Barriers and facilitators to exchanging health information: a systematic review.
Barriers and facilitators to exchanging health information: a systematic review.
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DOI：
10.1016/j.ijmedinf.2016.01.004
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发表时间：
2016-04
影响因子：
4.9
通讯作者：
Hersh WR
中科院分区：
文献类型：
--
作者：
Eden KB;Totten AM;Kassakian SZ;Gorman PN;McDonagh MS;Devine B;Pappas M;Daeges M;Woods S;Hersh WR
我们对评估使用健康信息交换（HIE）的促进因素和障碍的研究进行了系统回顾。我们在1990年1月至2015年2月期间检索MEDLINE、PsycINFO、CINAHL和Cochrane图书馆数据库，使用与HIE相关的术语。包括确定实际HIE障碍和促进因素的英语研究。提取并确认有关研究设计、偏倚风险、环境、地理位置、HIE特征、感知障碍和使用促进因素的数据。10个横断面研究、7个多地点案例研究和2个前后研究，包括来自多个来源（调查、访谈、焦点小组和用户观察）的数据，评估了使用HIE的感知障碍和促进因素。使用HIE最常见的障碍是信息不完整、工作流程效率低下，以及交换的信息不能满足用户需求的报告。审查确定了几个要使用的促进器。在美国进行的研究中一直提到患者信息不完整，但在美国以外进行的少数采用集体方法进行医疗保健的研究中没有提到。在美国，个体患者和诊所可以行使参与（或不参与）HIE的权利，这会影响可交换的患者信息的完整性。工作流结构和用户角色是关键，但尚未得到充分研究。我们在研究中确定了几个促进电子健康数据交换的因素：获得更完整的患者信息；在HIE中折叠的周到的工作流；并在实施的早期纳入用户。
We conducted a systematic review of studies assessing facilitators and barriers to use of health information exchange (HIE). We searched MEDLINE, PsycINFO, CINAHL, and the Cochrane Library databases between January 1990 and February 2015 using terms related to HIE. English-language studies that identified barriers and facilitators of actual HIE were included. Data on study design, risk of bias, setting, geographic location, characteristics of the HIE, perceived barriers and facilitators to use were extracted and confirmed. Ten cross-sectional, seven multiple-site case studies, and two before-after studies that included data from several sources (surveys, interviews, focus groups, and observations of users) evaluated perceived barriers and facilitators to HIE use. The most commonly cited barriers to HIE use were incomplete information, inefficient workflow, and reports that the exchanged information that did not meet the needs of users. The review identified several facilitators to use. Incomplete patient information was consistently mentioned in the studies conducted in the US but not mentioned in the few studies conducted outside of the US that take a collective approach toward healthcare. Individual patients and practices in the US may exercise the right to participate (or not) in HIE which effects the completeness of patient information available to be exchanged. Workflow structure and user roles are key but understudied. We identified several facilitators in the studies that showed promise in promoting electronic health data exchange: obtaining more complete patient information; thoughtful workflow that folds in HIE; and inclusion of users early in implementation.