Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 1/2015

Open Access 01-12-2015 | Research article

A user needs assessment to inform health information exchange design and implementation

Authors: Alexandra T. Strauss, Diego A. Martinez, Andres Garcia-Arce, Stephanie Taylor, Candice Mateja, Peter J. Fabri, Jose L. Zayas-Castro

Published in: BMC Medical Informatics and Decision Making | Issue 1/2015

Login to get access

Abstract

Background

Important barriers for widespread use of health information exchange (HIE) are usability and interface issues. However, most HIEs are implemented without performing a needs assessment with the end users, healthcare providers. We performed a user needs assessment for the process of obtaining clinical information from other health care organizations about a hospitalized patient and identified the types of information most valued for medical decision-making.

Methods

Quantitative and qualitative analysis were used to evaluate the process to obtain and use outside clinical information (OI) using semi-structured interviews (16 internists), direct observation (750 h), and operational data from the electronic medical records (30,461 hospitalizations) of an internal medicine department in a public, teaching hospital in Tampa, Florida.

Results

13.7 % of hospitalizations generate at least one request for OI. On average, the process comprised 13 steps, 6 decisions points, and 4 different participants. Physicians estimate that the average time to receive OI is 18 h. Physicians perceived that OI received is not useful 33–66 % of the time because information received is irrelevant or not timely. Technical barriers to OI use included poor accessibility and ineffective information visualization. Common problems with the process were receiving extraneous notes and the need to re-request the information. Drivers for OI use were to trend lab or imaging abnormalities, understand medical history of critically ill or hospital-to-hospital transferred patients, and assess previous echocardiograms and bacterial cultures. About 85 % of the physicians believe HIE would have a positive effect on improving healthcare delivery.

