Electronic health information exchange in underserved settings: examining initiatives in small physician practices & community health centers.

BackgroundHealth information exchange (HIE) is an important tool for improving efficiency and quality and is required for providers to meet Meaningful Use certification from the United States Centers for Medicare and Medicaid Services. However widespread adoption and use of HIE has been difficult to achieve, especially in settings such as smaller-sized physician practices and federally qualified health centers (FQHCs). We assess electronic data exchange activities and identify barriers and benefits to HIE participation in two underserved settings.MethodsWe conducted key-informant interviews with stakeholders at physician practices and health centers. Interviews were recorded, transcribed, and then coded in two waves: first using an open-coding approach and second using selective coding to identify themes that emerged across interviews, including barriers and facilitators to HIE adoption and use.ResultsWe interviewed 24 providers, administrators and office staff from 16 locations in two states. They identified barriers to HIE use at three levels-regional (e.g., lack of area-level exchanges; partner organizations), inter-organizational (e.g., strong relationships with exchange partners; achieving a critical mass of users), and intra-organizational (e.g., type of electronic medical record used; integration into organization's workflow). A major perceived benefit of HIE use was the improved care-coordination clinicians could provide to patients as a direct result of the HIE information. Utilization and perceived benefit of the exchange systems differed based on several practice- and clinic-level factors.ConclusionsThe adoption and use of HIE in underserved settings appears to be impeded by regional, inter-organizational, and intra-organizational factors and facilitated by perceived benefits largely at the intra-organizational level. Stakeholders should consider factors both internal and external to their organization, focusing efforts in changing modifiable factors and tailoring HIE efforts based on all three categories of factors. Collective action between organizations may be needed to address inter-organizational and regional barriers. In the interest of facilitating HIE adoption and use, the impact of interventions at various levels on improving the use of electronic health data exchange should be tested

A Framework for Evaluating the Tension between Sharing and Protecting Health Information

Health information exchange (HIE) is expected to improve the quality and cost of healthcare but sustained use of HIE by providers has been difficult to achieve. A number of factors play a role in that process including concern for the security and privacy of the exchanged information. This tension between the expected benefits of HIE resulting from collaboration and information sharing on the one hand, and the potential security risks inherent in the exchange process on the other hand, is not well understood. We propose an information security control theory to explain this tension. We evaluate this theory through a case study of the iterative development of the information security policy for an HIE in the western United States. We find that the theory offers a good framework through which to understand the information security policy development process

Electronic health information exchange in underserved settings: examining initiatives in small physician practices & community health centers

abstract: Background Health information exchange (HIE) is an important tool for improving efficiency and quality and is required for providers to meet Meaningful Use certification from the United States Centers for Medicare and Medicaid Services. However widespread adoption and use of HIE has been difficult to achieve, especially in settings such as smaller-sized physician practices and federally qualified health centers (FQHCs). We assess electronic data exchange activities and identify barriers and benefits to HIE participation in two underserved settings. Methods We conducted key-informant interviews with stakeholders at physician practices and health centers. Interviews were recorded, transcribed, and then coded in two waves: first using an open-coding approach and second using selective coding to identify themes that emerged across interviews, including barriers and facilitators to HIE adoption and use. Results We interviewed 24 providers, administrators and office staff from 16 locations in two states. They identified barriers to HIE use at three levels—regional (e.g., lack of area-level exchanges; partner organizations), inter-organizational (e.g., strong relationships with exchange partners; achieving a critical mass of users), and intra-organizational (e.g., type of electronic medical record used; integration into organization’s workflow). A major perceived benefit of HIE use was the improved care-coordination clinicians could provide to patients as a direct result of the HIE information. Utilization and perceived benefit of the exchange systems differed based on several practice- and clinic-level factors. Conclusions The adoption and use of HIE in underserved settings appears to be impeded by regional, inter-organizational, and intra-organizational factors and facilitated by perceived benefits largely at the intra-organizational level. Stakeholders should consider factors both internal and external to their organization, focusing efforts in changing modifiable factors and tailoring HIE efforts based on all three categories of factors. Collective action between organizations may be needed to address inter-organizational and regional barriers. In the interest of facilitating HIE adoption and use, the impact of interventions at various levels on improving the use of electronic health data exchange should be tested.The electronic version of this article is the complete one and can be found online at: https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-14-41

Information seeking behavioural paths of physicians for diabetes mellitus care: a qualitative comparative analysis of information needs, sources, and barriers

This study addresses diabetes physicians’ information seeking behavioural paths (digital, conventional, interpersonal) which lead to information needs satisfaction and the barriers encountered in this process. The study was based on empirical evidence from a survey of 159 physicians. Theoretical analysis was informed by Wilson’s model of information seeking behaviour. The data were analysed using fuzzy set qualitative comparative analysis method. The method was successful in identifying five behavioural paths leading to physicians’ information needs satisfaction (professional/health coaching) which demonstrate different relationships between information sources (conventional/interpersonal/digital) and information barriers (personal/digital illiteracy) and five behavioural paths that are not leading to satisfaction

The Process of Building Patient Trust in Health Information Exchange (HIE): The Impacts of Perceived Benefits, Perceived Transparency of Privacy Policy, and Familiarity

