Health Information Exchange in the ED: What Do ED Clinicians Think?

Hospital's adoption of multiple methods of obtaining outside information and use of that information

OBJECTIVE

Hospitals have multiple methods available to engage in health information exchange (HIE); however, it is not well understood whether these methods are complements or substitutes. We sought to characterize patterns of adoption of HIE methods and examine the association between these methods and increased availability and use of patient information.

MATERIALS AND METHODS

Cross-sectional analysis of 3208 nonfederal acute care hospitals in the 2019 American Hospital Association Information Technology Supplement.

RESULTS

The median hospital obtained outside information through 4 methods. Hospitals that obtained data through a regional HIE organization were 2.2 times more likely to also obtain data via Direct using a health information service provider (HISP) than hospitals that did not (P < .001). Hospitals in a single electronic health record (EHR) vendor network were no more or less likely to participate in a HISP or HIE. Six of 7 methods were associated with greater information availability. Only 4 of 7 methods (portals, interfaces, single vendor networks and multi-vendor networks but not access to outside EHR, regional exchange or Direct using a HISP) were associated with more frequent use of information, and single vendor networks were most strongly associated with more frequent use (odds ratio = 4.7, P < .001).

DISCUSSION

Adoption of some methods was correlated, indicating complementary use. Few methods were negatively correlated, indicating limited competition. Although information availability was common, low correlation with use indicated that challenges related to integration may be slowing use of information.

CONCLUSION

Complementarities between methods, and the role of integration in supporting information use, indicate the potential value of efforts aimed at ensuring exchange methods work well together, such as the Trusted Exchange Framework and Common Agreement.

The effect of My Health Record use in the emergency department on clinician-assessed patient care: results from a survey

Background

The emergency department has been a major focus for the implementation of Australia’s national electronic health record, known as My Health Record. However, the association between use of My Health Record in the emergency department setting and patient care is largely unknown. The aim of this study was to explore the perspectives of emergency department clinicians regarding My Health Record use frequency, the benefits of My Health Record use (with a focus on patient care) and the barriers to use.

Methods

All 393 nursing, pharmacy, physician and allied health staff employed within the emergency department at a tertiary metropolitan public hospital in Melbourne were invited to participate in a web-based survey, between 1 May 2021 and 1 December 2021, during the height of the Delta and Omicron Covid-19 outbreaks in Victoria, Australia.

Results

Overall, the survey response rate was 18% (70/393). Approximately half of the sample indicated My Health Record use in the emergency department (n = 39, 56%, confidence interval [CI] 43–68%). The results showed that users typically only engaged with My Health Record less than once per shift (n = 15, 39%, CI 23–55%). Just over half (n = 19/39, 54%, CI 32–65%) of all participants who use My Health Record agreed they could remember a time when My Health Record had been critical to the care of a patient. Overall, clinicians indicated the biggest barrier preventing their use of My Health Record is that they forget to utilise the system.

Conclusion

The results suggest that My Health Record has not been adopted as routine practice in the emergency department, by the majority of participants. Close to half of self-identified users of My Health Record do not associate use as being critical to patient care. Instead, My Health Record may only be used in scenarios that clinicians perceive will yield the greatest benefit—which clinicians in this paper suggest is patients with chronic and complex conditions. Further research that explores the predictors to use and consumers most likely to benefit from use is recommended—and strategies to socialise this knowledge and educate clinicians is desperately required.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-022-01920-8.

Physicians' and pharmacists' use of My Health Record in the emergency department: results from a mixed-methods study

Purpose

This study aimed to explore pharmacists' and physicians' perceptions of use, barriers to use and the healthcare outcomes associated with use of Australia's national personally controlled electronic health record-known as My Health Record-in the emergency department.

Methods

A mixed methods approach was deployed, including surveys and individual semi-structured interviews. All physicians and pharmacists who work in the emergency department at Cabrini Health (a non-for-profit healthcare provider in Victoria, Australia) were invited to participate. Due to the timing of elective blocks, physician trainees were excluded from interviews.

Results

A total of 40 emergency medicine clinicians responded to the survey. Over 50% (n = 22) of all respondents had used My Health Record in the emergency department at least once. A total of 18 clinicians participated in the semi-structured interviews, which led to the identification of three themes with multiple sub-themes regarding My Health Record: (1) benefits; (2) effectiveness; and; (3) barriers.

Conclusion

Participants reported My Health Record use in the emergency department delivers efficiencies for clinicians and has a heightened utility for complex patients, consistent with previous research conducted outside of the Australian setting. Barriers to use were revealed: outdated content, a lack of trust, a low perception of value, no patient record and multiple medical record systems. The participants in this study highlighted that training and awareness raising is needed in order to improve My Health Record use in the emergency department, a need stressed by physician's. Further observational research is required to explores meaningful MHR use at scale.

Impact of Provider Prior Use of HIE on System Complexity, Performance, Patient Care, Quality and System Concerns

To date, most HIE studies have investigated user perceptions of value prior to use. Few studies have assessed factors associated with the value of HIE through its actual use. This study investigates provider perceptions on HIE comparing those who had prior experience vs those who had no experience with it. In so doing, we identify six constructs: prior use, system complexity, system concerns, public/population health, care delivery, and provider performance. This study uses a mixed methods approach to data collection. From 15 interviews of medical community leaders, a survey was constructed and administered to 263 clinicians. Descriptive statistics and analysis of variance was used, along with Tukey HSD tests for multiple comparisons. Results indicated providers whom previously used HIE had more positive perceptions about its benefits in terms of system complexity (p = .001), care delivery (p = .000), population health (p = .003), and provider performance (p = .005); women providers were more positive in terms of system concerns (p = .000); patient care (p = .031), and population health (p = .009); providers age 44-55 were more positive than older and younger groups in terms of patient care (p = .032), population health (p = .021), and provider performance (p = .014); while differences also existed across professional license groups (physician, nurse, other license, admin (no license)) for all five constructs (p < .05); and type of organization setting (hospital, ambulatory clinic, medical office, other) for three constructs including system concerns (p = .017), population health (p = .018), and provider performance (p = .018). There were no statistically significant differences found between groups based on a provider's role in an organization (patient care, administration, teaching/research, other). Different provider perspectives about the value derived from HIE use exist depending on prior experience with HIE, age, gender, license (physician, nurse, other license, admin (no license)), and type of organization setting (hospital, ambulatory clinic, medical office, other). This study draws from the theory of planned behavior to understand factors related to physicians' perceptions about HIE value, serving as a departure point for more detailed investigations of provider perceptions and behavior in regard to future HIE use and promoting interoperability.