Health information exchange in Memphis: impact on the physician-patient relationship.

Vanderbilt University, TN, USA.
The Journal of Law Medicine &amp Ethics (Impact Factor: 0.94). 03/2010; 38(1):50-7. DOI: 10.1111/j.1748-720X.2010.00465.x
Source: PubMed

ABSTRACT Health information exchanges represent one way of making medical information available to practitioners across institutional boundaries. One health information exchange in Memphis Tennessee has been operational since May of 2006 and provides information supporting care for over 1.2 million individuals. Creating such an exchange challenged traditional institutional boundaries, roles, and perceptions. Approaching these challenges required leadership, trust, sound policy, new forms of dialogue, and an incremental approach to technology. Early evidence suggests a positive impact on patient care and a change in the way providers interact with their patients and on another. Personal health records, consolidated EHR systems, and other alternative models promise to have similar impacts on the way in which providers and patients interact with one another.

  • [Show abstract] [Hide abstract]
    ABSTRACT: We explore what emergency physicians with access to health information exchange have to say about it and strive to better understand the factors affecting their use of it. A qualitative study using grounded theory principles was conducted in 4 urban emergency departments that had health information exchange access for 4 years. Data were collected with unstructured interviews from 15 emergency physicians. Emergency physicians reported that a number of factors affected their use of health information exchange, but the most prevalent was that it was not user friendly and disrupted workflow. Five major themes emerged: variations in using health information exchange and its access, influencing clinical decisions, balancing challenges and barriers, recognizing benefits and success factors, and justifying not using health information exchange. The themes supported a theoretical interpretation that the process of using health information exchange is more complex than balancing challenges or barriers against benefits, but also how they justify not using it when making clinical decisions. We found that health information exchange systems need to be transformed to meet the needs of emergency physicians and incorporated into their workflow if it is going to be successful. The emergency physicians also identified needed improvements that would increase the frequency of health information exchange use. The emergency physicians reported that health information exchange disrupted their workflow and was less than desirable to use. The health information exchange systems need to adapt to the needs of the end user to be both useful and useable for emergency physicians.
    Annals of emergency medicine 10/2013; 63(3). DOI:10.1016/j.annemergmed.2013.09.024 · 4.33 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Health information exchange (HIE) is the interorganizational sharing of patient information and is one of many health information technology initiatives expected to transform the U.S. healthcare system. Two outcomes expected to be improved by HIE are patient-provider communication and patient satisfaction . This analysis examined the relationship between the level of HIE engagement and these two factors in a sample of U.S. hospitals. Independent variables came from existing secondary sources and the dependent measures were from the Hospital Consumer Assessment of Healthcare Providers and Systems. The analysis included 3,278 hospitals. Using ordinary least squares regression, implemented HIE was positively associated with the percentage of patients reporting nurses communicated well and higher satisfaction. Due to the potential for selection bias, results were further explored using a propensity score analysis. Hospitals that had adopted HIE, but not yet implemented saw no benefits. Hospitals' level of HIE was not associated with the percentage of patients reporting doctors communicated well. According to propensity score corrected estimates, implemented HIE was associated with the percentage of patients who reported nurses always communicated well and who would definitely recommend the hospital. Few studies have examined the impact of HIE at the organizational level. This examination provides some evidence that hospitals engaging in HIE are associated with higher patient satisfaction.
    Applied Clinical Informatics 01/2011; 2(4):447-59. DOI:10.4338/ACI-2011-06-RA-0040 · 0.39 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The overall aim of this study was to clarify the outcomes, i.e. the benefits and effectiveness, of health information exchange (HIE) through regional health information system (RHIS) concerning patient service package and health care delivery in one hospital district area in the five-year period of 2004–2008. Both qualitative and quantitative research methods were used for the empirical demonstration and evaluation of the benefits of HIE through RHIS. A systematic literature review was used to find out the outcomes of the different types of regional health information systems in health care delivery. Quantitative outcome measurement, a retrospective, comparative, longitudinal five-year follow-up study, was used to evaluate the impact of HIE on health care delivery. A qualitative themed interview study design was used to provide a deeper understanding of the research results and the outcomes obtained with the use of HIE through RHIS. There were three different sets of data in this study. The first set of data consisted of 24 empirical studies. The second set of data consisted of selected outcomes obtained from registry-based statistical data, comprising data routinely obtained of total laboratory tests, radiology examinations, appointments, emergency department visits, primary care referrals and emergency referrals to special care, and the viewed references in the five-year follow-up period, 2004–2008, both in primary and special care. The third set was interview data of health care professionals (physicians, nurses, department secretaries), and administrative representatives, total (n=43) and chronically ill patients (n=10), who had the most experience of HIE. Content analysis was used to analyse the review articles. Inductive content analysis was used to analyse both the review articles and the interview data. Additional deductive content analysis was used to categorize the interview data of chronically ill patients. Trend analysis was used for selected outcomes, and the t-test was used to determine the changes over the follow-up period. Linearity regression was used for modelling the link between the viewed references and selected outcomes during the five-year period. Analysis of Variance (ANOVA) was used to test the differences in averages between groups. The main outcome areas found based on the literature review were flow of information, collaboration, process redesign, usability and factors affecting the organizational culture. Substantial changes in the selected outcomes were found in the follow-up period. The trends of HIE usage increased in each professional groups. There was also a significant association between the number of laboratory tests, radiology examinations, appointments, emergency visits, emergency referrals and the number of viewed references, i.e. HIE usage. When physicians made emergency referrals to special care, they viewed significantly more reference information and nurses used HIE significantly more in viewing reference information in emergency visits and when making emergency referrals. Also, the more appointments made with doctors there were, the more department secretaries viewed the reference information. HIE usage may have increased the efficiency of health care delivery in patient care by improving the professionals’ access to patient information across organization boundaries. However, the changes observed in the use of HIE services have many other explanations, and more research is needed to understand the impact of HIE on the efficiency of health care delivery. Regional HIE changed the flow of information regarding the availability of information, exchange of information, and data protection after five-year usage. Regional collaboration improved between health care professionals, administrative staff and patients. HIE did not support the management of the patient service package, as patients were made more responsible for the management of their own service package and continuity of care. An improvement in the efficiency of working practices was observable among health care professionals, administrative staff and patients. The organizational commitment and management support of various stakeholders are needed for the necessary changes and a new way of working in health care delivery. The feedback from professionals is important for further development of health information systems. In this study, a patient service package refers to one or several sets of health care services given to a patient, where health care service providers are concerned. Here health care delivery refers to health care services offered by primary care and special care providers to patients from municipalities and municipality federations. The professionals working in health care include health care professionals and administrative representatives. The term health care professionals refer to physicians, nurses and department secretaries. The implementation of HIE through RHIS is a long-term process. In addition, investment in developing health information systems will continue. The study generated new knowledge about the the benefits and effectiveness of implementing health information exchange (HIE) through regional health information systems (RHISs) in health care delivery.
    Edited by Tampere University Press and the author, 10/2012; Acta Universitatis Tamperensis 1760., ISBN: 978-951-44-8895-5

Mark Frisse