Improving Healthcare Processes and Outcomes by Directly Integrating Health Information Exchange Data in the Clinical Workflow (Indiana)

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Integrating health information exchange (HIE) data directly into electronic health records has the potential to improve delivery of care and patient outcomes, as well as increase clinician satisfaction by providing efficient access to HIE data.

Project Details - Ongoing


Patient health data exchanged across multiple healthcare systems can provide important information about a patient that may not be documented in a patient’s medical record at the emergency department (ED) where the patient is currently seeking care. Integrating these data has the potential to decrease repeated or unnecessary diagnostic tests, reduce medical expenses, lower healthcare utilization rates, and reduce provider burden. However, the HIE is often difficult and burdensome to access from a provider standpoint, requiring external navigation outside of a healthcare organization’s electronic health record (EHR) system. The disruption of the clinical workflow to access HIE data is not conducive to a provider who needs convenient and easy access to data. Directly integrating HIE data into a healthcare organization’s EHR may facilitate data access and use by providers, and thus maximize the benefits of HIE technologies.

The research team will evaluate an HIE/EHR integration by implementing an integration application, Health Dart, that incorporates relevant HIE information directly into the EHR used in the ED.

The specific aims of the research are as follows:

  • Assess the impact of direct and seamless HIE/EHR integration on clinician perceptions and acceptance of HIE in the ED setting. 
  • Evaluate the impact of HIE/EHR integration on HIE use by ED clinicians. 
  • Determine the impact of HIE/EHR integration on clinical care processes and outcomes in the ED. 

To assess the impact of the Health Dart application, the research team will enroll 14 Indiana University EDs in a cluster non-randomized study design, requiring each ED to serve as both a control and an intervention site. The intervention will be implemented in waves, requiring the control sites to switch to integrate the Health Dart application 2 months into the study. The integrated application grants providers access to relevant HIE data based on an initial set of conditions, including chest pain, abdominal pain, dizziness, back pain, pregnancy, arrhythmia, and dyspnea. The researchers will use a collection of surveys, focus groups, HIE usage log files, and data from the EHR to measure the acceptance by clinicians, observe the rates of data utilization, and assess the overall impact on clinical outcomes.

The anticipated outcome of HIE/EHR integration will increase the use of the HIE for information to improve care delivery, patient outcomes, and clinician satisfaction and efficiency compared to the current method of accessing HIE data. This study will further our understanding of how interoperable technology can be a tool in advancing data interoperability among healthcare systems nationwide.

More information on Dr. Schleyer's work (PDF, 1.9 MB).