JMIR Publications

ABSTRACT

Background:

Health information exchange (HIE) supports clinical decision-making in emergency medicine settings. Despite evidence and policies that encourage adoption of HIE, usage by clinicians is limited. Moreover, few studies examine usage of HIE years after adoption by hospitals or clinics.

Objective:

To examine perceptions and usage of a mature, operational HIE system by emergency department (ED) clinicians years after its implementation.

Methods:

We interviewed 21 clinicians in various roles (e.g., attending physician, nurse practitioner) across multiple health systems that participate in a statewide HIE network. We asked questions about their use of the HIE system and the factors that facilitate or inhibit use. Analysis of interview transcripts was guided by a theoretical framework derived from information systems theories describing individual perception of and usage behavior towards HIE systems.

Results:

A total of 26 factors across 6 domains were identified by respondents. All respondents recognized the value of HIE for medical decision-making in the ED, and access to information via the HIE was preferred over traditional methods of calling other facilities or waiting for faxed records. Ease of use, particularly single sign on (SSO) functionality, was recognized as a key facilitator to routine use, enabling clinician access via a single click from their EHR directly into the patient’s HIE record. Access to integrated data and advanced search features supported clinical decision-making. Limited training and poor system usability were identified as barriers to use.

Conclusions:

Achieving widespread adoption and use of HIE systems globally will require a focused effort to address multiple individual perception and behavioral factors. Researchers, HIE organizational leaders, and policymakers alike should leverage these factors to achieve the goals of HIE and interoperability. Clinical Trial: N/A