JMIR Publications

ABSTRACT

Background:

Health information exchange (HIE) between care providers who cooperate in the treatment of patients with diabetes mellitus (DM) has been rated as an important aspect of successful care. Patient-sharing relations between care providers permit inferences about corresponding information-sharing relations.

Objective:

By analyzing patient-sharing relations between various types of care providers (ToCPs) - such as hospitals, pharmacies and different outpatient specialists - within a nationwide claims dataset of Austrian DM patients, we aimed to obtain information for an effective design of HIE platforms to be used in DM care. We focus on two parameters derived from patient-sharing networks: (i) the principal HIE partners of the different ToCPs involved in the treatment of DM, and (ii) the required participation rate of ToCPs in HIE platforms for the purpose of effective communication.

Methods:

Claims data of 7.9 million Austrian patients from 2006 and 2007 served as our data source. DM patients were identified by their medication. We established metrics for the quantification of our two parameters of interest. The principal HIE partners are derived from the portions of a care provider’s patient-sharing relations with different ToCPs. For the required participation rate of ToCPs in an HIE platform, we determine the concentration of patient-sharing relations between ToCPs. Our corresponding metrics are derived in analogy from existing work for the quantification of the continuity of care.

Results:

We identified 324,703 DM patients treated by 12,226 care providers; the latter were members of 16 ToCPs. Based on their score for our two parameters, we categorized the ToCPs into “low”, “medium”, and “high”. For the parameter named “most important HIE partner”, pharmacies, general practitioners (GPs), and laboratories were the representatives of the top group, i.e. our care providers shared the highest numbers of DM patients with these ToCPs. Concerning the parameter “required participation rate of ToCP in HIE platform”, the concentration of DM patient-sharing relations with a ToCP tended to be inversely related to the ToCP’s member count.

Conclusions:

We conclude that GPs, pharmacies, and laboratories should be core members of any HIE platform that supports DM care, as they are the most important DM patient-sharing partners. We further conclude that, for implementing HIE with ToCPs that have many members (in Austria particularly GPs and pharmacies), an HIE solution with high participation rates of these ToCPs (ideally a nationwide HIE platform with obligatory participation of the concerned ToCPs) seems essential. This will raise the probability of HIE being achieved with any care provider of these ToCPs. As chronic diseases are rising due to aging societies, we believe that our quantification of HIE requirements in the treatment of DM can provide valuable insights for many industrial countries.