Health information exchange usage in emergency departments and clinics: the who, what, and why

Abstract

Objective: Health information exchange (HIE) systems are being developed across the nation. Understanding approaches taken by existing successful exchanges can help new exchange efforts determine goals and plan implementations. The goal of this study was to explore characteristics of use and users of a successful regional HIE.

Design: We used a mixed-method analysis, consisting of cross-sectional audit log data, semi-structured interviews, and direct observation in a sample of emergency departments and ambulatory safety net clinics actively using HIE. For each site, we measured overall usage trends, user logon statistics, and data types accessed by users. We also assessed reasons for use and outcomes of use.

Results: Overall, users accessed HIE for 6.8% of all encounters, with higher rates of access for repeat visits, for patients with comorbidities, for patients known to have data in the exchange, and at sites providing HIE access to both nurses and physicians. Discharge summaries and test reports were the most frequently accessed data in the exchange. Providers consistently noted retrieving additional history, preventing repeat tests, comparing new results to retrieved results, and avoiding hospitalizations as a consequence of HIE access.

Conclusion: HIE use in emergency departments and ambulatory clinics was focused on patients where missing information was believed to be present in the exchange and was related to factors including the roles of people with access, the setting, and other site-specific issues that impacted the overall breadth of routine system use. These data should form an important foundation as other sites embark upon HIE implementation.

Figure 1

Health information exchange Overview screen (showing test data only).

Figure 2

Health information exchange Recent Registration screen (showing test data only). This screen, which commonly is the launching off point for providers, displays whether the exchange contains data from other sites.

Figure 3

Health information exchange (HIE) access overview. This figure depicts monthly emergency department visits at participating sites, percent of visits for which HIE data were accessed, and the number of participating sites. Total visits increased as more sites began participating in HIE. The sharp decline in HIE access in June 2008 corresponded to a policy change at one major healthcare organization, where staff access was revoked once the Recent Registration screen was implemented at that site.

Figure 4

Health information exchange (HIE) access rate by site. The figure shows rates of HIE access with 95% CIs for new and return visits, and associated logon activity for each site. Physician and nurse/clerk logon activity are shown separately. For each site, we list the total number of new and return visits, as well as the numbers of doctors and nurses/clerks who had access. Safety net sites are denoted by *. ED, emergency department.

Figure 5

Frequency of data types accessed.