Conclusions

Although hospitalists are challenged by a complex process to obtain OI, they recognize the value of specific information for enhancing medical decision-making. HIE systems are likely to have increased utilization and effectiveness if specific patient-level clinical information is delivered at the right time to the right users.
Appendix
Available only for authorised users
Literature
1.
Anderson G, Knickman JR. Changing the chronic care system to meet people’s needs. Health Aff. 2001;20:146–60.CrossRef
2.
Pham HH, Schrag D, O’Malley AS, Wu B, Bach PB. Care patterns in Medicare and their implications for pay for performance. N Engl J Med. 2007;356:1130–9.CrossRefPubMed
3.
Gandhi TK, Sittig DF, Franklin M, Sussman AJ, Fairchild DG, Bates DW. Communication breakdown in the outpatient referral process. J Gen Intern Med. 2000;15:626–31.CrossRefPubMedPubMedCentral
4.
Jha AK, Chan DC, Ridgway AB, Franz C, Bates DW. Improving safety and eliminating redundant tests: cutting costs in U.S. hospitals. Health Aff (Millwood). 2009;28:1475–84.CrossRef
5.
Blumenthal D. Stimulating the adoption of health information technology. N Engl J Med. 2009;360:1477–9.CrossRefPubMed
6.
Rudin RS, Motala A, Goldzwelg CL, Shekelle PG. Usage and effect of health information exchange: a systematic review. Ann Intern Med. 2014;161:803–12.CrossRefPubMed
7.
Rahurkar S, Vest JR, Menachemi N. Despite the spread of health information exchange, there is little evidence of its impact on cost, use, and quality of care. Health Aff (Millwood). 2015;34:477–83.CrossRef
8.
Ballard J, Rosenman M, Weiner M. Harnessing a health information exchange to identify surgical device adverse events for urogynecologic mesh. In: AMIA Annual Symposium proceedings, vol. 2012. 2012. p. 1109–18.
9.
Kaelber DC, Bates DW. Health information exchange and patient safety. J Biomed Inform. 2007;40(6 Suppl):S40–5.CrossRefPubMed
10.
Kouroubali A, Starren JB, Clayton PD. Costs and benefits of connecting community physicians to a hospital WAN. In: AMIA Annual Symposium proceedings. 1998. p. 205–9.
11.
Bailey JE, Wan JY, Mabry LM, Landy SH, Pope RA, Waters TM, et al. Does health information exchange reduce unnecessary neuroimaging and improve quality of headache care in the emergency department? J Gen Intern Med. 2012;28(2):176–83.CrossRefPubMedPubMedCentral
12.
Bailey JE, Pope RA, Elliott EC, Wan JY, Waters TM, Frisse ME. Health information exchange reduces repeated diagnostic imaging for back pain. Ann Emerg Med. 2013;62:16–24.CrossRefPubMed
13.
Overhage JM, Dexter PR, Perkins SM, Cordell WH, McGoff J, McGrath R, et al. A randomized, controlled trial of clinical information shared from another institution. Ann Emerg Med. 2002;39:14–23.CrossRefPubMed
14.
Callen J, Paoloni R, Li J, Stewart M, Gibson K, Georgiou A, et al. Perceptions of the effect of information and communication technology on the quality of care delivered in emergency departments: a cross-site qualitative study. Ann Emerg Med. 2013;61:131–44.CrossRefPubMed
15.
Ozkaynak M, Brennan PF. Revisiting sociotechnical systems in a case of unreported use of health information exchange system in three hospital emergency departments. J Eval Clin Pract. 2013;19:370–3.CrossRefPubMed
16.
Thorn SA, Carter MA. The potential of health information exchange to assist emergency nurses. J Emerg Nurs. 2013;39:e91–6.CrossRefPubMed
17.
Frisse ME, Johnson KB, Nian H, Davison CL, Gadd CS, Unertl KM, et al. The financial impact of health information exchange on emergency department care. J Am Med Inform Assoc. 2012;19(3):328–33.CrossRefPubMed
18.
19.
Nguyen OK, Chan CV, Makam A, Stieglitz H, Amarasingham R. Envisioning a social-health information exchange as a platform to support a patient-centered medical neighborhood: a feasibility study. J Gen Intern Med. 2014;30(1):60–7.CrossRefPubMedPubMedCentral
20.
Lang E, Afilalo M, Vandal AC, Boivin J-F, Xue X, Colacone A, et al. Impact of an electronic link between the emergency department and family physicians: a randomized controlled trial. CMAJ. 2006;174:313–8.CrossRefPubMedPubMedCentral
21.
Hansagi H, Olsson M, Hussain A, Ohlén G. Is information sharing between the emergency department and primary care useful to the care of frequent emergency department users? Eur J Emerg Med. 2008;15:34–9.CrossRefPubMed
22.
Adler-Milstein J, Jha AK. Health information exchange among U.S. hospitals: who’s in, who’s out, and why? Healthcare. 2014;2:26–32.CrossRefPubMed
23.
24.
