Appl Clin Inform 2014; 05(04): 861-877
DOI: 10.4338/ACI-2014-06-RA-0055
Research Article
Schattauer GmbH

How could health information exchange better meet the needs of care practitioners?

P. Kierkegaard
1   University of Copenhagen, Department of Computer Science, København S, Denmark
,
R. Kaushal
2   Department of Healthcare Policy and Research, Center for Healthcare Informatics and Policy, Weill Cornell Medical College, New York, USA, Health Information Technology Evalution Collaborative (HITEC), New York, USA
,
J.R. Vest
3   Weill Cornell Medical College, Department of Healthcare Policy and Research, New York, New York, United States
› Author Affiliations
Further Information

Correspondence to:

Patrick Kierkegaard
Department of Computer Science
University of Copenhagen
Njalsgade 128, Bygning 24, 5. sal
2300 København S, Denmark

Publication History

received: 20 June 2014

accepted: 24 September 2014

Publication Date:
19 December 2017 (online)

 

Summary

Background: Health information exchange (HIE) has the potential to improve the quality of health-care by enabling providers with better access to patient information from multiple sources at the point of care. However, HIE efforts have historically been difficult to establish in the US and the failure rates of organizations created to foster HIE have been high.

Objectives: We sought to better understand how RHIO-based HIE systems were used in practice and the challenges care practitioners face using them. The objective of our study were to so investigate how HIE can better meet the needs of care practitioners.

Methods: We performed a multiple-case study using qualitative methods in three communities in New York State. We conducted interviews onsite and by telephone with HIE users and non-users and observed the workflows of healthcare professionals at multiple healthcare organizations participating in a local HIE effort in New York State.

Results: The empirical data analysis suggests that challenges still remain in increasing provider usage, optimizing HIE implementations and connecting HIE systems across geographic regions. Important determinants of system usage and perceived value includes users experienced level of available information and the fit of use for physician workflows.

Conclusions: Challenges still remain in increasing provider adoption, optimizing HIE implementations, and demonstrating value. The inability to find information reduced usage of HIE. Healthcare organizations, HIE facilitating organizations, and states can help support HIE adoption by ensuring patient information is accessible to providers through increasing patient consents, fostering broader participation, and by ensuring systems are usable.

Citation: Kierkegaard P, Kaushal R, Vest JR. How could health information exchange better meet the needs of care practitioners? Appl Clin Inf 2014; 5: 861–877

http://dx.doi.org/10.4338/ACI-2014-06-RA-0055


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Conflicts of interest

The authors declare that they has no competing interests.

