JMIR Publications

ABSTRACT

Background:

Patients with co-occurring behavioral health and chronic medical conditions frequently overutilize inpatient hospital services. This pattern of overuse contributes to inefficient healthcare spending. These patients require coordinated care to achieve optimal health outcomes. However, the poor exchange of health-related information between various clinicians renders the delivery of coordinated care challenging. Health information exchanges (HIEs) facilitate health-related information sharing and have been shown to be effective in chronic disease management, but their effectiveness in the delivery of integrated care is less clear. It is prudent to consider new approaches to sharing both general medical and behavioral health information.

Objective:

We identified and described factors that influence the intention to use behavioral health information that is shared through HIEs.

Methods:

A mixed methods study consisting of two phases was conducted. A validated survey instrument was emailed to clinical and non-clinical staff in Alabama and Oklahoma. The survey captured information about the impact of predictors on the intention to use behavioral health data in clinical decision-making. Follow-up interviews were conducted with a subsample of participants to understand the survey results better. Partial least squares structural equation modeling (PLS-SEM) was used to analyze survey data. Thematic analysis was used to identify themes from the interviews.

Results:

Sixty-two participants completed the survey. 62.91% of the participants were clinicians. Performance expectancy (β= .382, P= .01) and trust (β= .539, P= .00) predicted intention to use behavioral health information shared via HIEs. Interviewees expressed that behavioral health information could be useful in clinical decision-making. However, privacy and confidentiality concerns discourage sharing this information, and it is generally missing from the patient record altogether. The interviewees (n= 5) also stated that training for HIE use was not mandatory, and the training that was provided did not focus on the exchange of behavioral health information specifically.

Conclusions:

Despite barriers, individuals are willing to use behavioral health information from HIEs if they believe that it will enhance job performance and if the information being transmitted is trustworthy. The findings contribute to our understanding of the role HIEs can play in delivering integrated care, particularly to vulnerable patients.