Outcomes of Regional Health Information Exchange in Health Care Delivery

Acta Universitatis Tamperensis No. 1760


By Tiina Mäenpää
December 2012
Tampere University Press
Distributed By Coronet Books Inc.
ISBN: 9789514488948                       
170 pages
$82.50 Paper Original

The overall aim of this study was to clarify the outcomes, i.e. the benefits and effectiveness, of health information exchange (HIE) through regional health information system (RHIS) concerning patient service package and health care delivery in one hospital district area in the five-year period of 2004–2008.

Both qualitative and quantitative research methods were used for the empirical demonstration and evaluation of the benefits of HIE through RHIS. A systematic literature review was used to find out the outcomes of the different types of regional health information systems in health care delivery. Quantitative outcome measurement, a retrospective, comparative, longitudinal five-year follow-up study, was used to evaluate the impact of HIE on health care delivery. A qualitative themed interview study design was used to provide a deeper understanding of the research results and the outcomes obtained with the use of HIE through RHIS.

There were three different sets of data in this study. The first set of data consisted of 24 empirical studies. The second set of data consisted of selected outcomes obtained from registry-based statistical data, comprising data routinely obtained of total laboratory tests, radiology examinations, appointments, emergency department visits, primary care referrals and emergency referrals to special care, and the viewed references in the five-year follow-up period, 2004–2008, both in primary and special care. The third set was interview data of health care professionals (physicians, nurses, department secretaries), and administrative representatives, total (n=43) and chronically ill patients (n=10), who had the most experience of HIE.

Content analysis was used to analyse the review articles. Inductive content analysis was used to analyse both the review articles and the interview data. Additional deductive content analysis was used to categorize the interview data of chronically ill patients. Trend analysis was used for selected outcomes, and the t-test was used to determine the changes over the follow-up period. Linearity regression was used for modelling the link between the viewed references and selected outcomes during the five-year period. Analysis of Variance (ANOVA) was used to test the differences in averages between groups.

The main outcome areas found based on the literature review were flow of information, collaboration, process redesign, usability and factors affecting the organizational culture. Substantial changes in the selected outcomes were found in the follow-up period. The trends of HIE usage increased in each professional groups. There was also a significant association between the number of laboratory tests, radiology examinations, appointments, emergency visits, emergency referrals and the number of viewed references, i.e. HIE usage. When physicians made emergency referrals to special care, they viewed significantly more reference information and nurses used HIE significantly more in viewing reference information in emergency visits and when making emergency referrals. Also, the more appointments made with doctors there were, the more department secretaries viewed the reference information. HIE usage may have increased the efficiency of health care delivery in patient care by improving the professionals’ access to patient information across organization boundaries. However, the changes observed in the use of HIE services have many other explanations, and more research is needed to understand the impact of HIE on the efficiency of health care delivery.

Regional HIE changed the flow of information regarding the availability of information, exchange of information, and data protection after five-year usage. Regional collaboration improved between health care professionals, administrative staff and patients. HIE did not support the management of the patient service package, as patients were made more responsible for the management of their own service package and continuity of care. An improvement in the efficiency of working practices was observable among health care professionals, administrative staff and patients. The organizational commitment and management support of various stakeholders are needed for the necessary changes and a new way of working in health care delivery. The feedback from professionals is important for further development of health information systems.

In this study, a patient service package refers to one or several sets of health care services given to a patient, where health care service providers are concerned. Here health care delivery refers to health care services offered by primary care and special care providers to patients from municipalities and municipality federations. The professionals working in health care include health care professionals and administrative representatives. The term health care professionals refer to physicians, nurses and department secretaries.

The implementation of HIE through RHIS is a long-term process. In addition, investment in developing health information systems will continue. The study generated new knowledge about the the benefits and effectiveness of implementing health information exchange (HIE) through regional health information systems (RHISs) in health care delivery.


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