  • References

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  • 3 Bailey JE, Wan JY, Mabry LM, Landy SH, Pope RA, Waters TM, Frisse ME. Does Health Information Exchange Reduce Unnecessary Neuroimaging and Improve Quality of Headache Care in the Emergency Department?. Journal of General Internal Medicine 2013; 28 (02) 176-183. doi: 10.1007/s11606–012–2092–7.
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  • 24 Vest JR, Zhao H, Jaspserson J, Gamm LD, Ohsfeldt RL. Factors motivating and affecting health information exchange usage. Journal of the American Medical Informatics Association 2011; 18 (02) 143-149. doi: 10.1136/jamia.2010.004812.
  • 25 Abramson EL, McGinnis S, Moore J, Kaushal R. rinvestigators H. A Statewide Assessment of Electronic Health Record Adoption and Health Information Exchange among Nursing Homes. Health Services Research 2014; 49 1pt2 361-372. doi: 10.1111/1475–6773.12137.
  • 26 Kern LM, Ancker JS, Abramson E, Patel V, Dhopeshwarkar RV, Kaushal R. Evaluating health information technology in community-based settings: lessons learned. Journal of the American Medical Informatics Association. 2011; 18 (06) 749-53. doi: 10.1136/amiajnl-2011-000249.
  • 27 Phillips AB, Wilson RV, Kaushal R, Merrill JA. with the HITEC investigators. Implementing health information exchange for public health reporting: a comparison of decision and risk management of three regional health information organizations in New York state. Journal of the American Medical Informatics Association 2014; 21 e1 e173-e177. doi: 10.1136/amiajnl-2013–001716.
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  • 43 Shapiro JS, Bartley J, Kuperman G. Initial Experience with Opt-in Consent at the New York Clinical Information Exchange (NYCLIX). AMIA Annu Symp Proc; 2009: 1029.
  • 44 Shapiro JS, Kannry J, Kushniruk AW, Kuperman G, Subcommittee TNYCIECA. Emergency Physicians’ Perceptions of Health Information Exchange. Journal of the American Medical Informatics Association 2007; 14 (06) 700-705. doi: 10.1197/jamia. M2507.
  • 45 Kern LM, Barron Y, Abramson EL, Patel V, Kaushal R. HEAL NY: Promoting Interoperable Health Information Technology In New York State. Health Affairs 2009; 28 (02) 493-504. doi: 10.1377/hlthaff.28.2.493.
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  • 51 Patel VN, Dhopeshwarkar RV, Edwards A, Barrón Y, Sparenborg J, Kaushal R. Consumer support for health information exchange and personal health records: a regional health information organization survey. Journal of Medical Systems 2012; 36 (03) 1043-1052.
  • 52 Ancker JS, Silver M, Miller MC, Kaushal R. Consumer experience with and attitudes toward health information technology: a nationwide survey. Journal of the American Medical Informatics Association 2013; 20 (01) 152-156. doi: 10.1136/amiajnl-2012–001062.
  • 53 Goldstein MM. Health Information Technology and the Idea of Informed Consent. The Journal of Law, Medicine & Ethics 2010; 38 (01) 27-35. doi: 10.1111/j.1748–720X.2010.00463.x.
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Correspondence to:

Patrick Kierkegaard
Department of Computer Science
University of Copenhagen
Njalsgade 128, Bygning 24, 5. sal
2300 København S, Denmark

