The American Journal of Managed Care Special Issue: Health Information Technology
Information Retrieval Pathways for Health Information Exchange in Multiple Care Settings
In addition, of interest to the leadership of health organizations, these findings indicate that both clinical and nonclinical staff would benefit from organizational support. First, the sheer number of available information sources does not, in and of itself, create increases in productivity.41 Multiple systems with different log-ins, use cases, and designs can place strains on the organization and on individuals.42
As more demands are being placed on the workforce for technology skills and competencies,43 managers need to ensure that staff members have sufficient computer skills to navigate multiple systems and avenues when challenges arise. One possibility to address the complex data-gathering situation for clinicians would be to introduce medical scribes. By assuming most of the data-gathering and documentation responsibilities, scribes tend to increase physician productivity.44 Second, the multiple information retrieval pathways indicates that professionals have complex mental models of determining where the data are available and under what circumstances they expect to find it. With the increased availability of externally created information, healthcare organizations are going to need to develop formalized methods for retaining and using this knowledge. These strategies can include creating directories, developing formal learning collaboratives, sharing best practices, holding discussion groups, or specific trainings.45-47
The primary limitation of this study is that it is confined to experiences in New York state; the differences in infrastructure, policies, and maturity of HIE systems may limit the generalizability of our findings. Additionally, while our sample included both urban and rural settings and organizations of different types and sizes, we cannot speak to the experiences of specialty care providers or use of HIE systems for inpatient care.
The exchange of health information is a critical strategy to improve patient safety and the quality of care. Healthcare professionals make use of a variety of technologies and methods to support their information needs. Understanding clinicians’ information retrieval pathways for HIE can assist in improving the design and functionality of HIE systems and aid their integration into organizational work flows. These findings provide insights for informatics professionals about the usage of information, indicate the need for managerial support within each organization, and suggest approaches to improve systems for organizations and agencies working to expand HIE adoption.
We would like to thank the health information exchange efforts, the public health departments, and study participants for their cooperation in the data collection. This project was funded by the New York eHealth Collaborative as a part of the State HIE Cooperative Agreement Program evaluation. The Institutional Review Board of Weill Cornell Medical College approved this study.
Author Affiliations: University of Copenhagen, Denmark (PK); Center for Healthcare Informatics & Policy, Department of Healthcare Pol- icy and Research, Weill Cornell Medical College, New York, NY (RK, JRV).
Source of Funding: This project was funded by the New York eHealth Collaborative as a part of the State HIE Cooperative Agreement Program evaluation.
Author Disclosures: Drs Kierkegaard, Vest, and Kaushal report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article. Dr Vest has plans to submit a grant proposal with Rochester RHIO as the study site in the future, but there is no funding for them other than as a data provider.
Authorship Information: Concept and design (PK, RK, JRV); acquisi- tion of data (PK, JRV); analysis and interpretation of data (PK, RK, JRV); drafting of the manuscript (PK, RK, JRV); critical revision of the manuscript for important intellectual content (PK, RK, JRV); statistical analy- sis (PK, JRV); obtaining funding (RK, JRV); administrative, technical, or logistic support (RK).
Address correspondence to: Patrick Kierkegaard, PhD, University of Copenhagen, Njalsgade 128, Bygning 24, 5. sal, 2300 København S, Denmark. E-mail: firstname.lastname@example.org.
1. Vest J. Health information exchange: national and international ap- proaches. Adv Health Care Manag. 2012;12:3-24.
2. Committee on Quality of Health Care in America; Kohn LT, Corrigan JM, Donaldson MS, eds. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000.
3. Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007;297(8):831-841.
4. Elder NC, Hickner J. Missing clinical information: the system is down. JAMA. 2005;293(5):617-619.
5. Smith PC, Araya-Guerra R, Bublitz C, et al. Missing clinical informa- tion during primary care visits. JAMA. 2005;293(5):565-571.
6. Burnett S, Deelchand V, Franklin BD, Moorthy K, Vincent C. Missing clinical information in NHS hospital outpatient clinics: prevalence, causes and effects on patient care. BMC Health Serv Res. 2011;11:114.
7. Tam VC, Knowles SR, Cornish PL, Fine N, Marchesano R, Etchells EE. Frequency, type and clinical importance of medication his- tory errors at admission to hospital: a systematic review. CMAJ. 2005;173(5):510-515.
8. Rosenfeld S, Koss S, Caruth K, Fuller G. Evolution of State Health Information Exchange/A Study of Vision, Strategy, and Progress. Rockville, MD:The Agency for Healthcare Research and Quality; 2006.
9.The National Alliance for Health InformationTechnology. Report to the Office of the National Coordinator for Health InformationTechnology on Defining Key Health InformationTechnologyTerms. Washington, DC: Office of the National Coordinator for Health Information Technology; 2008.
10. National eHealth Collaborative. Health Information Exchange Roadmap: The Landscape and the Path Forward. Washington, DC: National eHealth Collaborative; 2012.
11. Hripcsak G, Kaushal R, Johnson KB, et al.The United Hospital Fund meeting on evaluating health information exchange. J Biomed Inform. 2007;40(6Suppl):S3-S10.
12. Bailey JE, Wan JY, Mabry LM, et al. Does health information exchange reduce unnecessary neuroimaging and improve quality of headache care in the emergency department? J Gen Intern Med. 2013;28(2):176-183.
13. Kaelber DC, Bates DW. Health information exchange and patient safety. J Biomed Inform. 2007;40(6Suppl):S40-S45.
14. Frisse ME, Holmes RL. Estimated financial savings associated with health information exchange and ambulatory care referral. J Biomed Inform. 2007;40(6 suppl):S27-S32.