Furukawa MF, King J, Patel V, Hsiao C-J, Adler-Milstein J, Jha AK. Despite substantial progress in EHR adoption, health information exchange and patient engagement remain low in office settings. Health Aff (Millwood). 2014;33(9):1672–9. hlthaff.2014.0445.CrossRef
25.
Leu MG, Cheung M, Webster TR, Curry L, Bradley EH, Fifield J, et al. Centers speak up: the clinical context for health information technology in the ambulatory care setting. J Gen Intern Med. 2008;23:372–8.CrossRefPubMedPubMedCentral
26.
Finnell JT, Overhage JM. Emergency medical services: the frontier in health information exchange. AMIA Annu Symp Proc. 2010;2010:222–6.PubMedPubMedCentral
27.
Vest JR, Zhao H, Jasperson J, Jaspserson J, Gamm LD, Ohsfeldt RL. Factors motivating and affecting health information exchange usage. J Am Med Inform Assoc. 2011;18:143–9.CrossRefPubMedPubMedCentral
28.
Vest JR, Jasperson ‘S, Zhao H, Gamm LD, Ohsfeldt RL. Use of a health information exchange system in the emergency care of children. BMC Med Inform Decis Mak. 2011;11:78.CrossRefPubMedPubMedCentral
29.
Vest JR, Grinspan ZM, Kern LM, Campion TR, Kaushal R. Using a health information exchange system for imaging information: patterns and predictors. AMIA Annu Symp Proc. 2013;2013:1402–11.PubMedPubMedCentral
30.
Campion TR, Ancker JS, Edwards AM, Patel VN, Kaushal R. Push and pull: physician usage of and satisfaction with health information exchange. AMIA Annu Symp Proc. 2012;2012:77–84.PubMedPubMedCentral
31.
Vest JR, Jasperson ‘S. How are health professionals using health information exchange systems? Measuring usage for evaluation and system improvement. J Med Syst. 2012;36:3195–204.CrossRefPubMed
32.
Ross SE, Schilling LM, Fernald DH, Davidson AJ, West DR. Health information exchange in small-to-medium sized family medicine practices: motivators, barriers, and potential facilitators of adoption. Int J Med Inform. 2010;79:123–9.CrossRefPubMed
33.
Wright A, Soran C, Jenter CA, Volk LA, Bates DW, Simon SR. Physician attitudes toward health information exchange: results of a statewide survey. J Am Med Inform Assoc. 2010;17:66–70.CrossRefPubMedPubMedCentral
34.
Sicotte C, Paré G. Success in health information exchange projects: solving the implementation puzzle. Soc Sci Med. 2010;70:1159–65.CrossRefPubMed
35.
GmbH. ATLAS.ti version 6.2.23. [Computer Software]. Berlin, Germany. 2009. Licensed through University of South Florida.
36.
Rudin RS, Salzberg CA, Szolovits P, Volk LA, Simon SR, Bates DW. Care transitions as opportunities for clinicians to use data exchange services: how often do they occur? J Am Med Inform Assoc. 2011;18:853–8.CrossRefPubMedPubMedCentral
37.
O’Malley AS, Grossman JM, Cohen GR, Kemper NM, Pham HH. Are electronic medical records helpful for care coordination? Experiences of physician practices. J Gen Intern Med. 2010;25:177–85.CrossRefPubMed
38.
39.
Electronic Health Record Vendors Reported by Hospitals Participating in the CMS EHR Incentive Programs,’ Health IT Quick-Stat #29 [dashboard.healthit.gov/quickstats/pages/FIG-Vendors-of-EHRs-to-Participating-Hospitals.php]. Access date Oct 8 2015.
40.
Hennrikus E. Communication between the primary care physician and the hospital at the time of patient admission. J Clin Outcomes Manag. 2012;19:453–9.
Metadata
Title
A user needs assessment to inform health information exchange design and implementation
Authors
Alexandra T. Strauss
Diego A. Martinez
Andres Garcia-Arce
Stephanie Taylor
Candice Mateja
Peter J. Fabri
Jose L. Zayas-Castro
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Medical Informatics and Decision Making / Issue 1/2015
Electronic ISSN: 1472-6947
DOI
https://doi.org/10.1186/s12911-015-0207-x

Other articles of this Issue 1/2015

BMC Medical Informatics and Decision Making 1/2015 Go to the issue

Research article

Multiple perspectives on clinical decision support: a qualitative study of fifteen clinical and vendor organizations

Study protocol

Randomized trial of a novel game-based appointment system for a university hospital venereology unit: study protocol

Research article

Knowledge and attitudes of doctors towards e-health use in healthcare delivery in government and private hospitals in Northern Uganda: a cross-sectional study

Research article

Details of development of the resource for adults with asthma in the RAISIN (randomized trial of an asthma internet self-management intervention) study

Research article

Logic regression-derived algorithms for syndromic management of vaginal infections

Research article

Non-redundant association rules between diseases and medications: an automated method for knowledge base construction