Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Division of Medical Information Technology and Administration Planning, Kyoto University Hospital, Kyoto, Japan.
JMIR Med Inform. 2024 Oct 9;12:e56263. doi: 10.2196/56263.
Over 200 health information exchanges (HIEs) are currently operational in Japan. The most common feature of HIEs is remote on-demand viewing or searching of aggregated patient health data from multiple institutions. However, the usage of this feature by individual users and institutions remains unknown.
This study aims to understand usage of the on-demand patient data viewing feature of large-scale HIEs by individual health care workers and institutions in Japan.
We conducted audit log analyses of large-scale HIEs. The research subjects were HIEs connected to over 100 institutions and with over 10,000 patients. Each health care worker's profile and audit log data for HIEs were collected. We conducted four types of analyses on the extracted audit log. First, we calculated the ratio of the number of days of active HIE use for each hospital-affiliated doctor account. Second, we calculated cumulative monthly usage days of HIEs by each institution in financial year (FY) 2021/22. Third, we calculated each facility type's monthly active institution ratio in FY2021/22. Fourth, we compared the monthly active institution ratio by medical institution for each HIE and the proportion of cumulative usage days by user type for each HIE.
We identified 24 HIEs as candidates for data collection and we analyzed data from 7 HIEs. Among hospital doctors, 93.5% (7326/7833) had never used HIEs during the available period in FY2021/22, while 19 doctors used them at least 30% of days. The median (IQR) monthly active institution ratios were 0.482 (0.470-0.487) for hospitals, 0.243 (0.230-0.247) for medical clinics, and 0.030 (0.024-0.048) for dental clinics. In 51.9% (1781/3434) of hospitals, the cumulative monthly usage days of HIEs was 0, while in 26.8% (921/3434) of hospitals, it was between 1 and 10, and in 3% (103/3434) of hospitals, it was 100 or more. The median (IQR) monthly active institution ratio in medical institutions was 0.511 (0.487-0.529) for the most used HIE and 0.109 (0.0927-0.117) for the least used. The proportion of cumulative usage days of HIE by user type was complex for each HIE, and no consistent trends could be discerned.
In the large-scale HIEs surveyed in this study, the overall usage of the on-demand patient data viewing feature was low, consistent with past official reports. User-level analyses of audit logs revealed large disparities in the number of days of HIE use among health care workers and institutions. There were also large disparities in HIE use by facility type or HIE; the percentage of cumulative HIE usage days by user type also differed by HIE. This study indicates the need for further research into why there are large disparities in demand for HIEs in Japan as well as the need to design comprehensive audit logs that can be matched with other official datasets.
目前日本有超过 200 个健康信息交换中心（HIE）在运营。HIE 最常见的功能是远程按需查看或搜索来自多个机构的聚合患者健康数据。然而，个体用户和机构对这一功能的使用情况尚不清楚。
本研究旨在了解日本大型 HIE 中个体医疗保健工作者和机构对患者数据按需查看功能的使用情况。
我们对大型 HIE 进行了审核日志分析。研究对象为连接超过 100 家机构和超过 10000 名患者的 HIE。收集了每个医疗保健工作者的个人资料和 HIE 的审核日志数据。我们对提取的审核日志进行了四种类型的分析。首先，计算每个医院附属医生账户的 HIE 活跃使用天数的比例。其次，计算每个机构在 2021/22 财年的 HIE 累计月使用天数。第三，计算每个设施类型在 2021/22 财年的每月活跃机构比例。第四，比较每个 HIE 的每月活跃机构比例和每个 HIE 的用户类型累计使用天数的比例。
我们确定了 24 个 HIE 作为数据收集的候选对象，并分析了 7 个 HIE 的数据。在医院医生中，93.5%（7326/7833）在 2021/22 财年的可用期间从未使用过 HIE，而 19 名医生至少使用了 30%的天数。医院的中位数（IQR）每月活跃机构比例为 0.482（0.470-0.487），诊所为 0.243（0.230-0.247），牙科诊所为 0.030（0.024-0.048）。在 51.9%（1781/3434）的医院中，HIE 的累计月使用天数为 0，而在 26.8%（921/3434）的医院中，使用天数在 1 到 10 天之间，在 3%（103/3434）的医院中，使用天数为 100 天或以上。使用最频繁的 HIE 的医疗机构中位数（IQR）每月活跃机构比例为 0.511（0.487-0.529），使用最不频繁的 HIE 的比例为 0.109（0.0927-0.117）。每个 HIE 用户类型的 HIE 累计使用天数比例复杂，没有明显的趋势。
在本研究调查的大型 HIE 中，患者数据按需查看功能的整体使用情况较低，这与过去的官方报告一致。审核日志的用户级别分析显示，医疗保健工作者和机构之间的 HIE 使用天数存在很大差异。设施类型或 HIE 的 HIE 使用情况也存在很大差异；用户类型的 HIE 累计使用天数的百分比也因 HIE 而异。本研究表明，有必要进一步研究为什么日本对 HIE 的需求存在如此大的差异，以及需要设计可以与其他官方数据集匹配的综合审核日志。
