Understanding the impact of health information exchange technology: workflow elements, patterns of use, and information ecologies

Abstract

The concept of health information exchange (HIE) among organizations in the United States has evolved over the last 25 years, from early efforts to build Community Health Information Networks to recent collaborations in the form of Regional Health Information Organizations (RHIOs). Previous HIE research focused on organizational issues, technological challenges, and impact on healthcare utilization. The research study was set in the MidSouth eHealth Alliance (MSeHA), a RHIO in southwestern Tennessee that has exchanged health data since 2006. This research applied qualitative methods to evaluate the impact of the HIE system on workflow and information flow at MSeHA-participating sites. The study was conducted over a 9-month period at six emergency departments and nine ambulatory clinics. Data collection focused on use of the same HIE technology across widely varying clinical contexts and health information technology (HIT) infrastructures. The researcher observed use of HIE technology and healthcare workflow for 187 hours and conducted semi-structured interviews to confirm observation data. Research results include identification of HIE-related workflow patterns, reasons for HIE technology use, and outcomes of HIE use. The research contributes an understanding of real-world HIE technology usage patterns across organizations, proposes context-aware implementation strategies for HIE systems, and identifies the potential of HIE technology to help transform healthcare.