For clinicians, using patient health information exchanged across healthcare systems is often cumbersome and disruptive. Systematic reviews report promising effects of health information exchange (HIE) on healthcare processes and outcomes, such as decreased repeat/unnecessary tests, costs, and admission/readmission rates. However, until HIE is widely and firmly integrated in the practice and workflow of clinicians, it is unlikely that we will fully realize the potential benefits of the significant investment in the adoption and use of health information technologies. Direct integration of HIE and electronic health records (EHR) has not been widely implemented and studied, offering the opportunity to measure how putting relevant and timely information directly at the clinician?s fingertips could impact care compared to traditional ways of accessing information in an HIE. The objective of our project is to evaluate a novel application called CareView that seamlessly integrates highly relevant information from the HIE directly with the EHR in the emergency department (ED). Our central hypothesis is that this HIE/EHR integration will increase HIE information use and improve care delivery, patient outcomes, and clinician satisfaction and efficiency compared to current methods of accessing HIE data.
Our specific aims are to assess the impact of HIE/EHR integration on: (1) clinician perceptions and acceptance of HIE in the ED setting; (2) HIE use by ED clinicians; and (3) clinical care processes and outcomes in the ED. Based on our successful 2018 pilot implementation at Indiana University (IU) Health Methodist, the largest ED in the IU Health system, we will roll out CareView at additional IU Health EDs in waves of three to four sites for intervention periods of two months in a total of 14 IU Health EDs. Using a stepped-wedge, cluster non-randomized controlled study design, each site will serve as a control and, subsequently, intervention site. CareView supports the clinical conditions of chest pain, abdominal pain, weakness/ dizziness/ headache, back/ flank pain, pregnancy, arrhythmia and dyspnea, and we expect our study to involve approximately 139 clinicians during nearly 100,000 of the 370,000 annual ED visits in the IU Health system. Our project is significant because it will evaluate a method to efficiently and effectively retrieve relevant information from an HIE within an EHR; focus on the ED, where using HIE information is typically highly relevant and impactful; and generate evidence for the implementation and impact of interoperability, a key health IT focus of federal, state and other agencies. The project is innovative because it (1) seamlessly integrates HIE data with the EHR; (2) uses the novel Fast Healthcare Interoperability Resources (FHIR) standard, which the AHRQ has endorsed, to facilitate generalizability; and (3) employs a rigorous study design that allows us to make causal inferences about the impact of HIE/EHR integration. This project will promote the mission of the Agency for Healthcare Research and Quality (AHRQ) by providing real-world evidence regarding the causal effects of HIE on improving healthcare processes, quality and patient outcomes.
For clinicians, using patient health information exchanged across healthcare systems is often cumbersome and disruptive. Integrating such information directly and seamlessly in the electronic health record (EHR), where clinicians spend most of their time, can put relevant and timely information at their fingertips, and possibly make care more efficient and effective. This project will generate foundational evidence for how this type of integration impacts healthcare processes and outcomes.
