title: Revisiting sociotechnical systems in a case of unreported use of health information exchange system in three hospital emergency departments.
abstract: BACKGROUND
  Health information exchange (HIE) allows clinicians to access patient level health care information. HIE can potentially improve patient care in emergency departments.
  
  
  METHODS
  We present a selected piece of evaluation of an HIE implementation in three Midwestern emergency departments. Data were collected through over 210 hours of direct observations and short interviews with 13 clinicians.
  
  
  RESULTS
  The results suggest that the usage rate of the HIE was low. Moreover, two ways of unreported use of the HIE system by clinicians was uncovered: (1) The HIE system was being used mostly for patients only with specific characteristics. (2) The information from the HIE system could be used to confront with the patients.
  
  
  CONCLUSIONS
  This study provides a case of how social system may shape a HIE technology. In order to fully benefit from HIE, understanding organizational and social context during the HIE design and implementation is needed. Such an understanding will also allow us to identify and detail required additional resources and organizational interventions that will complement HIE such as a case management strategy.
authors.affiliation: Industrial Engineering, Worcester Polytechnic Institute, Worcester, MA 01605-2661, USA. mozkaynak@wpi.edu
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ozkaynak
authors.forename: Patricia Flatley
authors.initials: PF
authors.lastname: Brennan
mesh_terms: D004636:Emergency Service, Hospital; D063005:Health Information Systems / Q000706:statistics & numerical data*; D008498:Medical Record Linkage; D015146:Midwestern United States; D036301:Qualitative Research