  • References

  • 1 The National Alliance for Health Information Technology.. Report to the Office of the National Coordinator for Health Information Technology on Defining Key Health Information Technology Terms. Washington, DC: Office of the National Coordinator for Health Information Technology; 2008
  • 2 Hripcsak G, Kaushal R, Johnson KB, Ash JS, Bates DW, Block R, Frisse ME, Kern LM, Marchibroda J, Overhage JM, Wilcox AB. The United Hospital Fund meeting on evaluating health information exchange. Journal of Biomedical Informatics 2007; 40 (06) Supplement S3-S10. doi: http://dx.doi.org/10.1016/j.jbi.2007.08.002.
  • 3 Bailey JE, Wan JY, Mabry LM, Landy SH, Pope RA, Waters TM, Frisse ME. Does Health Information Exchange Reduce Unnecessary Neuroimaging and Improve Quality of Headache Care in the Emergency Department?. Journal of General Internal Medicine 2013; 28 (02) 176-183. doi: 10.1007/s11606–012–2092–7.
  • 4 Kaelber DC, Bates DW. Health information exchange and patient safety. Journal of Biomedical Informatics 2007; 40 (06) Supplement S40-S45. doi: http://dx.doi.org/10.1016/j.jbi.2007.08.011.
  • 5 Frisse ME, Holmes RL. Estimated financial savings associated with health information exchange and ambulatory care referral. Journal of Biomedical Informatics 2007; 40 (06) Supplement S27-S32. doi: http://dx.doi.org/10.1016/j.jbi.2007.08.004.
  • 6 Fostering Rapid Advances in Health Care:Learning from System Demonstrations. Corrigan JM, Greiner A, Erickson SM. editors: The National Academies Press; 2002
  • 7 Walker J, Pan E, Johnston D, Adler-Milstein J, Bates DW, Middleton B. The Value Of Health Care Information Exchange And Interoperability. Health Affairs. 2005 doi: 10.1377/hlthaff.w5.10.
  • 8 Steinbrook R. Health Care and the American Recovery and Reinvestment Act. New England Journal of Medicine 2009; 360 (11) 1057-1060. doi: doi:10.1056/NEJMp0900665. PubMed PMID: 19224738.
  • 9 HITECH Programs & Advisory Committees. State Health Information Exchange Cooperative Agreement Program: healthit.gov. 2013 [cited 2013 Oct 8]. Available from: http://www.healthit.gov/policy-researchers-implementers/state-health-information-exchange
  • 10 Dullabh P, Milstein J-A, Nye C, Moiduddin A, Virost LM, Babalola E, Mahmud A, Jha AK. Evaluation of the State Health Information Exchange Cooperative Agreement Program: Early Findings from a Review of Twenty-Seven States Bethesda, MD 20814. 2012
  • 11 Dullabh P, Hovey L, Ubri P. Evaluation of the State Health Information Exchange Cooperative Agreement Program: Case Study Synthesis: Experiences from Five States in Enabling HIE Bethesda, MD 20814. 2013 HHSP2337010T/OS33547
  • 12 Blumenthal D, Glaser JP. Information Technology Comes to Medicine. New England Journal of Medicine 2007; 356 (24) 2527-2534. doi: doi:10.1056/NEJMhpr066212. PubMed PMID: 17568035.
  • 13 Vest JR, Gamm LD. Health information exchange: persistent challenges and new strategies. Journal of the American Medical Informatics Association 2010; 17 (03) 288-294. doi: 10.1136/jamia.2010.003673.
  • 14 Harris Healthcare Solutions. Harness the Power of Enterprise HIE Harris Healthcare Solutions. 2012
  • 15 Winden T, Boland L, Frey N, Satterlee P, Hokanson J. Care Everywhere, a Point-to-Point HIE Tool: Utilization and Impact on Patient Care in the ED. Applied clinical informatics 2013; 5 (02) 388-401.
  • 16 Adler-Milstein J, Bates DW, Jha AK. U. S. Regional Health Information Organizations: Progress And Challenges. Health Affairs 2009; 28 (02) 483-492. doi: 10.1377/hlthaff.28.2.483.
  • 17 Miller RH, Miller BS. The Santa Barbara County Care Data Exchange: What Happened?. Health Affairs. 2007; 26 (05) w568-w580. doi: 10.1377/hlthaff.26.5.w568.
  • 18 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. International Journal of Medical Informatics 2010; 79 (02) 123-129.
  • 19 Sicotte C, Paré G. Success in health information exchange projects: Solving the implementation puzzle. Social Science & Medicine 2010; 70 (08) 1159-1165. doi: http://dx.doi.org/10.1016/j.socscimed.2009.11.041.
