JMIR Publications

ABSTRACT

Background:

The transfer of patients between hospitals, i.e., interhospital transfer (IHT), introduces discontinuity of care including gaps in health information transfer, which may worsen patient outcomes.

Objective:

This is this first phase of a five-year research study. Our goals are (1) to understand the gaps in health information exchange (HIE) and the clinician experience in accessing and using the electronic health record (EHR) during IHT; and (2) to identify clinician user requirements for development of an internal EHR solution for IHT.

Methods:

We utilized prior work on health information exchange (HIE) during IHT coupled with a user-centered design (UCD) process to engage discussions with clinical users and gather input on EHR workflow during IHT patient admission and planning. Eight UCD sessions were held between 2/2023-7/2023, involving 18 clinicians who interact with the EHR during IHT, including 3 medicine residents, 10 advanced practice providers and 5 direct care attendings – all responsible for caring for IHT patients at Brigham and Women’s Cardiology, Medicine, Oncology and ICU services. Discussions highlighted facilitators and barriers, and suggested improvements for data access and availability at the time of transfer. UCD sessions were recorded, analyzed, and coded by two independent reviewers to identify common themes driving sub-optimal HIE. User requirements were derived from the sessions with users and iteratively refined throughout the process.

Results:

Qualitative analysis revealed that a significant number of frontline clinicians experience suboptimal availability of clinical information in the EHR at the time of IHT, including gaps in communication, incomplete data, and inefficient access to clinical data. User requirements emerged from these themes and primarily focused on information prioritization, data accessibility and workflow and efficiency.

Conclusions:

Notable levels of missing information and inefficient access to clinical data were reported by end-users caring for IHT patients at time of transfer. Conducting user research to understand the current process of IHT, involving users in conceptual design and information architecture, and generating prototypes for feedback from users can aid in designing a solution that meets user needs. Results of these early UCD activities will be used to develop and implement a data platform to support clinicians during IHT.