Exchange technologies such as health information exchanges (HIE) currently lack acceptance theories that consider not only cognitive beliefs that result in adoption behavior but also emotional factors that may influence adoption intention. Based on the theory of reasoned action (TRA), the technology-adoption literature, and the trust literature, I theoretically explain and empirically test the impact that perceived benefits, perceived transparency of privacy policy, and familiarity have on cognitive trust and emotional trust in HIE. Moreover, I analyze the effect that cognitive trust and emotional trust have on individuals’ intention to opt into HIE and their willingness to disclose health information. I conducted an online survey using data from individuals who knew about HIE through experiences with providers that participated in a regional consumer-mediated HIE network. In my SEM analysis, I found empirical support for the proposed model. My findings indicate that, when patients know more about HIE benefits, HIE sharing procedures, and privacy guidelines, they feel more in control, more assured, and less at risk. The results also show that patient trust in HIE may take the forms of intentions to opt in to HIE and patients’ willingness to disclose personal health information that providers exchange through the HIE. I discuss the implications my results have for both academics and practitioners

Electronic health information exchange in underserved settings: examining initiatives in small physician practices & community health centers

BackgroundHealth information exchange (HIE) is an important tool for improving efficiency and quality and is required for providers to meet Meaningful Use certification from the United States Centers for Medicare and Medicaid Services. However widespread adoption and use of HIE has been difficult to achieve, especially in settings such as smaller-sized physician practices and federally qualified health centers (FQHCs). We assess electronic data exchange activities and identify barriers and benefits to HIE participation in two underserved settings.MethodsWe conducted key-informant interviews with stakeholders at physician practices and health centers. Interviews were recorded, transcribed, and then coded in two waves: first using an open-coding approach and second using selective coding to identify themes that emerged across interviews, including barriers and facilitators to HIE adoption and use.ResultsWe interviewed 24 providers, administrators and office staff from 16 locations in two states. They identified barriers to HIE use at three levels-regional (e.g., lack of area-level exchanges; partner organizations), inter-organizational (e.g., strong relationships with exchange partners; achieving a critical mass of users), and intra-organizational (e.g., type of electronic medical record used; integration into organization's workflow). A major perceived benefit of HIE use was the improved care-coordination clinicians could provide to patients as a direct result of the HIE information. Utilization and perceived benefit of the exchange systems differed based on several practice- and clinic-level factors.ConclusionsThe adoption and use of HIE in underserved settings appears to be impeded by regional, inter-organizational, and intra-organizational factors and facilitated by perceived benefits largely at the intra-organizational level. Stakeholders should consider factors both internal and external to their organization, focusing efforts in changing modifiable factors and tailoring HIE efforts based on all three categories of factors. Collective action between organizations may be needed to address inter-organizational and regional barriers. In the interest of facilitating HIE adoption and use, the impact of interventions at various levels on improving the use of electronic health data exchange should be tested

An Examination of Physician Resistance Related to Electronic Medical Records Adoption

The 2009 American Recovery and Reinvestment Act, signed under the Obama administration, mandated physicians to complete certification for electronic medical records (EMRs). Despite these mandates and the increased access to information technology, slow adoption rates persist on the use of EMRs. Guided by the theory of planned behavior and the technology acceptance model, the purpose of this quantitative study was to examine the relationship between the independent variables perceived ease of use, perceived usefulness, perceived behavioral control, perceived social influence, attitudes toward EMR, and the dependent variable user acceptance. This study identified physicians in the United States as end-users of EMRs. In this study, 76 randomly selected physicians in the United States, identified as end-users of EMRs, completed an electronic survey requiring responses to a 5-point Likert Scale model. Standard multiple regression analysis served as the means used to analyze the regression model. Despite the regression model being statistically significant, none of the individual independent variables had statistical significance in predicting user acceptance. Interdependence and homoscedasticity likely contributed to this phenomenon. Social change implications include understanding of physician perceptions and beliefs--how physician perceptions and beliefs affect EMR adoption. Because adoption rates did not achieve 100% certification by end-users, another social change implication includes the necessity of examining how end-user acceptance could decrease medical errors, increase efficiencies in physician workload, and improve communication within the health care industry

Factors Associated with Provider Utilization of the Heath Information Exchange in the State of Hawaii

In a context where technology is increasingly being incorporated into health care practice, many U.S. health care providers and organizations are finding it challenging to connect disparate electronic documentation systems to retrieve patient information when coordinating care across providers and heath care entities. Local and regional health information exchange (HIE) systems were created to facilitate collecting information into one integrated patient record to address information transfer between heath care providers. Yet, adoption and use of HIEs have been low. The purpose of this study was to review the predictive factors accounting for physicians\u27 use of a HIE in the U.S. state of Hawaii. Key factors from the technology acceptance model were evaluated to determine the behavioral intention resulting in actual use of the Hawaii health information exchange (HHIE). Physician characteristics (medical specialty, age, and gender) and location characteristics were also assessed. The total population of the study contained 1034 Hawaii physicians who have signed up to use the HHIE. Linear and logistic regression models were structured to evaluate the predictive nature of (a) use to determine if a physician has ever logged into the HIE and (b) usage to evaluate the extent to which a physician is logging into the HIE. Findings from the study reveal a predictive relationship between the characteristic of medical specialty and HHIE use when comparing primary care and emergency department physicians to physician specialists. Using study results, health care leaders can improve physician outreach and review barriers when using the HIE systems to coordinate care. Policy implications include the possible formulation of future requirements surrounding HIE physician participation