Health information exchange usage in emergency departments and clinics: the who, what, and why
Health information exchange usage in emergency departments and clinics: the who, what, and why
复制标题
DOI：
10.1136/amiajnl-2011-000308
复制
发表时间：
2011-09-01
影响因子：
6.4
通讯作者：
Frisse, Mark
中科院分区：
文献类型：
--
作者：
Johnson, Kevin B.;Unertl, Kim M.;Frisse, Mark
目的卫生信息交换(HIE)系统正在全国范围内发展。了解现有成功交易所采取的方法可以帮助新的交易所努力确定目标和计划实施。本研究的目的是探索成功的区域性HIE的使用特点和使用者。设计我们采用了混合方法分析，包括横断面审计日志数据、半结构化访谈和对积极使用HIE的急诊科和门诊安全网诊所的直接观察。对于每个站点，我们测量了总体使用趋势、用户登录统计数据和用户访问的数据类型。我们还评估了使用的原因和结果。结果总体而言，用户访问HIE的比例为6.8%，重复访问、合并症患者、已知有数据在交换中的患者以及向护士和医生提供HIE访问的站点的访问率更高。出院总结和测试报告是交易所中访问最频繁的数据。供应商一直注意到检索额外的历史记录、防止重复测试、将新结果与检索的结果进行比较以及避免因HIE访问而住院。结论HIE在急诊科和门诊诊所的使用主要集中在那些认为交流中存在缺失信息的患者，并与影响常规系统使用总体广度的因素有关，包括访问人员的角色、环境和其他特定地点的问题。随着其他站点开始实施HIE，这些数据应该成为重要的基础。
Objective Health information exchange (HIE) systems are being developed across the nation. Understanding approaches taken by existing successful exchanges can help new exchange efforts determine goals and plan implementations. The goal of this study was to explore characteristics of use and users of a successful regional HIE.Design We used a mixed-method analysis, consisting of cross-sectional audit log data, semi-structured interviews, and direct observation in a sample of emergency departments and ambulatory safety net clinics actively using HIE. For each site, we measured overall usage trends, user logon statistics, and data types accessed by users. We also assessed reasons for use and outcomes of use.Results Overall, users accessed HIE for 6.8% of all encounters, with higher rates of access for repeat visits, for patients with comorbidities, for patients known to have data in the exchange, and at sites providing HIE access to both nurses and physicians. Discharge summaries and test reports were the most frequently accessed data in the exchange. Providers consistently noted retrieving additional history, preventing repeat tests, comparing new results to retrieved results, and avoiding hospitalizations as a consequence of HIE access.Conclusion HIE use in emergency departments and ambulatory clinics was focused on patients where missing information was believed to be present in the exchange and was related to factors including the roles of people with access, the setting, and other site-specific issues that impacted the overall breadth of routine system use. These data should form an important foundation as other sites embark upon HIE implementation.