What Affects Clinicians’ Usage of Health Information Exchange?
15 March 2011
accepted: 17 May 2011
16 December 2017 (online)
Background: The ability to electronically exchange health information among healthcare providers holds enormous promise to improve care coordination and reduce costs. Provider-to-provider data exchange is an explicit goal of the American Recovery and Reinvestment Act of 2009 and may be essential for the long-term success of the Affordable Care Act of 2010. However, little is known about what factors affect clinicians’ usage of health information exchange (HIE) functionality.
Objective: To identify factors that affect clinicians’ HIE usage - in terms of frequency of contributing data to and accessing data from aggregate patient records - and suggest policies for fostering its usage.
Methods: We performed a qualitative study using grounded theory by interviewing clinician-users and HIE staff of one operational HIE which supported aggregate patient record functionality. Fifteen clinicians were interviewed for one hour each about what factors affect their HIE usage. Five HIE staff were asked about technology and training issues to provide context. Interviews were recorded, transcribed and analyzed. Recruitment excluded clinicians with little or no familiarity with the HIE and was restricted to one community and a small number of specialties.
Results: Clinicians were motivated to access the HIE by perceived improvements in care quality and time savings, but their motivation was moderated by an extensive list of factors including gaps in data, workflow issues and usability issues. HIE access intensities varied widely by clinician. Data contribution intensities to the HIE also varied widely and were affected by billing concerns and time constraints.
Conclusions: Clinicians, EHR and HIE product vendors and trainers should work toward integrating HIE into clinical workflows. Policies should create incentives for HIE organizations to assist clinicians in using HIE, develop measures of HIE contributions and accesses, and create incentives for clinicians to contribute data to HIEs.
- 1 Walker J, Pan E, Johnston D, Adler-Milstein J, Bates DW, Middleton B. The value of health care information exchange and interoperability. Health Aff (Millwood) 2005; Suppl Web Exclusives: W5–10–W5–18. Available from: http://dx.doi.org/10.1377/hlthaff.w5.10.
- 2 Bates DW, Bitton A. The future of health information technology in the patient-centered medical home. Health Aff (Millwood) 2010; 29 (04) 614-621. Available from: http://dx.doi.org/10.1377/hlthaff.2010.0007.
- 3 McClellan M, McKethan AN, Lewis JL, Roski J, Fisher ES. A national strategy to put accountable care into practice. Health Aff (Millwood) 2010; 29 (05) 982-990. Available from: http://dx.doi.org 10. 1377/hlthaff.2010.0194.
- 4 Adler-Milstein J, Bates DW, Jha AK. U. S. Regional health information organizations: progress and challenges. Health Aff (Millwood) 2009; 28 (02) 483-492. Available from: http://dx.doi.org 10. 1377/hlthaff.28.2.483.
- 5 Office of the National Coordination for Health Information Technology.. American Recovery and Reinvestment Act. 2009 Available from: http://healthit.hhs.gov/.
- 6 Department of Health and Human Services.. Final Rule; 2010. Available from: http://www.ofr.gov/OFRU pload/OFRData/2010–17207_PI.pdf (accessed July 2010).
- 7 Hincapie AL, Warholak TL, Murcko AC, Slack M, Malone DC. Physicians’ opinions of a health information exchange. J Am Med Inform Assoc 2011; 18 (01) 60-65. Available from: http://dx.doi.org 10. 1136/jamia.2010.006502.
- 8 Vest JR, Zhao H, ’jon Jaspserson Gamm LD, Ohsfeldt RL. Factors motivating and affecting health information exchange usage. J Am Med Inform Assoc 2011; 18: 143-149. Available from: http://dx.doi.org 10. 1136/jamia.2010.004812.
- 9 Tripathi M, Delano D, Lund B, Rudolph L. Engaging patients for health information exchange. Health Aff (Millwood) 2009; 28 (02) 435-443. Available from: http://dx.doi.org/10.1377/hlthaff.28.2.435.
- 10 Berg BL. Qualitative research methods for the social sciences. 6th edition. Pearson; 2007
- 11 Charmaz K. Constructing grounded theory: a practical guide through qualitative analysis. Sage; 2006
- 12 Venkatesh V, Morris MG, Davis GB, Davis FD. User acceptance of information technology: toward a unified view. MIS Quarterly 2003; 27: 425-478.
