Brigham and Women's Hospital and Harvard Medical School, Division of General Internal Medicine and Primary Care, 1620 Tremont Street, 3rd Floor, Boston, 02120-1613, USA.
Brigham and Women's Hospital and Harvard Medical School, Division of General Internal Medicine and Primary Care, 1620 Tremont Street, 3rd Floor, Boston, MA 02120-1613, USA.
Int J Med Inform. 2020 May;137:104102. doi: 10.1016/j.ijmedinf.2020.104102. Epub 2020 Feb 19.
Health is poorer in rural areas and a major challenge is care coordination for complex chronic conditions. The HITECH and 21 Century Cure Acts emphasize health information exchange which underpins activities required to improve care coordination.
Using semi-structured interviews and surveys, we examined how providers experience electronic health information exchange during care coordination since these Acts were implemented, with a focus on rural settings where health disparities exist. We used a purposive sample that included primary care, acute care hospitals, and community health services in the United States.
We identified seven themes related to care coordination and information exchange: 'insufficient trust of data'; 'please respond'; 'just fax it'; 'care plans'; 'needle in the haystack'; 're-documentation'; and 'rural reality'. These gaps were magnified when information exchange was required between unaffiliated electronic health records (EHRs) about shared patients, which was more pronounced in rural settings.
Policy and incentive modifications are likely needed to overcome the observed health information technology (HIT) shortcomings. Rural settings in the United States accentuate problems that can be addressed through international medical informatics policy makers and the implementation and evaluation of interoperable HIT systems.
农村地区的健康状况较差，主要挑战是协调复杂慢性病的护理。《健康信息技术促进经济和临床健康法案》和《21 世纪治愈法案》强调了卫生信息交换，这是改善护理协调所需的活动的基础。
本研究采用半结构式访谈和调查，考察了自这些法案实施以来，医疗服务提供者在协调护理过程中电子健康信息交换的体验，重点关注存在健康差异的农村地区。我们使用了一个有目的的样本，包括美国的初级保健、急性护理医院和社区卫生服务。
我们确定了与护理协调和信息交换相关的七个主题：“对数据的信任不足”；“请回复”；“直接传真过来”；“护理计划”；“大海捞针”；“重复记录”；和“农村现实”。当需要在共享患者的不相关电子健康记录（EHR）之间进行信息交换时，这些差距就会放大，而在农村地区，这种情况更为明显。
可能需要修改政策和激励措施，以克服观察到的卫生信息技术（HIT）缺陷。美国农村地区突出了可以通过国际医学信息学政策制定者以及互操作 HIT 系统的实施和评估来解决的问题。
