Background
As the potential financial and medical benefits of health information exchange (HIE) continue to be explored nationally, the roll-out of such systems has been met with both optimistic expectation and resistance.1,2 Widespread use of HIE systems around the country is a key aspect of the American Recovery and Reinvestment Act with the goals of more efficient information sharing and ultimately the formation of a national health information network.3 Since 2009, Nebraska’s HIE has been maintained through the Nebraska Health Information Initiative (NeHII).4
NeHII is a query-based HIE sponsored by Nebraska health care providers and health insurers who share and use information for treatment, payment and public health reporting purposes. NeHII is a web-based system accessed by each authorized provider using a unique identification number and password. The statewide network allows participating providers to query and securely view patient information. NeHII connects pharmacy, laboratory and insurer data allowing prescribers to view patient medication histories, laboratory results and formulary information from multiple sources.
Barriers to both initial adoption and long-term utilization of HIEs exist. Others have reported that while many physicians see HIE as likely to have positive impact on patient care, payment for access to the system is a common barrier to adoption. In Massachusetts, for example, only 37% of physicians agreed to pay a monthly access fee of US$150.5 Efficient workflow integration is another recognized barrier for the initial adoption and continues to be a primary concern among current HIE users.6 As such, delays in patient visit interaction brought about by entering or locating patient data in the electronic systems have been associated with a decrease in HIE use.6–8
Regular HIE utilization is associated with the willingness of patients and physicians to contribute information into the data sharing systems. Practitioners’ rating of an HIE’s helpfulness is associated with the completeness of the available data.9 If a physician is unable to find the desired information for a significant number of the patients queried, continued use of the HIE is unlikely. In addition, completeness of data is contingent on the belief that system security is maintained adequately. Data sharing is linked intrinsically with patient privacy. Mental health practitioners may be especially concerned with security of patient data in electronic systems.10
The purpose of this study was to conduct a comprehensive assessment of Nebraska health care providers’ perspectives on a query-based HIE, including barriers to adoption and important functionality for continued utilization. This survey was a component of a comprehensive evaluation of HIE in Nebraska. Identification of implementation barriers and assessment of desired clinical information can be used to improve provider training and inform future system functionality.