15. 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.
16. Frisse ME, Johnson KB, Nian H, et al.The financial impact of health information exchange on emergency department care. J Am Med Inform Assoc. 2012;19(3):328-333.
17. Campion TR Jr, Ancker JS, Edwards AM, Patel VN, Kaushal R; HI-TECH Investigators. Push and pull: physician usage of and satisfaction with health information exchange. AMIA Annu Symp Proc. 2012;77-84.
18. Solomon MR. Regional health information organizations: a vehicle for transforming health care delivery? J Med Syst. 2007;31(1):35-47.
19. Harris Healthcare Solutions. Harness the Power of Enterprise HIE. Melbourne, FL: Harris; 2012.
20.WindenTJ, Boland LL, Frey NG, Satterlee PA, Hokanson JS. Care everywhere, a point-to-point HIE tool: utilization and impact on patient care in the ED. Appl Clin Inform. 2014;5(2):388-401.
21. A practical guide to understanding HIE, assessing your readiness and selecting HIE options in Minnesota. website http://www.health.state.mn.us/divs/hpsc/ohit/hieguidance/index.html. Updated July 2013. Accessed March 23, 2014.
22. Simon SR, Evans JS, Benjamin A, Delano D, Bates DW. Patients’ attitudes toward electronic health information exchange: qualitative study. J Med Internet Res. 2009;11(3):e30.
23. Kuperman GJ. Health-information exchange: why are we doing it, and what are we doing? J Am Med Inform Assoc. 2011;18(5):678-682.
24. Johnson KB, Unertl KM, Chen Q, et al. Health information exchange usage in emergency departments and clinics: the who, what, and why. J Am Med Inform Assoc. 2011;18(5):690-697.
25. Vest JR, Zhao H, Jasperson J, Gamm LD, Ohsfeldt RL. Factors motivating and affecting health information exchange usage. J Am Med Inform Assoc. 2011;18(2):143-149.
26. Unertl KM, Johnson KB, Lorenzi NM. Health information exchange technology on the front lines of healthcare: workflow factors and patterns of use. J Am Med Inform Assoc. 2012;19(3):392-400.
27. Kaelber DC, Waheed R, Einstadter D, Love TE, Cebul RD. Use and perceived value of health information exchange: one public healthcare system’s experience. Am J Manag Care. 2013;19(10 Spec No.): SP337-SP343.
28. Kern LM, Wilcox A, Shapiro J, Dhopeshwarkar RV, Kaushal R. Which components of health information technology will drive financial value? Am J Manag Care.18(8):438-445.
29. Wians FH Jr. Clinical laboratory tests: which, why, and what do the results mean? Lab Med. 2009;40(2):105-113.
30. Gunderman RB.The medical community’s changing vision of the patient: the importance of radiology. Radiology. 2005;234(2):339-342.
31. Healthcare Information & Management Systems Society Health Information Exchange Best PracticesTask Force. Health Information Exchanges: Similarities and Differences. HIMSS HIE Common Practices Survey Results White Paper. Chicago, IL: HIMSS; 2009.
32. Phillips AB, Wilson RV, Kaushal R, Merrill JA; HITECH 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. J Am Med Inform Assoc. 2014;21(e1):e173-e177.
33. Guba EG, LincolnYS. Fourth Generation Evaluation.Thousand Oaks, CA: SAGE Publications, Inc; 1989.
34. Dubé L, Paré G. Rigor in information systems positivist case research: current practices, trends, and recommendations. MIS Quarterly. 2003;27(4):597-635.
35. Crabtree BF, MillerWL. Doing qualitative research:Thousand Oaks, CA: Sage Publications, Inc; 1999.
36. Sadler GR, Lee HC, Lim RS, Fullerton J. Recruitment of hard-to- reach population subgroups via adaptations of the snowball sampling strategy. Nurs Health Sci. 2010;12(3):369-374.
37. Atkinson P, Hammersley M. Ethnography: Principles in Practice. 3rd ed. NewYork, NY: Routledge; 2007.
38. Morse JM.The significance of saturation. Qual Health Res. 1995; 5(2):147-149.
39. Glaser BG, Strauss AL. The Discovery of Grounded Theory; Strategies for Qualitative Research. Chicago, IL: AldineTransaction; 1968.
40. Vest JR, Issel LM, Lee S. Experience of using information systems in public health practice: findings from a qualitative study. Online J Public Health Inform. 2014;5(3):227.
41. Brynjolfsson E.The productivity paradox of information technology. Commun ACM. 1993;36(12):66-77.
42. Bawden D, Robinson L.The dark side of information: overload, anxiety and other paradoxes and pathologies. J Inf Sci. 2009;35(2):180-191.
43. Morrison F, Zimmerman J, Hall M, Chase H, Kaushal R, Ancker JS. Developing an online and in-person HIT workforce training program using a team-based learning approach. AMIA Annu Symp Proc. 2011; 63-71.
44. Bank AJ, Obetz C, Konrardy A, et al. Impact of scribes on patient interaction, productivity, and revenue in a cardiology clinic: a prospective study. Clinicoecon Outcomes Res. 2013;5:399-406.
45. Alavi M, Leidner DE. Review: knowledge management and knowledge management systems: conceptual foundations and research issues. MIS Quarterly. 2001;25(1):107-136.
46. Guptill J. Knowledge management in health care. J Health Care Finance. 2005;31(3):10-14.
47. Yeager VA, Walker D, Cole E, Mora AM, Diana ML. Factors related to health information exchange participation and use. J Med Sys. 2014;38(8):78.