- 13 Grossman JM, Kushner KL, November EA. Creating sustainable local health information exchanges: can barriers to stakeholder participation be overcome? Center for Studying Health System Change. 2008 Research brief.
- 14 Miller RH, Miller BS. The Santa Barbara County Care Data Exchange: what happened?. Health Aff (Mill-wood) 2007; 26 (05) w568-w580. Available from: http://dx.doi.org/10.1377/hlthaff.26.5.w568.
- 15 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. Available from: http://dx.doi.org/10.1197/jamia. M3241.
- 16 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.
- 17 Greenhalgh T, Stramer K, Bratan T, Byrne E, Mohammad Y, Russell J. Introduction of shared electronic records: multi-site case study using diffusion of innovation theory. BMJ 2008; 337: a1786.
- 18 Shapiro JS, Kannry J, Kushniruk AW, Kuperman G, Subcommittee NYCIENCA. Emergency physicians’ perceptions of health information exchange. J Am Med Inform Assoc 2007; 14 (06) 700-705.
- 19 Ross SE, Schilling LM, Fernald DH, Davidson AJ, West DR. Health information exchange in small-to-medium sized family medicine practices: motivators, barriers, and potential facilitators of adoption. Int J Med Inform 2010; 79 (02) 123-129. Available from: http://dx.doi.org/10.1016/j.ijmedinf.2009.12.001.
- 20 Fontaine P, Zink T, Boyle RG, Kralewski J. Health information exchange: participation by Minnesota primary care practices. Arch Intern Med 2010; 170 (07) 622-629. Available from: http://dx.doi.org 10. 1001/archinternmed.2010.54.
- 21 Rudin RS, Simon SR, Volk LA, Tripathi M, Bates D. Understanding the decisions and values of stakeholders in health information exchanges: experiences from Massachusetts. Am J Public Health 2009; 99 (05) 950-955. Available from: http://dx.doi.org/10.2105/AJPH.2008.144873.
- 22 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. Available from: http://dx.doi.org 10. 1016/j.ijmedinf.2010.11.008.
- 23 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.
- 24 Bourgeois FC, Olson KL, Mandl KD. Patients treated at multiple acute health care facilities: quantifying information fragmentation. Arch Intern Med 2010; 170 (022) 1989-1995. Available from: http://dx.doi. org/10.1001/archinternmed.2010.439.
- 25 Halamka JD. Making the most of federal health information technology regulations. Health Aff (Mill-wood) 2010; 29 (04) 596-600. Available from: http://dx.doi.org/10.1377/hlthaff.2010.0232.
- 26 Berg M. Patient care information systems and health care work: a sociotechnical approach. Int J Med Inform 1999; 55 (02) 87-101.
- 27 Fisher ES, Staiger DO, Bynum JPW, Gottlieb DJ. Creating accountable care organizations: the extended hospital medical staff. Health Aff (Millwood) 2007; 26 (01) w44-w57. Available from: http://dx.doiorg/10.1377/hlthaff.26.1.w44.
- 28 American Academy of Family Physicians.. Joint principles of the patient-centered medical home. Del Med J 2008; 80 (01) 21-22.
- 29 Vest JR, Jasperson J. What should we measure? Conceptualizing usage in health information exchange. J Am Med Inform Assoc 2010; 17 (03) 302-307. Available from: http://dx.doi.org 10. 1136/jamia.2009.000471.
- 30 The Direct Project.. Available from: http://directproject.org (accessed February 20, 2011).
- 31 Smith PC, Araya-Guerra R, Bublitz C, Parnes B, Dickinson LM, Vorst RV. et al. Missing clinical information during primary care visits. JAMA 2005; 293 (05) 565-571. Available from: http://dx.doi.org 10. 1001/jama.293.5.565.
- 32 van Walraven C, Taljaard M, Bell CM, Etchells E, Zarnke KB, Stiell IG. et al. Information exchange among physicians caring for the same patient in the community. CMAJ 2008; 179 (010) 1013-1018. Available from: http://dx.doi.org/10.1503/cmaj.080430.
- 33 Gandhi TK, Sittig DF, Franklin M, Sussman AJ, Fairchild DG, Bates DW. Communication breakdown in the outpatient referral process. J Gen Intern Med 2000; 15 (09) 626-631.