  • 20 Johnson KB, Unertl KM, Chen Q, Lorenzi NM, Nian H, Bailey J, Frisse M. Health information exchange usage in emergency departments and clinics: the who, what, and why. Journal of the American Medical Informatics Association 2011; 18 (05) 690-697. doi: 10.1136/amiajnl-2011–000308.
  • 21 Overhage JM, Dexter PR, Perkins SM, Cordell WH, McGoff J, McGrath R, McDonald CJ. A randomized, controlled trial of clinical information shared from another institution. Annals of emergency medicine 2002; 39 (01) 14-23.
  • 22 Wilcox A, Kuperman G, Dorr DA, Hripcsak G, Narus SP, Thornton SN, Evans RS. editors. Architectural strategies and issues with health information exchange. AMIA Annual Symposium Proceedings. 2006
  • 23 Grossman JM, Bodenheimer TS, McKenzie K. Hospital-Physician Portals: The Role Of Competition In Driving Clinical Data Exchange. Health Affairs 2006; 25 (06) 1629-1636. doi: 10.1377/hlthaff.25.6.1629.
  • 24 Vest JR, Zhao H, Jaspserson J, Gamm LD, Ohsfeldt RL. Factors motivating and affecting health information exchange usage. Journal of the American Medical Informatics Association 2011; 18 (02) 143-149. doi: 10.1136/jamia.2010.004812.
  • 25 Abramson EL, McGinnis S, Moore J, Kaushal R. rinvestigators H. A Statewide Assessment of Electronic Health Record Adoption and Health Information Exchange among Nursing Homes. Health Services Research 2014; 49 1pt2 361-372. doi: 10.1111/1475–6773.12137.
  • 26 Kern LM, Ancker JS, Abramson E, Patel V, Dhopeshwarkar RV, Kaushal R. Evaluating health information technology in community-based settings: lessons learned. Journal of the American Medical Informatics Association. 2011; 18 (06) 749-53. doi: 10.1136/amiajnl-2011-000249.
  • 27 Phillips AB, Wilson RV, Kaushal R, Merrill JA. with the HITEC investigators. Implementing health information exchange for public health reporting: a comparison of decision and risk management of three regional health information organizations in New York state. Journal of the American Medical Informatics Association 2014; 21 e1 e173-e177. doi: 10.1136/amiajnl-2013–001716.
  • 28 NYeC. Statewide Network (SHIN-NY) > Regional Networks: New York eHealth Collaborative; 2013 [cited 2013 19 August]. Available from: http://nyehealth.org/what-we-do/statewide-network/regional-networks.
  • 29 Guba E, Lincoln Y. Fourth generation evaluation, 1989 Sage Publications, California, Seen in, Koch T Establishing rigour in qualitative research: the decision trail. J Adv Nursing 1994; 19: 976-986.
  • 30 Corrigan JM, Greiner A, Erickson SM. Fostering Rapid Advances in Health Care:: Learning from System Demonstrations. National Academies Press; 2002
  • 31 Atkinson R, Flint J. Accessing hidden and hard-to-reach populations: Snowball research strategies. Social research update 2001; 33 (01) 1-4.
  • 32 Hammersley M, Atkinson P. Ethnography: Principles in practice. Routledge; 2007
  • 33 Morse JM. The Significance of Saturation. Qualitative Health Research 1995; 5 (02) 147-149. doi: 10.1177/104973239500500201.
  • 34 Glaser BG, Strauss AL. The Discovery of Grounded Theory; Strategies for Qualitative Research. Chicago: Aldine Transaction; 1968
  • 35 Corbin J, Strauss A. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. 3rd ed: SAGE Publications, Inc; 2008
  • 36 Cutcliffe JR. Methodological issues in grounded theory. Journal of advanced nursing 2000; 31 (06) 1476-1484.
  • 37 Ahern KJ. Ten tips for reflexive bracketing. Qualitative health research 1999; 9 (03) 407-411.
  • 38 Campion Jr TR, Ancker JS, Edwards AM, Patel VN, Kaushal R. Push and Pull: Physician Usage of and Satisfaction with Health Information Exchange. AMIA Annual Symposium Proceedings 2012; 2012: 77.
  • 39 Yeager VA, Walker D, Cole E, Mora AM, Diana ML. Factors Related to Health Information Exchange Participation and Use. Journal of Medical Systems 2014; 38 (08) 1-9.
  • 40 Hewitt H, McCloughan L, McKinstry B. Front desk talk: discourse analysis of receptionistpatient interaction. British Journal of General Practice 2009; 59 (565) e260-e266. doi: 10.3399/bjgp09X453774.
