USAGE PATTERNS OF HEALTH INFORMATION EXCHANGE: ANTECEDENTS AND CONSEQUENCES

Health information exchange (HIE) systems integrate patient-level data that originates in several health information systems (HISs). As these systems bridge information gaps, they are expected to improve the caregiving process in terms of resource utilization and quality of care. Nevertheless, effective use of the system is a hurdle in realizing these benefits fully. Understanding actual individual use of the system is therefore of great importance. Several studies described factors that result in the use of the system, yet seldom examined their affect on characteristics of use. Furthermore, few studies empirically evaluated the association between the characteristics of actual individual use and decisions made during treatment. In this study, we intend to identify the antecedents of pattern of system use, namely patient-related, user-related, and environmental factors. The pattern of use is described by several variables. We then explore the link of the pattern of use and potential antecedents to clinical decisions, specifically the unit to which patients were admitted and the number of ancillary tests ordered. Our hypotheses are tested using clinical data and HIE log files of an emergency department (ED) in a large Israeli hospital

The role of cardiac troponin I as a prognosticator in critically ill medical patients: a prospective observational cohort study

INTRODUCTION: Myocardial injury is frequently unrecognized in intensive care unit (ICU) patients. Cardiac troponin I (cTnI), a surrogate of myocardial injury, has been shown to correlate with outcome in selected groups of patients. We wanted to determine if cTnI level measured upon admission is an independent predictor of mortality in a heterogeneous group of critically ill medical patients. METHODS: We conducted a prospective observational cohort study; 128 consecutive patients admitted to a medical ICU at a tertiary university hospital were enrolled. cTnI levels were measured within 6 h of admission and were considered positive (>0.7 ng/ml) or negative. A variety of clinical and laboratory variables were recorded. RESULTS: Both cTnI positive and negative groups were similar in terms of age, sex and pre-admission co-morbidity. In a univariate analysis, positive cTnI was associated with increased mortality (OR 7.0, 95% CI 2.44–20.5, p < 0.001), higher Acute Physiology and Chronic Health Evaluation (APACHE) II scores and a higher rate of multi-organ failure and sepsis. This association between cTnI and mortality was more pronounced among elderly patients (>65 years of age). Multivariate analysis controlling for APACHE II score revealed that elevated cTnI levels are not independently associated with 28-day mortality. CONCLUSION: In critically ill medical patients, elevated cTnI level measured upon admission is associated with increased mortality rate. cTnI does not independently contribute to the prediction of 28-day mortality beyond that provided by APACHE II

The Impact of Introducing an Electronic Medical Record on the Use of Health Information Exchange in the Emergency Department

Whereas physicians access multiple systems in search of information about patients, there is little research on how their use of one system is affected by the introduction of another system. This research-in-progress examines how the use of a health information exchange system (HIE) by physicians treating critically-ill patients in the emergency department is affected by the introduction of an electronic medical record (EMR). We test how the number of screens viewed (volume) and the time devoted to each screen (duration) are affected by variables characterizing the patient, physician, situation, and available information, and how these effects are moderated by EMR availability. Our preliminary results show that following EMR implementation, physicians access the HIE less frequently and view the same number of screens, yet they devote more time to each screen. Moderation effects suggest that the context of use is crucial to understanding system complementarity and substitution in health information ecosystems

Unravelling the determinants of medical practice variation in referrals among primary care physicians: insights from a retrospective cohort study in Southern Israel

Objectives Reducing medical practice variation (MPV) is a central theme of system improvement because it is associated with poor health outcomes, increased costs and disparities in care. This study aimed to estimate the extent to which each determinant (patient, physician, clinic) explains MPV among primary care physicians and to identify the characteristics of health services with a greater explained variance.Methods A retrospective cohort study of primary care physicians practising in non-private clinics of Clalit Health Services in Southern Israel, for longer than a year between 2011 and 2017 and with more than 100 adult patients per practice. We assessed the variation in referral rates among 17 health services and the proportion explained by each domain (patient, physician and clinic). We used generalised linear negative binomial mixed models and the Nakagawa’s R2, computing the marginal r2.Results The study included 243 physicians working in 295 practices and 139 clinics. The mean-explained variance was 28.5%±10.0%, where physician characteristics explained 4.5% of the variation. The intrapractice variation (within a single physician between the years) was explained better than the interphysician (between physicians). Health services with high explained variation were blood tests characterised by both low intrapractice variation (Rs=−0.65, p value=0.005) and high referral rates (Rs=0.46, p value=0.06).Conclusion Over 70% of MPV is not explained by the patient, clinic and physician demographic and professional characteristics. Future research should focus on the fraction of MPV that is explained by the physicians’ psychological characteristics, and thus potentially identify psychological targets for behavioural modifications aimed at reducing MPV