Clinical Value-Add for Health Information Exchange (HIE)

摘要

Objectives: We describe the clinical utility- both positive and negative- of Health Information Exchanges (HIE) in order to ascertain how true value can be attained through the adoption of such a system.Methods: We performed a literature review over multiple databases of 350 articles pertaining to the topic. After screening for relevance, we selected 135 articles that discuss studies pertaining to HIE. Results: We populated two tables with information synthesized form the 135 journal articles. One table focuses on the positive aspects of HIE, and the second table focuses on the negative aspects of HIE. Our focus is to highlight clear benefits, notable uncertainties, and position them in juxtapose to establish a clear comparison.Conclusions: Though HIE have both positive and negative aspects, one must focus on the specificities of the health institution, including patient volume, demographics, and health focus, in order to determine the value of implementing such a system. Introduction Health Information Exchanges (HIE) are rapidly advancing as the next step in improving patient care using technological applications. HIE affect the fundamental patient care system by transforming how medical information is delivered and disseminated. Medicine in America has long been a fragmented field; and with the ever increasing amount of transactional volume of patient information, the need to integrate the system in a coherent manner becomes all the more imperative. However, intuitive benefits of such a system belie inherent risks in creating such a system. Adapting a large scale HIE creates logistical and patient safety related problems. Numerous government and private organizations have developed studies or simulations detailing both the positive and negative aspects of HIE. Published studies that demonstrate seemingly apparent benefits are often limited in nature and contingently specific. We perform a systematic review of the literature and present the information to obtain a comprehensive view of how truly effective HIE can be. We focus our review on the clinical implications of HIE systems.From the available data, we extrapolate key parameters to construct a value-added table highlighting the benefits and risks or uncertainties of a HIE. We focus on those attributes which affect patient management, influence physician decision-making, and impact both short-term and long-term decision analyses. Methods We performed an indexed internet search using the following search engines: PubMed, Cochrane Database, and Google scholar. The searches took place June, July, August, and October of 2010. We began with the phrase, “Health Information Exchange (HIE)”, and broadened the search terminology to include similar terminology associated with HIE, thus maximizing sensitivity. We reviewed the literature directly addressing studies and surveys conducted on the topic. Sources include independent consultant reviews, academic journals, and articles detailing academic based HIE initiatives. Our search catered to broad based studies pertinent to the general patient population, and not any specialty specific study. Although we did not distinguish set criteria for what constitutes our targeted practice, we took aims to distinguish the scope of each study to better assess its applicability in reflecting general populations.Studies were mostly taken from academic published journals available through the search engines. However, a few private, consulting based studies were included in the study, but denoted as such.Data was extracted from the study, synthesized, and integrated into descriptive excerpts detailing key points. We populated the data within a two dimensional matrix highlighting key clinical parameters. Clinical parameters and the associated benefits included are commonly accepted metrics used to gauge improvements upon implementing EMR/EHR.1 A literature search and expert review at the Chicago Health Information Technology Regional Extension Cente