Use patterns of health information exchange systems and admission decisions: Reductionistic and configurational approaches |
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| Institution: | 1. Department of Industrial Engineering & Management, Ben-Gurion University of the Negev, Israel;2. Clinical Research Center, Soroka University Medical Center, Israel;1. Clinical Research Center, Soroka University Medical Center, Be''er-Sheva, Israel;2. Faculty of Health Sciences, Ben-Gurion University of the Negev, Be''er-Sheva, Israel;3. Hospital Division, Clalit Health Services, Tel Aviv, Israel;4. Infection Control Unit, Soroka University Medical Center, Be''er-Sheva, Israel;1. CHRU de Montpellier, départment d’endocrinologie, 34295 Montpellier cedex 5, France;2. CHRU de Montpellier, département de médecine interne, 34295 Montpellier cedex 5, France;3. CHRU de Montpellier, départment de rhumatologie, 34295 Montpellier cedex 5, France;4. Faculté de médecine de Montpellier-Nîmes, département de médecine générale, 34060 Montpellier cedex 2, France;5. CHRU de Montpellier, département de santé publique, 34295 Montpellier cedex 5, France;6. CHRU de Montpellier, département de cardiologie, 34295 Montpellier cedex 5, France;7. CHRU de Montpellier, 34295 Montpellier cedex 5, France;8. Aviitam, 34960 Montpellier cedex 2, France;9. CHRU de Nîmes, département de médecine générale, 30029 Nîmes, France;10. CHRU de Montpellier, département des maladies respiratoires et addictologie, 34295 Montpellier cedex 5, France;11. CHRU de Nîmes, département de physiologie, 30029 Nîmes, France;12. URPS Médecins, 34000 Montpellier, France;13. CHRU de Nîmes, 30029 Nîmes, France;14. Université Montpellier 1, 34090 Montpellier, France;15. CHRU de Montpellier, MACVIA-LR, contre les maladies chroniques pour un vieillissement actif en Languedoc-Roussillon, European Innovation Partnership on Active and Healthy Ageing Reference Site, 34295 Montpellier cedex 5, France;16. Inserm U1018, 94807 Villejuif cedex, France;1. Akron Children''s Hospital, Department of Pediatrics, Akron, OH, USA;2. Yale University School of Medicine, Department of Pediatrics, Division of Critical Care, New Haven, CT, USA;3. Biostats Inc, East Canton, OH, USA;4. Cincinnati Children''s Hospital, Department of Pediatrics, Division of Emergency Medicine, Cincinnati, OH, USA |
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| Abstract: | BackgroundResearch that endeavors to identify the value of electronic health information exchange (HIE) systems to the healthcare industry and, specifically, to clinical decision making is often inconclusive or theory-based. Studies seeking to identify how clinical decisions relate to patterns of actual HIE use, often by analyzing system log files, generally rely on dichotomous distinctions between system use and no-use, disregard the availability of information in the system, and control for few user characteristics.ObjectiveWe aim at empirically exploring the associations between use patterns of HIE systems and subsequent clinical decisions on the basis of broad definitions of use patterns, available information, and control variables.MethodsWe examine the decision to admit critically-ill patients either to the intensive care unit (ICU) or to another ward at a busy emergency department in the period 2010–2012. Using HIE log files, use patterns are characterized by the variables of number of users, volume, diversity, granularity, duration, and content. We test the association between HIE use patterns and the admission decision, after controlling for multiple demographic, clinical, physician, and situational variables and for available HIE information. This association is examined by taking a reductionistic approach that focuses on independent use variables and a configurational approach that focuses on use profiles.ResultsFive use profiles were identified, the largest of which (46.95% of encounters) described basic HIE access. ICU admission is more probable when the HIE system is perused by multiple users (odds increase by 31%) and when use profiles include prolonged screen viewing (odds increase by 159%) or access to diverse and multiple types of information, specifically on test results, procedures, and previous encounters.DiscussionReductionistic and configurational approaches yield complementary insights, which advance the understanding of how actual HIE use is associated with clinical decision making. The study shows that congruent profiles of HIE use enhance the predictability of the admission decision beyond what can be explained by independent variables of HIE use. |
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| Keywords: | Health information exchange Use pattern Clinical decision making Emergency department Intensive care unit |
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