Rudin R, Volk L, Simon S, Bates D
MIT CSAIL, Cambridge, USA.
Appl Clin Inform. 2011 Jan 1;2(3):250-262. doi: 10.4338/ACI-2011-03-RA-0021.
The ability to electronically exchange health information among healthcare providers holds enormous promise to improve care coordination and reduce costs. Provider-to-provider data exchange is an explicit goal of the American Recovery and Reinvestment Act of 2009 and may be essential for the long-term success of the Affordable Care Act of 2010. However, little is known about what factors affect clinicians' usage of health information exchange (HIE) functionality. OBJECTIVE: To identify factors that affect clinicians' HIE usage - in terms of frequency of contributing data to and accessing data from aggregate patient records - and suggest policies for fostering its usage. METHODS: We performed a qualitative study using grounded theory by interviewing clinician-users and HIE staff of one operational HIE which supported aggregate patient record functionality. Fifteen clinicians were interviewed for one hour each about what factors affect their HIE usage. Five HIE staff were asked about technology and training issues to provide context. Interviews were recorded, transcribed and analyzed. Recruitment excluded clinicians with little or no familiarity with the HIE and was restricted to one community and a small number of specialties. RESULTS: Clinicians were motivated to access the HIE by perceived improvements in care quality and time savings, but their motivation was moderated by an extensive list of factors including gaps in data, workflow issues and usability issues. HIE access intensities varied widely by clinician. Data contribution intensities to the HIE also varied widely and were affected by billing concerns and time constraints. CONCLUSIONS: Clinicians, EHR and HIE product vendors and trainers should work toward integrating HIE into clinical workflows. Policies should create incentives for HIE organizations to assist clinicians in using HIE, develop measures of HIE contributions and accesses, and create incentives for clinicians to contribute data to HIEs.
医疗服务提供者之间通过电子方式交换健康信息，有望极大地改善医疗协调并降低成本。提供者之间的数据交换是2009年《美国复苏与再投资法案》的明确目标，对于2010年《平价医疗法案》的长期成功可能至关重要。然而，对于影响临床医生使用健康信息交换（HIE）功能的因素却知之甚少。
确定影响临床医生使用HIE的因素——从向汇总患者记录贡献数据和从汇总患者记录访问数据的频率方面——并提出促进其使用的政策建议。
我们采用扎根理论进行了一项定性研究，通过采访一家支持汇总患者记录功能的运营中的HIE的临床医生用户和HIE工作人员。对15名临床医生每人进行了1小时的访谈，询问影响他们使用HIE的因素。向5名HIE工作人员询问了技术和培训问题以提供背景信息。访谈进行了录音、转录和分析。招募工作排除了对HIE几乎不熟悉或完全不熟悉的临床医生，并且仅限于一个社区和少数几个专业领域。
临床医生因认为护理质量有所提高和节省时间而有动力访问HIE，但他们的动力受到一系列因素的制约，包括数据缺口、工作流程问题和可用性问题。临床医生的HIE访问强度差异很大。向HIE的数据贡献强度也差异很大，并受到计费问题和时间限制的影响。
临床医生、电子健康记录（EHR）和HIE产品供应商及培训人员应努力将HIE集成到临床工作流程中。政策应激励HIE组织协助临床医生使用HIE，制定HIE贡献和访问的衡量标准，并激励临床医生向HIE贡献数据。
