Running head: Value from health information exchange

Information processing in electronic medical records: A survey validation

OBJECTIVE

The purpose of this study was to validate the Clinical Information Processing Instrument. This instrument attempts to examine information processing in electronic medical records (EMRs). We drew upon the theory of swift and even flow to guide survey development and construction.

MATERIALS AND METHODS

We used a mixed-methods approach to gather data from registered nurses. Nurses were invited to participate in focus groups, an expert panel, and the survey validation process. A semi-structured questionnaire addressed the following themes: method of communication, quality of information, and usability of the system.

RESULTS

We conducted a confirmatory factor analysis using structural equation modelling. The Kaiser-Meyer-Olkin measure was greater than 0.7 (0.90), and the Bartlett's test of sphericity was significant (X²  = 1519.03, df = 105, P < 0.001). The proposed structural equation model was analysed and revised to a final model that was statistically significant. The final survey, Clinical Information Processing Instrument, contained 18 Likert scale questions that supported the tenets of the theory of swift and even flow.

DISCUSSION

The nurses perceived EMRs as efficient for medication management, time management, and communication. The Clinical Information Processing Instrument is a validated survey tool that assesses information flow in EMRs.

CONCLUSIONS

The Clinical Information Processing Instrument was validated as an approach to analyse the utility of EMR in disseminating information among clinical staff. To increase the utility and meaningful use of EMR systems, it is important to consider factors that affect the distribution of information among clinicians.

Does participation in health information exchange improve hospital efficiency?

The federal government allocated nearly $30 billion to spur the development of information technology infrastructure capable of supporting the exchange of interoperable clinical data, leading to growth in hospital participation in health information exchange (HIE) networks. HIEs have the potential to improve care coordination across healthcare providers, leading ultimately to increased productivity of health services for hospitals. However, the impact of HIE participation on hospital efficiency remains unclear. This dynamic prompts the question asked by this study: does HIE participation improve hospital efficiency. This study estimates the effect of HIE participation on efficiency using a national sample of 1017 hospitals from 2009 to 2012. Using a two-stage analytic design, efficiency indices were determined using the Malmquist algorithm and then regressed on a set of hospital characteristics. Results suggest that any participation in HIE can improve both technical efficiency change and total factor productivity (TFP). A second model examining total years of HIE participation shows a benefit of one and three years of participation on TFP. These results suggest that hospital investment in HIE participation may be a useful strategy to improve hospital operational performance, and that policy should continue to support increased participation and use of HIE. More research is needed to identify the exact mechanisms through which HIE participation can improve hospital efficiency.