  • 41 Eisner M, Britten N. What do general practice receptionists think and feel about their work?. British Journal of General Practice 1999; 49 (439) 103-106.
  • 42 Ward J, McMurray R. The unspoken work of general practitioner receptionists: A re-examination of emotion management in primary care. Social Science & Medicine 2011; 72 (10) 1583-1587. doi: http://dx.doi.org/10.1016/j.socscimed.2011.03.019.
  • 43 Shapiro JS, Bartley J, Kuperman G. Initial Experience with Opt-in Consent at the New York Clinical Information Exchange (NYCLIX). AMIA Annu Symp Proc; 2009: 1029.
  • 44 Shapiro JS, Kannry J, Kushniruk AW, Kuperman G, Subcommittee TNYCIECA. Emergency Physicians’ Perceptions of Health Information Exchange. Journal of the American Medical Informatics Association 2007; 14 (06) 700-705. doi: 10.1197/jamia. M2507.
  • 45 Kern LM, Barron Y, Abramson EL, Patel V, Kaushal R. HEAL NY: Promoting Interoperable Health Information Technology In New York State. Health Affairs 2009; 28 (02) 493-504. doi: 10.1377/hlthaff.28.2.493.
  • 46 Office of the National Coordinator for Health Information Technology.. Meaningful Use Definition & Objectives HealthIT. Gov2013 [23 MAY 2013]. Available from: http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives.
  • 47 Vest JR, Campion Jr TR, Kaushal R. investigators ftH. Challenges, alternatives, and paths to sustainability for health information exchange efforts. Journal of Medical Systems. 2014
  • 48 Rubin RD. The Community Health Information Movement: Where it’s been, where it’s going. In: O’Carroll PW, Yasnoff WA, Ward ME, Ripp LH, Martin EL. editors. Public Health Informatics & Information Systems. New York: Springer; 2003
  • 49 Boom JA, Sahni LC, Nelson CS, Dragsbaek AC, Franzini L. Immunization information system opt-in consent: at what cost?. J Public Health Manag Pract 2010; 16 (05) E18-E25. Epub 2010/05/01. doi: 10.1097/PHH.0b013e3181cbc4ec. PubMed PMID: 20431419.
  • 50 Dhopeshwarkar RV, Kern LM, O’Donnell HC, Edwards AM, Kaushal R. Health Care Consumers’ Preferences Around Health Information Exchange. The Annals of Family Medicine 2012; 10 (05) 428-434. doi: 10.1370/afm.1396.
  • 51 Patel VN, Dhopeshwarkar RV, Edwards A, Barrón Y, Sparenborg J, Kaushal R. Consumer support for health information exchange and personal health records: a regional health information organization survey. Journal of Medical Systems 2012; 36 (03) 1043-1052.
  • 52 Ancker JS, Silver M, Miller MC, Kaushal R. Consumer experience with and attitudes toward health information technology: a nationwide survey. Journal of the American Medical Informatics Association 2013; 20 (01) 152-156. doi: 10.1136/amiajnl-2012–001062.
  • 53 Goldstein MM. Health Information Technology and the Idea of Informed Consent. The Journal of Law, Medicine & Ethics 2010; 38 (01) 27-35. doi: 10.1111/j.1748–720X.2010.00463.x.
  • 54 Wilcox A, Kuperman G, Dorr DA, Hripcsak G, Narus SP, Thornton SN, Evans RS. Architectural strategies and issues with health information exchange. AMIA Annu Symp Proc. 2006: 814-818. Epub 2007/01/24. doi: 86118 [pii]. PubMed PMID: 17238454.
  • 55 Tripathi M, Delano D, Lund B, Rudolph L. Engaging patients for health information exchange. Health Affairs 2009; 28 (02) 435-443.
  • 56 Clemensen J, Larsen SB, Kyng M, Kirkevold M. Participatory design in health sciences: using cooperative experimental methods in developing health services and computer technology. Qualitative health research 2007; 17 (01) 122-130.
  • 57 Bansler JP, Havn E. Pilot implementation of health information systems: Issues and challenges. International Journal of Medical Informatics 2010; 79 (09) 637-648.
  • 58 Vest JR, Gamm LD, Ohsfeldt RL, Zhao H, Jasperson J. Factors Associated with Health Information Exchange System Usage in a Safety-Net Ambulatory Care Clinic Setting. Journal of Medical Systems 2012; 36 (04) 2455-2461. doi: 10.1007/s10916–011–9712–3.
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