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Use Patterns of Health Information Exchange (HIE) Systems in the Emergency Department: A Novel Outlook on System Use and Decision Making
Researchers: Lior Fink1, Shlomi Codish2, Iftach Sagy2
- Ben-Gurion University of the Negev
- Soroka University Medical Center
Background: Realizing the benefits of health information exchange systems (HIEs) depends on how they are used. Previous studies seldom focused on predicting use patterns, their associations with clinical decisions, and the implications of implementing an electronic medical record (EMR) on these associations. Such analyses are of particular importance in Israel, where an HIE is nationally deployed.
Objectives: Examining the association between the volume of consumed information and the duration of its consumption, between use patterns and a clinical decision, and the effects of implementing an EMR on these associations.
Method: A retrospective, observational study that focuses on critically-ill patients treated in the internal emergency department of Soroka University Medical Center during 2010-2012 and 2015 (before and after an EMR was implemented, respectively). Use patterns are characterized with log files derived from OFEK HIE. They are described using the configurational (theoretical and empirical use profiles) and reductionistic (separate use variables) approaches. The focal clinical decision is the admission decision. The analyses control for variables that describe the availability of information in the HIE, patient, physician, medical environment, and use dynamics within the encounter.
Findings: The primary use profile is "quick and basic". The information available in the HIE, particularly test results and discharge summaries, as well as the use dynamics within the encounter, are valuable for the prediction of use patterns and the admission decision. EMR availability is associated with a decrease in HIE use rate and an increase in HIE use duration.
Conclusions: The findings corroborate the limited time and resources at the disposal of the physician, stress the importance of the HIE to the physician, and highlight the contribution of specific information components.
Recommendations: Recommendations towards more efficient information displays, monitoring use patterns, and controlling the decrease in HIE use rate.
Research number: A/112/2015
Research end date: 12/2017