Rivera Rebecca L, Hosler Heidi, Jang Jeong Hoon, Schaffer Jason T, Price John, Vest Joshua R, Schleyer Titus K
Clem McDonald Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, Indiana, United States.
Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States.
ACI open. 2023;7(2):e49-e60. doi: 10.1055/s-0043-1772583. Epub 2023 Sep 28.
This article (1) develops a Fast Healthcare Interoperability Resources app, Health Dart, that integrates information from Indiana's community health information exchange (HIE), the Indiana Network for Patient Care (INPC), directly with Cerner, an electronic health record (EHR), and (2) evaluates the effect of Health Dart's implementation on HIE use.
Health Dart was implemented in 14 Indiana University Health emergency departments (EDs) using a stepped-wedge study design. We analyzed rates of INPC use in 286,175 ED encounters between October 1, 2019 and December 31, 2020. Logistic regression was used to model the probability of INPC use given the implementation context, such as user interface (UI) enhancements and the coronavirus disease 2019 pandemic.
INPC use increased by 131% across all encounters (from 3.6 to 8.3%; < 0.001) after Health Dart implementation. INPC use increased by 144% (from 3.6 to 8.8%; < 0.001) more than 2 months postimplementation. After UI enhancements, postimplementation INPC use increased by 123% (from 3.5 to 7.8%) compared to 181% (from 3.6 to 10.1%; < 0.001) in postimplementation encounters that occurred before UI enhancements. During the pandemic, postimplementation INPC use increased by 135% (from 3.4 to 8.0%; < 0.001) compared to 178% (from 3.6 to 10%; < 0.001) in postimplementation encounters that occurred before the pandemic. Statistical significance was determined using 95% confidence intervals (α = 0.05).
Direct integration of HIE information into an EHR substantially increased frequency of HIE use, but the effect was weakened by the UI enhancements and pandemic. HIE information integrated into EHRs in the form of problem-oriented dashboards can potentially make information retrieval more efficient and effective for clinicians.
本文（1）开发了一款快速医疗保健互操作性资源应用程序Health Dart，该程序将印第安纳州社区卫生信息交换（HIE）、印第安纳州患者护理网络（INPC）的信息直接与电子健康记录（EHR）系统Cerner集成，（2）评估Health Dart实施对HIE使用的影响。
采用阶梯楔形研究设计，在印第安纳大学健康系统的14个急诊科实施Health Dart。我们分析了2019年10月1日至2020年12月31日期间286,175次急诊科就诊中INPC的使用情况。使用逻辑回归模型来模拟在实施背景下（如用户界面（UI）增强和2019冠状病毒病大流行）使用INPC的概率。
实施Health Dart后，所有就诊中INPC的使用增加了131%（从3.6%增至8.3%；P<0.001）。实施后两个多月，INPC的使用增加了144%（从3.6%增至8.8%；P<0.001）。在UI增强后，实施后INPC的使用增加了123%（从3.5%增至7.8%），而在UI增强之前的实施后就诊中增加了181%（从3.6%增至10.1%；P<0.001）。在大流行期间，实施后INPC的使用增加了13S%（从3.4%增至8.0%；P<0.001），而在大流行之前的实施后就诊中增加了178%（从3.6%增至10%；P<0.001）。使用95%置信区间确定统计学显著性（α=0.05）。
将HIE信息直接集成到EHR中显著提高了HIE的使用频率，但UI增强和大流行削弱了这种效果。以面向问题的仪表板形式集成到EHR中的HIE信息可能会使临床医生的信息检索更高效、更有效。
