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The complementary nature of query-based and directed health information exchange in primary care practice.

TitleThe complementary nature of query-based and directed health information exchange in primary care practice.
Publication TypeJournal Article
Year of Publication2019
AuthorsVest JR, Unruh MA, Casalino LP, Shapiro JS
JournalJ Am Med Inform Assoc
Date Published2019 Oct 08

OBJECTIVE: Many policymakers and advocates assume that directed and query-based health information exchange (HIE) work together to meet organizations' interoperability needs, but this is not grounded in a substantial evidence base. This study sought to clarify the relationship between the usage of these 2 approaches to HIE.

MATERIALS AND METHODS: System user log files from a regional HIE organization and electronic health record system were combined to model the usage of HIE associated with a patient visit at 3 federally qualified health centers in New York. Regression models tested the hypothesis that directed HIE usage was associated with query-based usage and adjusted for factors reflective of the FITT (Fit between Individuals, Task & Technology) framework. Follow-up interviews with 8 key informants helped interpret findings.

RESULTS: Usage of query-based HIE occurred in 3.1% of encounters and directed HIE in 23.5%. Query-based usage was 0.6 percentage points higher when directed HIE provided imaging information, and 4.8 percentage points higher when directed HIE provided clinical documents. The probability of query-based HIE was lower for specialist visits, higher for postdischarge visits, and higher for encounters with nurse practitioners. Informants used query-based HIE after directed HIE to obtain additional information, support transitions of care, or in cases of abnormal results.

DISCUSSION: The complementary nature of directed and query-based HIE indicates that both HIE functionalities should be incorporated into EHR Certification Criteria.

CONCLUSIONS: Quantitative and qualitative findings suggest that directed and query-based HIE exist in a complementary manner in ambulatory care settings.

Alternate JournalJ Am Med Inform Assoc
PubMed ID31592529
Health Policy & Economics
Faculty Publication