The complementary nature of query-based and directed health information exchange in primary care practice.
The complementary nature of query-based and directed health information exchange in primary care practice.
复制标题
初级保健实践中基于查询和定向的健康信息交换的互补性。
DOI：
10.1093/jamia/ocz134
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Shapiro,JasonS
中科院分区：
文献类型：
--
作者：
Vest,JoshuaR;Unruh,MarkA;Casalino,LawrenceP;Shapiro,JasonS
目的许多政策制定者和倡导者认为，定向的和基于查询的健康信息交换(HIE)共同努力，以满足组织的互操作性需求，但这并没有实质性的证据基础。这项研究试图阐明这两种方法对HIE的使用之间的关系。材料和方法来自地区HIE组织的系统用户日志文件和电子健康记录系统结合在一起，模拟了纽约3个联邦合格卫生中心的HIE患者就诊相关的使用情况。回归模型测试了这一假设，即定向HIE使用与基于查询的使用相关联，并根据反映FITT(个人、任务和技术之间的匹配)框架的因素进行了调整。结果3.1%的病例使用了基于查询的HIE，23.5%的病例使用了直接HIE。当直接HIE提供成像信息时，基于查询的使用率高出0.6个百分点，而当直接HIE提供临床文档时，基于查询的使用率高出4.8个百分点。基于询问的HIE的概率在专科就诊时较低，在出院后就诊时较高，在遇到执业护士时较高。被调查者在指导HIE后使用基于查询的HIE，以获取额外信息，支持护理过渡，或在结果异常的情况下。讨论定向HIE和基于查询的HIE的互补性表明，这两种HIE功能都应纳入EHR认证标准。结论定量和定性的研究结果表明，在门诊护理环境中，定向和基于查询的HIE以互补的方式存在。
ObjectiveMany policymakers and advocates assume that directed and query-based health information exchange (HIE) work together to meet organizations’ interoperability needs, but this is not grounded in a substantial evidence base. This study sought to clarify the relationship between the usage of these 2 approaches to HIE.Materials and MethodsSystem user log files from a regional HIE organization and electronic health record system were combined to model the usage of HIE associated with a patient visit at 3 federally qualified health centers in New York. Regression models tested the hypothesis that directed HIE usage was associated with query-based usage and adjusted for factors reflective of the FITT (Fit between Individuals, Task & Technology) framework. Follow-up interviews with 8 key informants helped interpret findings.ResultsUsage of query-based HIE occurred in 3.1% of encounters and directed HIE in 23.5%. Query-based usage was 0.6 percentage points higher when directed HIE provided imaging information, and 4.8 percentage points higher when directed HIE provided clinical documents. The probability of query-based HIE was lower for specialist visits, higher for postdischarge visits, and higher for encounters with nurse practitioners. Informants used query-based HIE after directed HIE to obtain additional information, support transitions of care, or in cases of abnormal results.DiscussionThe complementary nature of directed and query-based HIE indicates that both HIE functionalities should be incorporated into EHR Certification Criteria.ConclusionsQuantitative and qualitative findings suggest that directed and query-based HIE exist in a complementary manner in ambulatory care settings.
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