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Information Retrieval Pathways for Health Information Exchange in Multiple Care Settings
Patrick Kierkegaard, PhD; Rainu Kaushal, MD, MPH; and Joshua R. Vest, PhD, MPH
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Information Retrieval Pathways for Health Information Exchange in Multiple Care Settings

Patrick Kierkegaard, PhD; Rainu Kaushal, MD, MPH; and Joshua R. Vest, PhD, MPH
Healthcare professionals used a complex combination of information retrieval pathways for health information exchange to obtain clinical information from external organizations.
The choice of primary and secondary information sources among different sites suggests implementation priorities for those fostering exchange. Based on this study, push methods would address many of the work flow and information needs of primary care settings, particularly when considering patient information like medication and laboratory results that have discrete data elements capable of being parsed. The nature of care in the ED suggests using RHIO-pull may be the best match. Public health agencies have less advanced internal information systems, but they possess a voracious appetite for information and their work flows are based on prolonged data collection and investigation.40 HIE systems using RHIO-pull fit the public health work flow, but only if they contain a broad amount of information sources. Remote portal access to local hospitals will support public health work, but will not necessarily help efficiency if users have to repeatedly search multiple systems institution by institution.

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

Study Limitations

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:


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