Factors associated with health information exchange system usage in a safety-net ambulatory care clinic setting.

The Meaningful Use criteria promises to make health information exchange (HIE) much more widespread. However, the usage of the information systems made available by existing HIE efforts tends to be very low. This study sought to examine the factors associated with usage of an operational HIE system during ambulatory care visits to safety-net clinics. Overall the HIE system was accessed for 21% of encounters. However, system access took on two distinct forms. In general, usage was more likely for patients with recent emergency department visits and chronic conditions. This study indicates the organizational commitment to engage in HIE does not necessarily mean that the information systems will be always used. In addition, system usage will take on various forms for different reasons. These results reveal considerations for the development, operation and evaluation of HIE efforts.

How are health professionals using health information exchange systems? Measuring usage for evaluation and system improvement.

Health information exchange (HIE) is an avenue to improving patient care and an important priority under the Meaningful Use requirements. However, we know very little about the usage of HIE systems. Understanding how healthcare professionals actually utilize HIE systems will provide practical insights to system evaluation, help guide system improvement, and help organizations assess performance. We developed a novel way of describing professionals' HIE usage from the log files of an operational HIE-facilitating organization. The system employed a webpage-style interface. The screen number, types, and variation served to cluster all sessions in to five categories of HIE usage: minimal usage, repetitive searching, clinical information, mixed information, and demographic information. This method reduced the 1,661 different patterns into five recognizable groups for analysis. Overall, most users engaged with the system in a minimal fashion. In terms of user characteristics, minimal usage was highest among physicians and the highest percentage of clinical information usage was among nurses. Usage also differed by organization with repetitive searching most common in settings with scheduled encounters and uncommon in the faster-paced emergency department. Lastly, usage also varied by timing of the patient encounter. Within a single HIE system, discernible types of users behavior existed and varied across jobs, organizations, and time. This approach relied on objective data and can be replicated. In addition, our approach demonstrates that substantial variation in user behaviors exists beyond the more simplistic measures of adoption/non-adoption or access/no-access applied in previous research. This approach can help leaders and evaluators assess their own and other organizations.

Use of a health information exchange system in the emergency care of children.

BACKGROUND: Children may benefit greatly in terms of safety and care coordination from the information sharing promised by health information exchange (HIE). While information exchange capability is a required feature of the certified electronic health record, we known little regarding how this technology is used in general and for pediatric patients specifically. METHODS: Using data from an operational HIE effort in central Texas, we examined the factors associated with actual system usage. The clinical and demographic characteristics of pediatric ED encounters (n = 179,445) were linked to the HIE system user logs. Based on the patterns of HIE system screens accessed by users, we classified each encounter as: no system usage, basic system usage, or novel system usage. Using crossed random effects logistic regression, we modeled the factors associated with basic and novel system usage. RESULTS: Users accessed the system for 8.7% of encounters. Increasing patient comorbidity was associated with a 5% higher odds of basic usage and 15% higher odds for novel usage. The odds of basic system usage were lower in the face of time constraints and for patients who had not been to that location in the previous 12 months. CONCLUSIONS: HIE systems may be a source to fulfill users' information needs about complex patients. However, time constraints may be a barrier to usage. In addition, results suggest HIE is more likely to be useful to pediatric patients visiting ED repeatedly. This study helps fill an existing gap in the study of technological applications in the care of children and improves knowledge about how HIE systems are utilized.