JMIR Publications

ABSTRACT

Background:

Despite potential benefits of electronic health information exchange (HIE) to improve the quality and efficiency of care, HIE use by ambulatory providers remain low. Ambulatory providers can greatly improve the quality of care by electronically exchanging health information with affiliated providers within their healthcare network as well as with unaffiliated, external providers

Objective:

To examine the extent of electronic HIE use by ambulatory clinics with affiliated providers within their health system and with external providers, as well as the key technological, organizational and environmental factors affecting the extent of HIE use within and outside the health system.

Methods:

Web-based survey of 320 ambulatory care providers was conducted in the state of Illinois. The study examined the extent of HIE usage by ambulatory providers with hospitals, clinics, and other facilities within and outside their healthcare system – encompassing seven kinds of healthcare data. Ten factors pertaining to technology (IT Compatibility, External IT Support, Security & Privacy Safeguards), organization (Workflow Adaptability, Senior Leadership Support, Clinicians health-IT knowledge, Staff health-IT knowledge) and environment (Government Efforts & Incentives, Partner Readiness, Competitors / Peers) were assessed. A series of multivariate regressions were used to examine predictor effects.

Results:

The six regressions produced adjusted R-squared values ranging from 0.44 to 0.63. We found that ambulatory clinics exchanged more health information electronically with affiliated entities within their health system as compared to those outside their health system. Partner readiness emerged as the most significant predictor of HIE usage with all entities. Governmental initiatives for HIE, clinicians’ prior familiarity and knowledge of health IT systems, implementation of appropriate security and privacy safeguards were also significant predictors. External information technology support and workflow adaptability emerged as key predictors for HIE use outside a clinic’s health system. Differences based on clinic size, ownership, and specialty were also observed.

Conclusions:

To promote HIE use by ambulatory clinics, continued government support, identifying and working with partners with HIE capabilities, improving the IT knowledge of clinicians, implementing security safeguards, increased external technical support, and designing adaptable workflows are important to its success.