JMIR Publications

ABSTRACT

Background:

A health information exchange (HIE) system enables healthcare providers and patients to exchange clinical data electronically across multiple healthcare institutions. Sharing medical information appropriately using HIE has several benefits in clinical practice. More than 200 HIEs have been implemented in Japan and are currently operational. However, in Japan, little academic research has been conducted on whether healthcare workers use HIE in the institutions where it was introduced. The primary objective of this study was to clarify the usage rate, usage frequency, and usage bias of large-scale HIEs in Japan by analyzing audit logs.

Objective:

The primary objective of this study was to clarify the usage rate, usage frequency, and usage bias of large-scale HIEs in Japan by analyzing audit logs.

Methods:

We conducted a retrospective cohort study. The research subjects were HIEs joined by over 100 facilities and 10,000 patients. Each healthcare worker’s profile and audit log data for HIE were collected. The following four analyses were conducted: First, we counted the annual number of days of HIE use by each hospital doctor in the financial year (FY) 2021/22 and calculated the Gini coefficient. Second, we calculated monthly HIE use frequency distribution for each facility type in FY2021/22. Third, we calculated each facility type's monthly HIE usage rate in FY2021/22. Fourth, we compared the monthly HIE usage rate by medical institution for each HIE and the proportion of man-days of HIE use by occupation for each HIE.

Results:

Twenty-four HIEs were identified as candidates for data collection, and we analyzed data from seven HIEs. Among the hospital doctors, 93.5% had never used HIE during the available period in FY2021/22. The Gini coefficient for each hospital doctor's estimated annual HIE usage days was 0.984. The monthly HIE usage rates were 0.482 (0.470-0.487) for hospitals, 0.243 (0.230-0.247) for medical clinics, and 0.030 (0.024-0.048) for dental clinics. In 51.9% of hospitals, the man-days of monthly HIE use was 0; in 26.8% of hospitals, it was between 1 and 10. In 3.0% of hospitals, it was 100 or more. The monthly HIE usage rate in medical institutions was 0.511(0.487-0.529) for the highest HIE and 0.109 (0.0927-0.117) for the lowest. The proportion of HIE usage frequency by occupation is complex, and no consistent trends can be discerned.

Conclusions:

This study suggests that HIEs in Japan are not fully utilized by most healthcare workers in daily clinical practice, even if the number of participating facilities and patients is large. The monthly utilization rate of HIEs varies greatly by facility type or HIE. We need more detailed and cross-sectional research using log data analysis on HIE use's success and failure factors.