Perceptions regarding the ease of use and usefulness of health information exchange systems among medical providers, case managers and non-clinical staff members working in HIV care and community settings

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Abstract

Purpose

The objective of this paper is to describe how members of HIV patients’ care teams perceived the usefulness and ease of use of newly implemented, innovative health information exchange systems (HIEs) in diverse HIV treatment settings. Five settings with existing electronic medical records (EMRs) received special funding to test enhancements to their systems. Participating clinics and community-based organizations added HIEs permitting bi-directional exchange of information across multiple provider sites serving the same HIV patient population.

Methods

We conducted in-depth qualitative interviews and quantitative web-based surveys with case managers, medical providers, and non-clinical staff members to assess the systems’ perceived usefulness and ease of use shortly after the HIEs were implemented. Our approach to data analysis was iterative. We first conducted a thematic analysis of the qualitative data and discovered that there were key differences in perceptions and actual use of HIEs across occupational groups. We used these results to guide our analysis of the quantitative survey data, stratifying by occupational group.

Results

We found differences in reports of how useful and how well-used HIEs were, by occupation. Medical providers were more likely to use HIEs if they provided easier access to clinical information than was present in existing EMRs. Case managers working inside medical clinics found HIEs to be less helpful because they already had access to the clinical data. In contrast, case managers working in community settings appreciated the new access to patient information that the HIEs provided. Non-clinical staff uniformly found the HIEs useful for a broad range of tasks including clinic administration, grant writing and generating reports for funders.

Conclusion

Our study offers insights into the use and potential benefits of HIE in the context of HIV care across occupational groups.

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.

Section snippets

Methods

In 2007, the US Health Services and Resources Administration (HRSA), under the Special Projects of National Significance (SPNS) program, funded six demonstration sites consisting of groups of participating organizations to design, implement and evaluate enhancements to existing electronic health information exchange (HIE) systems in clinical and community settings providing treatment and care for people living with HIV/AIDS. All participating organizations were existing recipients of funding to

Findings

From the qualitative data, we discovered that the adoption of the HIEs and perceptions of its use and usefulness varied by occupational role of the patient-care team: medical providers, case managers and non-clinical staff such as business managers, administrative staff and billing clerks. Adoption also varied by whether respondents worked within or outside clinics. Case managers, in particular, working outside of clinics in community-based organizations, routinely made use of the new systems.

Discussion

Overall, we found that perceptions and actual use of enhanced health information systems varied by the provider's role in the patient's care team and also by whether a provider had prior access to clinical information where they worked, be it in a clinic or in a community-based organization. In particular, community-based case managers working outside of clinical settings benefited from having direct access to what had earlier been difficult-to-access clinical information. Meanwhile, medical

Authors contributions

All authors provided final approval of the submitted version of this manuscript. Without the contribution of each of the authors, this paper would not have been possible and all authors contributed substantively to the paper.

Conflict of interest statement

None of the authors had any financial or personal relationships with other people or organizations that could have inappropriately influenced this work.

Summary points

“What is already known on this topic”

  • Health information exchange (HIE) implementation and adoption may facilitate coordination of care.

  • Little is known about provider attitudes and preferences related to HIE in the field of HIV.

“What this study has added to our knowledge”

  • Case managers with limited access to patient data benefit more

Acknowledgements

This paper was supported by grant number H97HA08477 from the Health Resources and Services Administration (HRSA) Special Projects of National Significance (SPNS) Program.

References (20)

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