Purpose

This study seeks to understand the key inhibitors for health information exchange (HIE) by ambulatory (outpatient) clinics. We examine the key technological, organizational and environmental factors that inhibit an ambulatory clinic from electronically exchanging health information with external clinics and hospitals.

Methods

We utilize survey data from 1285 ambulatory clinics in the US state of Minnesota. Using logistic regressions, we assess if the ambulatory clinic’s HIE with external clinics and external hospitals are associated with fourteen inhibitors from technological, organizational and environmental contexts in which ambulatory clinics operate.

Results

Among the technological inhibitors, we find lack of adequate technological infrastructure, difficulties in integrating external data with electronic medical record systems, and security concerns to inhibit ambulatory clinics’ HIE with both clinics and hospitals. Inadequate technical support was a barrier for HIE with hospitals, whereas inadequate training of staff was an inhibitor for clinic-to-clinic HIE. Of the environmental variables, legal concerns and complexity in framing HIE agreements with partners were found to inhibit ambulatory clinics’ HIE with both external clinics and hospitals. Lack of partner readiness and ability was an inhibiting factor for clinic-to-hospital HIE whereas issues in patient consent, and problems in choosing the right vendor with a good fit were inhibiting ambulatory clinics’ HIE with other clinics. Among the organizational variables, lack of adequate senior leadership support and complexity of workflow changes inhibited clinic-to-clinic health data sharing, whereas unclear return on investment (ROI) for HIE was a deterrent for ambulatory clinics’ HIE with hospitals.

Conclusions

This study throws light on electronic HIE practices and its key inhibitors in ambulatory clinics, an understudied area in digital health. This paper provides unique insights into specific inhibitors that deter clinic-to-clinic health information sharing versus those that affect and clinic-to-hospital health information exchange.

中文翻译：

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没有实现健康信息交换的承诺：是什么阻止了门诊诊所电子共享健康信息？

目的

本研究旨在了解门诊（门诊）诊所健康信息交换（HIE）的主要抑制因素。我们研究了关键技术，组织和环境因素，这些因素阻碍了门诊诊所与外部诊所和医院进行电子信息交换。

方法

我们利用来自美国明尼苏达州1285个门诊诊所的调查数据。使用逻辑回归，我们评估了非流动诊所与外部诊所和外部医院的HIE是否与非流动诊所在技术，组织和环境方面的十四种抑制因素相关。

结果

在技​​术阻碍因素中，我们发现缺乏足够的技术基础设施，难以将外部数据与电子病历系统集成在一起，并且出于安全考虑，无法在诊所和医院使用门诊诊所的HIE。技术支持不足是医院进行HIE的障碍，而员工培训不足则阻碍了从诊所到诊所的HIE。在环境变量中，发现法律问题和与合作伙伴订立HIE协议的复杂性抑制了门诊诊所与外部诊所和医院的HIE。缺乏伴侣准备和能力是诊所到医院HIE的一个抑制因素，而患者同意的问题以及选择合适的合适供应商的问题正在抑制门诊诊所与其他诊所的HIE。

结论

这项研究揭示了非门诊诊所中的电子HIE实践及其主要抑制因素，而门诊诊所是数字健康领域中一个尚未被充分研究的领域。本文提供了对特定抑制剂的独特见解，这些抑制剂可阻止临床到诊所的健康信息共享，而影响和临床到医院的健康信息交换的抑制剂则受到阻碍。