ. Community clinical data exchange for emergency medicine patients. AMIA Annu Symp Proc 2003: 235-238.
- 5 Stiell A, Forster AJ, Stiell IG, van Walraven C. Prevalence of information gaps in the emergency department and the effect on patient outcomes. CMAJ 2003; 169 (10) 1023-1028.
- 6 Shapiro JS, Kannry J, Kushniruk AW, Kuperman G. New York Clinical Information Exchange (NYCLIX) Clinical Advisory Subcommittee. Emergency physicians’ perceptions of health information exchange. J Am Med Inform Assoc 2007; 14 (06) 700-705.
- 7 Overhage JM, Dexter PR, Perkins SM, Cordell WH, McGoff J, McGrath R. et al. A randomized, controlled trial of clinical information shared from another institution. Ann Emerg Med 2002; 39 (01) 14-23.
- 8 Frisse ME, King JK, Rice WB, Tang L, Porter JP, Coffman TA. et al. A regional health information exchange: architecture and implementation. AMIA Annu Symp Proc 2008; 212-216.
- 9 Shapiro JS, Vaidya SR, Kuperman G. Preparing for the evaluation of health information exchange. AMIA Annu Symp Proc. 2008: 1128.
- 10 Curran-Smith J, Best S. An experience with an online learning environment to support a change in practice in an emergency department. Comput Inform Nurs 2004; 22 (02) 107-110.
- 11 Friedmann BE, Shapiro JS, Kannry J, Kuperman G. Analyzing workflow in emergency departments to prepare for health information exchange. AMIA Annu Symp Proc. 2006: 926.
- 12 Wright A, Soran C, Jenter CA, Volk LA, Bates DW, Simon SR. Physician attitudes toward health information exchange: results of a statewide survey. J Am Med Inform Assoc 2010; 17 (01) 66-70.
- 13 Gottlieb LK, Stone EM, Stone D, Dunbrack LA, Calladine J. Regulatory and policy barriers to effective clinical data exchange: lessons learned from MedsInfo-ED. Health Aff (Millwood) 2005; 24 (05) 1197-1204.
- 14 Patel V, Abramson EL, Edwards A, Malhotra S, Kaushal R. Physicians’ potential use and preferences related to health information exchange. Int J Med Inform 2011; 80 (03) 171-180.
- 15 Vest JR, Gamm LD. Health information exchange: persistent challenges and new strategies. J Am Med Inform Assoc 2010; 17 (03) 288-294.
- 16 Davison C, Johnson K, Estrin V, King J, Yang K, Tang L, Frisse M. Assessing Information Access in a Health Information Exchange. AMIA Annu Symp Proc. 2009
- 17 Johnson KB, Gadd CS, Aronsky D, Yang K, Tang L, Estrin V. et al. The MidSouth eHealth Alliance: use and impact in the first year. AMIA Annu Symp Proc 2008: 333-337.
- 18 The New York e-Health Collaborative: The Statewide Collaboration Process.. Privacy and security policies and procedures for RHIOs and their participants in New York State: Version 2.0. Nov 13, 2009. http://www. nyehealth.org/images/files/File_Repository16/heal5/PrivSec_PPs_V2.pdf.
- 19 Kuzel AJ. Sampling in qualitative inquiry. Doing qualitative research. 2nd ed. Thousand Oaks, CA: Sage Publications Inc; 1999. p.33.
- 20 Sittig DF, Ash JS, Guappone KP, Campbell EM, Dykstra RH. Assessing the anticipated consequences of computer-based provider order entry at three community hospitals using an open-ended, semi-structured survey instrument. Int J Med Inform 2008; 77 (07) 440-447.
- 21 Menachemi N, Powers T, Au DW, Brooks RG. Predictors of physician satisfaction among electronic health record system users. J Healthc Qual 2010; 32 (01) 35-41.
- 22 Chisolm DJ, Purnell TS, Cohen DM, McAlearney AS. Clinician perceptions of an electronic medical record during the first year of implementaton in emergency services. Pediatr Emerg Care 2010; 26 (02) 107-110.
- 23 Frisse ME, Holmes RL. Estimated financial savings associated with health information exchange and ambulatory care referral. J Biomed Inform 2007; 40 (Suppl. 06) S27-32.
- 24 Shablinsky I, Starren J, Friedman C. What do ER physicians really want? A method for elucidating ER information needs. Proc AMIA Symp 1999: 390-394.
- 25 Simon SR, Kaushal R, Jenter CA, Volk LA, Burdick E, Poon EG. et al. Readiness for electronic health records: comparison of characteristics of practices in a collaborative with the remainder of Massachusetts. Inform Prim Care 2008; 16 (02) 129-137.