Predictors of clinician use of Australia’s national health information exchange in the emergency Department: An analysis of log data

Abstract

ObjectiveThis study explores patient and context related factors associated with use of Australia’s national personally controlled Health Information Exchange (HIE), My Health Record, by emergency department (ED) clinicians. Materials and methodsA retrospective analysis explored secondary routinely-collected data including all patients who presented (between August 2019–2021) to the ED at a not-for-profit hospital in Melbourne. Presentation data were linked to the HIE access log-data, and human resources data. The primary outcome indicated HIE access by an ED pharmacist, doctor or nurse, within 3 days of the patient presenting to the ED, or not. Nine variables were explored with logistic regression, representing patient (gender, age, diagnosis) and other factors (presentation time, arrival method, referral, acuity/triage, length of stay, admitted into hospital). ResultsHIE is accessed in 17.43% of patient presentations to the ED, led by pharmacists (15.60%). Overall, as demonstrated in themultivariable analysis, increased HIE access was associated with increasing age, with the biggest effect for 75–84-year old’s (odd’s ratio 26.15; 95% confidence interval 15.37–44.50), when compared to < 4 years of age. HIE access was also significantly and positively associated with patients who were later admitted into hospital from theED (4.96; 4.61–5.34). ConclusionThe results suggest users of HIE in the ED employ the system to meet their needs, but not for all patients. To maximise value derived from HIE use, clinicians should target system access for patients where the benefit of accessing the record outweighs the cost - this research suggests that is for patients who are older in age and are likely to be admitted, potentially linked to greater condition complexity. If the use of a HIE is to improve the provision of care in the ED, the key stakeholders governing patient information within the HIE need to focus on improving clinician recording behaviours for older people and those suffering from complex medical conditions. Doctors and nurses lag behind with respect to the use of the HIE by pharmacists. Therefore, a focus on encouraging HIE engagement across these clinician groups is drastically required.