Background

Health is poorer in rural areas and a major challenge is care coordination for complex chronic conditions. The HITECH and 21^st Century Cure Acts emphasize health information exchange which underpins activities required to improve care coordination.

Objective and Methods

Using semi-structured interviews and surveys, we examined how providers experience electronic health information exchange during care coordination since these Acts were implemented, with a focus on rural settings where health disparities exist. We used a purposive sample that included primary care, acute care hospitals, and community health services in the United States.

Findings

We identified seven themes related to care coordination and information exchange: ‘insufficient trust of data’; ‘please respond’; ‘just fax it’; ‘care plans’; ‘needle in the haystack’; ‘re-documentation’; and ‘rural reality’. These gaps were magnified when information exchange was required between unaffiliated electronic health records (EHRs) about shared patients, which was more pronounced in rural settings.

Conclusion

Policy and incentive modifications are likely needed to overcome the observed health information technology (HIT) shortcomings. Rural settings in the United States accentuate problems that can be addressed through international medical informatics policy makers and the implementation and evaluation of interoperable HIT systems.

中文翻译：

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农村地区技术促进的医疗协调：需要什么？

背景

农村地区的健康状况较差，主要挑战是应对复杂的慢性病的护理协调。在HITECH和21^日世纪固化行为强调其巩固提高护理的协调活动所需的医疗信息交换。

目的与方法

自从这些法案实施以来，我们使用半结构化访谈和调查研究了医疗服务提供者在护理协调过程中如何体验电子健康信息交换，重点是存在卫生差异的农村地区。我们使用了一个有目的的样本，其中包括美国的初级保健，急诊医院和社区卫生服务。

发现

我们确定了与护理协调和信息交换有关的七个主题：“对数据的信任不足”；'请回复'; “只是传真”；“护理计划”；“大海捞针”；“重新记录”；和“农村现实”。当需要共享患者的非附属电子健康记录（EHR）之间的信息交换时，这些差距会扩大，这在农村地区更为明显。

结论

可能需要采取政策和激励措施来克服已观察到的健康信息技术（HIT）的缺点。美国的农村环境加剧了可以通过国际医学信息学政策制定者以及可互操作的HIT系统的实施和评估来解决的问题。