Introduction
Human immunodeficiency virus (HIV) infection is a chronic condition that, when successfully managed, requires patients to consistently engage with multiple medical and social service providers. Patients typically coordinate their own care, tracking and managing, for example, appointments at different care sites, multiple prescription refills, preventive screening schedules, and diagnostic testing in remote labs, among just a few health-related activities. Recent studies indicate patients’ current level of interaction with the care delivery system is not suboptimal; as many as two-thirds of people living with HIV in the US experience unsuppressed viral loads [1].
To improve patients’ care experiences and health outcomes, policymakers, health system managers and care providers are increasingly calling for the utilization of health information technology that facilitates the exchange of information among all providers involved in a patient's care as a solution for uncoordinated care [2]. Health information exchanges (HIE) that facilitate the exchange of health information across clinical and non-clinical settings can support teams of providers – physicians, health educators, social workers, and pharmacists – caring for patients with HIV [3] by expanding access to patient information.
HIEs are typically characterized by formal agreements and technologies that facilitate the electronic movement of health-related information across organizations within an area or community [4]. These systems allow all members of the patient-care team, regardless of their geographic location, to share key information such as diagnostic test results, existing treatments, kept and missed visits and previous diagnoses so that decisions about a patient's care are fully informed [5], [6].
HIEs can only realize their potential to improve care if the people working in health care organizations adopt them for their use. While medical providers are generally supportive of the idea of electronic systems for managing health information, the actual adoption of these systems has been less consistent [7], [8]. In studies of factors influencing providers’ adoption of HIEs, two concepts in particular predict their uptake. Perceived usefulness, defined as “the degree to which a person believes that using a particular system would enhance his or her job performance,” [9] is the most powerful predictor of actual use of HIEs. Perceived ease of use, defined as “the degree to which a person believes that using a particular system would be free of effort,” also influences a person's likelihood to use HIEs, but to a lesser degree than perceived usefulness [10].
The objective of this paper is to describe how members of HIV patients’ care teams perceived usefulness and ease of use of newly implemented, innovative HIEs in diverse HIV treatment settings. We asked medical providers, case managers and non-clinical members of the participating organizations to reflect on issues of use and usefulness and we examined qualitatively if there were differences in adoption across occupation type. We also asked staff working in the same settings to rate the systems’ usefulness and ease of use shortly after the systems were implemented. Our study addresses whether HIEs can be helpful for patient care team members seeking to deliver quality HIV care and offers insights into the use and potential benefits of HIEs in the context of HIV care.