Perception of utility of health information exchange in New York State and scoping review of health information exchange efforts in the United States.

摘要

The ability to exchange patient health information electronically among many providers holds an enormous promise to vastly improve care coordination and help curb the high costs of healthcare in the Unites States. Current evidence of Health Information Exchange (HIE) system usage and usability is limited in scope due to the low adoption and usage rates among clinical provider users. In this mixed-methods health services research study of clinical users of HIE systems, I strive to understand the socio-behavioral-technical factors that facilitate and hinder healthcare user adoption of HIE technologies. Focus group methodology was used to gather clinical users' perceptions about conditions that are favoring and against successful adoption and usage of HIE in their normal practice by applying the FITT analytical framework to elucidate the fit between technology and individuals. Overall, the clinical users of HIE voiced a wide variety of benefits to HIE usage as it pertains to providing better care, resulting in favorable health outcomes for their patients. At the same time, they expressed a deep concern over maintenance costs and overall sustainability of current HIE models. Many ideas for improvement were suggested especially as it pertains to policy development, business sustainability and governance strategies. Given that the HIE landscape is constantly evolving, so long as there are improved interoperability standards set by governing agencies, more studies will need to be done to continue evaluating gaps in clinical users' expectations versus deliverables by HIE entities.In addition to clinical user perspectives, a quantified scoping review of all HIE efforts in the United States is presented, with a proposed argument for defining HIE efforts based on geographic coverage service areas. This is a novel way of understanding HIE efforts across the country and would prove to be a valuable quantification tool for public health stakeholders at the state and federal level when planning healthcare services evaluation projects in the future. From a clinical perspective, HIE exchange service areas could be used by providers to make the best decisions on which HIE to participate in. In turn, allowing physicians to leverage HIE to participate in care coordination incentive programs such as ACOs or PCMH models in an attempt to provide higher quality, safer, efficient and possibly cost effective care. Overall, the exchange service areas would allow for better HIE analysis and evaluation,