Influences on Emergency Clinician Use of Health Information Exchange: Interview Study

Abstract

Background: Health information exchange (HIE) supports clinical decision-making in emergency medicine settings. Despite evidence and policies that encourage the adoption of HIE, use by clinicians is limited. Moreover, few studies examine HIE use years after adoption by hospitals or clinics. Objective: This study aims to examine the perceptions and use of a mature, operational HIE system by emergency department clinicians years after its implementation. Methods: We interviewed 21 clinicians in various roles (eg, attending physician and nurse practitioner) across multiple health systems that participate in a statewide HIE network. We asked questions about their use of the HIE system and the factors that facilitate or inhibit use. Analysis of interview transcripts was guided by a theoretical framework derived from information systems theories describing individual perception of, and use behavior toward, HIE systems. Results: A total of 26 factors across 6 domains were identified by respondents. All respondents recognized the value of HIE for medical decision-making in the emergency department, and access to information via the HIE system was preferred over traditional methods of telephoning other facilities or waiting for faxed records. Ease of use, particularly single sign-on functionality, was recognized as a key facilitator of routine use, enabling clinicians to access a patient's HIE record with a single click from within their electronic health record system. Access to integrated data and advanced search features supported clinical decision-making. Limited training and poor system usability were identified as barriers to use. Conclusions: Achieving widespread adoption and use of HIE systems globally will require a focused effort to address multiple individual perception and behavioral factors. Researchers, leaders of HIE organizations, and policymakers alike should leverage these factors to achieve the goals of HIE and interoperability.