Abstract
BackgroundChildren may benefit greatly in terms of safety and care coordination from the information sharing promised by health information exchange (HIE). While information exchange capability is a required feature of the certified electronic health record, we known little regarding how this technology is used in general and for pediatric patients specifically.MethodsUsing data from an operational HIE effort in central Texas, we examined the factors associated with actual system usage. The clinical and demographic characteristics of pediatric ED encounters (n = 179,445) were linked to the HIE system user logs. Based on the patterns of HIE system screens accessed by users, we classified each encounter as: no system usage, basic system usage, or novel system usage. Using crossed random effects logistic regression, we modeled the factors associated with basic and novel system usage.ResultsUsers accessed the system for 8.7% of encounters. Increasing patient comorbidity was associated with a 5% higher odds of basic usage and 15% higher odds for novel usage. The odds of basic system usage were lower in the face of time constraints and for patients who had not been to that location in the previous 12 months.ConclusionsHIE systems may be a source to fulfill users' information needs about complex patients. However, time constraints may be a barrier to usage. In addition, results suggest HIE is more likely to be useful to pediatric patients visiting ED repeatedly. This study helps fill an existing gap in the study of technological applications in the care of children and improves knowledge about how HIE systems are utilized.
Highlights
Children may benefit greatly in terms of safety and care coordination from the information sharing promised by health information exchange (HIE)
In terms of patient comorbidity, the odds of basic usage were 5% higher (OR = 1.05; 95%Confidence interval (CI) = 1.02, 1.08) for each additional recorded diagnosis category during the encounter
Specific to recent utilization history, increasing number of primary care visits, visits to other emergency department (ED), and prior hospitalization in the previous 12 months each increased the odds of basic usage
Summary
Children may benefit greatly in terms of safety and care coordination from the information sharing promised by health information exchange (HIE). While information exchange capability is a required feature of the certified electronic health record, we known little regarding how this technology is used in general and for pediatric patients . Health information exchange (HIE), the process of electronically sharing identified, patient-level information between different organizations,[1] is a potentially transformative solution to problems of cost,[2] timeliness,[3] patient-centeredness,[4] safety,[3] and efficiency [5] that plague the healthcare system. The Health Information Technology for Economic & Clinical Health (HITECH) Act, part of the American Recovery & Reinvestment Act, identified information exchange capability and connectivity as a required feature of certified electronic health records (EHRs). Despite the high level of support for HIE, we know very little about providers’ motivations to use HIE systems or the effectiveness of HIE,[16,17,18] beyond the fact that these information systems are predominately accessed by a minority of providers [19] and for a minority of patients [20]
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