When will HIE take off?

  • January 05, 2016

A double feature of some eHealth is its combination of widespread implementation with low utilisation. It creates a double-edged sword of high costs with low benefits. A report on Health Information Exchange (HIE) from the USA’s Agency for Healthcare Research and Quality (AHRQ) found a similar phenomenon. It includes the HIE study lad by Oregon Health and Science University.

It found increased HIE adoption by hospitals of 76% on 2014, an 85% increase since 2008 and 23% up on 2013. Alongside this, HIE was used by 38% of office-based physicians in 2012, and a miserly lees than 1% by long-term care providers.

Within organisations with HIE, the number of users, or the number of visits, using HIE was very low. HIE usability was linked to higher rates of use, but not associated with effectiveness outcomes. Barriers to using HIE were: 

  • Lack of critical mass electronically exchanging data
  • Inefficient workflow
  • Poorly designed interface and update features.

It’s not known if limited HIE usability caused by its function or architecture. Constraints were drawn from external environments and organisations’ internal characteristics that affect implementation and sustainability. The most frequent were the characteristics of HIEs’ organisation, including leadership or specific characteristics of HIE. Disincentives such as competition, or lack of a business case for HIE were the most frequently identified barriers.

Enabling environments includes some very challenging requirements that need integrating:

  • General structural characteristics, including leadership and prior experience with, or readiness for, ICT projects, an existing membership in a network and trust and solidarity among participating practices
  • Specific HIE structures, including governance, encouraging user engagement and stakeholder buy-in
  • Orientation shift in HIE organisations, such as mission or ideology, switching from competition to collaboration, changing from data ownership to continuity of care to realise the value of external information, shifting from HIE activities as a pilot to integrating them in workflow, and not staying in the pilot phase too long
  • Design characteristics need an understanding of work flow, perhaps adhering to smaller scale or more limited scope, and architecture and adaptability of information
  • Key functions must ensure HIE becomes part of healthcare routines to minimise the burden and time required of staff
  • Implementation support, including technical assistance, training infrastructure, ability for extensive testing for data quality and a comprehensive strategy for HIE activities
  • Expected outcomes include public HIE awareness, links to communities’ needs, and establishing tangible intermediate goals to keep stakeholder engaged and foster ongoing support
  • External policies, such as legislation and regulations.

These comprise an enormous and demanding part of HIE projects. African health systems need all of them in place before they start on HIE.