Interest in Health Information Exchange in Ambulatory Care: A Statewide Survey

Objective: Assess the interest in and preferences of ambulatory practitioners in HIE.

Background: Health information exchange (HIE) may improve the quality and efficiency of care. Identifying the value proposition for smaller ambulatory practices may help those practices engage in HIE.

Methods: Survey of primary care and specialist practitioners in the State of Colorado.

Results: Clinical data were commonly (always [2%], often [29%] or sometimes [49%]) missing during clinic visits. Of 12 data types proposed as available through HIE, ten were considered “extremely useful” by most practitioners. “Clinical notes/consultation reports,” “diagnosis or problem lists,” and “hospital discharge summaries” were considered the three most useful data types. Interest in EKG reports, diagnosis/problem lists, childhood immunizations, and discharge summaries differed among ambulatory practitioner groups (primary care, obstetrics-gynecology, and internal medicine subspecialties).

Conclusion: Practitioners express strong interest in most of the data types, but opinions differed by specialties on what types were most important. All providers felt that a system that provided all data types would be useful. These results support the potential benefit of HIE in ambulatory practices.

Interest in health information exchange in ambulatory care: a statewide survey

OBJECTIVE

Assess the interest in and preferences of ambulatory practitioners in HIE.

BACKGROUND

Health information exchange (HIE) may improve the quality and efficiency of care. Identifying the value proposition for smaller ambulatory practices may help those practices engage in HIE.

METHODS

Survey of primary care and specialist practitioners in the State of Colorado.

RESULTS

Clinical data were commonly (always [2%], often [29%] or sometimes [49%]) missing during clinic visits. Of 12 data types proposed as available through HIE, ten were considered "extremely useful" by most practitioners. "Clinical notes/consultation reports," "diagnosis or problem lists," and "hospital discharge summaries" were considered the three most useful data types. Interest in EKG reports, diagnosis/problem lists, childhood immunizations, and discharge summaries differed among ambulatory practitioner groups (primary care, obstetrics-gynecology, and internal medicine subspecialties).

CONCLUSION

Practitioners express strong interest in most of the data types, but opinions differed by specialties on what types were most important. All providers felt that a system that provided all data types would be useful. These results support the potential benefit of HIE in ambulatory practices.

Recurrent early childhood injuries among disadvantaged children in primary care settings

OBJECTIVE

To examine differences in social risk factors and health care use between young children with and without recurrent injuries.

DESIGN

Retrospective cohort study using administrative claims and medical records. Children with no, one, or more than one injury were compared.

SETTING

Integrated public healthcare system.

SUBJECTS

All children born at Denver Health Medical Center (DHMC) in 1993 who continued care there beyond 15 months of age. Children were followed to 36 months.

OUTCOME MEASURES

Sociodemographic information, service use, injury episodes, cause of injury, and social risk factors.

RESULTS

371 injury episodes occurred among 817 children. In the study cohort, 7% had >1 injury episode, 26% had one injury, and 67% had none. Among children with >1 injury episode, 78% had at least one social risk factor compared with 63% of children with one injury and 52% of children with none (p<0.0001). Risk factors for >1 injury included maternal substance abuse (p = 0.0003), maternal age under 18 years (p = 0.04), a primary caregiver who was single (p<0.0001) or mentally ill (p = 0.03), and a history of family violence (p = 0.01). Multiple injury episodes were associated with increased non-injury service use, including primary care visits (p<0.0001), emergency department visits (p<0.0001), and total non-injury encounters (p<0.0001).

CONCLUSIONS

Children with recurrent injury were more likely to have social risk factors, and used DHMC more frequently, than children with one or no injuries. Children with risk factors for recurrent injury can be identified and injury prevention counseling can be delivered to their families at their multiple visits to the system.