Factors Motivating & Affecting Information Seeking in a Health Information Exchan

说明(由申请人提供)：个人的相关健康信息存储在多个独立的来源中(医学研究所，2001年)。因此，并不是所有对提供者有用的临床信息都能在患者就诊期间获得，这意味着决策经常发生在医学知识不完整的情况下(Kalra 2004)。健康信息交换(HIE)是跨组织自动共享个人临床信息，有望提高质量和节省成本。HIE特别与慢性病患者的持续护理相关，有可能通过减少诊断测试的冗余来提高效率和及时性。此外，无法获取其他组织存储的信息可能成为多个提供者之间有效协调护理的障碍(Casalino、Gillie等人)。2003年)。建立HIE系统的努力是广泛的，并得到联邦政府的倡导(Walker，Panet al.2005)。然而，我们目前不知道卫生专业人员实际上是如何使用这些系统的(Ash和Guappone，2007)。 这项建议应用了以前关于信息寻求行为和组织技术使用的研究知识，以便在医疗保健遭遇的背景下了解卫生信息交换的使用情况。这项建议的具体目的是检查哪些患者特征(如慢性病)与系统使用有关。此外，由于医疗保健发生在组织内部，因此这些特征有助于个人使用该系统。假说将通过将德克萨斯州中部为贫困人口服务的HIE患者的次要数据与对参与该系统的组织的初步调查相结合的方式进行经验性检验。该系统通过提供有关患者和使用该系统的提供者的使用历史的数据，提供了一个独特的机会。后者的数据以系统使用日志的形式出现。该提案将模拟2007-2008年间发生的大约612,000次医疗事故期间HIE的实际使用情况，以确定与系统使用相关的因素。确定决定和影响HIE使用情况的因素将对从事HIE系统工作或开始使用HIE系统的地方组织以及国家政策制定者都很有用。了解HIE系统实际是如何使用的，对于癌症和精神疾病等慢性病患者的持续护理尤为相关，这些患者需要在多个提供者之间进行有效的护理协调，有许多药物和不同的实验室测试。 公共卫生相关性：医疗保健系统未能提供高效、及时和安全的护理的一个原因是个人的临床相关信息存储在多个独立的来源中。卫生信息交换是一项国家目标，目前在许多地方实施，并承诺大幅提高财务和质量。然而，这些系统实际上是如何使用的还不是很清楚，因此是一个需要研究的领域。

DESCRIPTION (provided by applicant): An individual's relevant health information is stored in multiple, independent sources (Institute of Medicine 2001). Therefore not all the clinical information useful to providers is available during a patient encounter, meaning decisions frequently occur with incomplete medical knowledge (Kalra 2004). Health information exchange (HIE), the automated sharing of individuals' clinical information across organizations, holds the promise of quality improvements and cost savings. Specifically relevant to the continuing care of patients with chronic conditions, HIE has the potential to improve efficiency and timeliness by reducing redundancy of diagnostic testing. Additionally, the lack of access to information stored by other organizations can be a barrier to effective coordination of care between multiple providers (Casalino, Gillies et al. 2003). Efforts at establishing systems of HIE are widespread and advocated by the federal government (Walker, Pan et al. 2005). However, we currently do not know how these systems are actually used by health professionals (Ash and Guappone 2007). This proposal applies knowledge from previous research on information seeking behavior and organizational technology usage in order to understand health information exchange usage in the context of a healthcare encounter. The specific aim of this proposal is to examine which patient characteristics (like chronic conditions) are associated with system usage. In addition, since healthcare occurs within an organization, those characteristics contribute to the usage of the system by individuals. Hypotheses will be empirically examined by combining secondary data on patients in a HIE serving the medically indigent in Central Texas with primary surveys of the organizations participating in the system. This system provides a unique opportunity by providing both data on the patients and on the usage history of those providers who utilize the system. Data on the latter come in the form of system usage logs. This proposal will model the actual usage of the HIE during approximately 612,000 healthcare encounters occurring in 2007-2008 to determine the factors associated with system usage. The identification of the factors determining and affecting HIE usage will be useful to both local organizations working with, or beginning, HIE systems and to national policy makers. Understanding how HIE systems are actually used is particularly relevant to the continuing care of patients with chronic conditions, like cancer and mental illness, who require an effective coordination of care between multiple providers, have many medications and different laboratory tests. PUBLIC HEALTH RELEVANCE: One reason the health care system fails to deliver efficient, timely and safe care is individuals' clinical relevant information is stored in multiple, independent sources. Health information exchange is a national goal, currently implemented in many locations, and promises huge financial and quality improvements. However, how these systems are actually used is not exactly known, and therefore a needed area of research.