title: Health information exchange system usage patterns in three communities: practice sites, users, patients, and data.
abstract: OBJECTIVE
  Public and private organizations are implementing systems for query-based health information exchange (HIE), the electronic aggregation of patient data from multiple institutions. However, existing studies of query-based HIE system usage have addressed a limited number of settings. Our goal was to quantify the breadth and depth of usage of a query-based HIE system implemented across multiple communities with diverse care settings and patient populations.
  
  
  METHODS
  We performed a cross-sectional study in three communities in New York State using system access log files from January 2009 to May 2011 to measure usage patterns of a query-based HIE web portal system with respect to practice sites, users, patients, and data.
  
  
  RESULTS
  System access occurred from 60% (n=200) of practice sites registered to use the system in Community A, 59% (n=156) in Community B, and 82% (n=28) in Community C. In Communities A and B, users were primarily non-clinical staff in outpatient settings, while in Community C inpatient physicians were the main users. Across communities, proportions of patients whose data were accessed varied with 5% (n=11,263) in Community A, 60% (n=212,586) in Community B, and 1% (n=1107) in Community C. In Community B, users updated patient consent through the HIE portal, whereas in the other communities, users updated patient consent through a separate system. Across communities, users most frequently accessed only patient summary data displayed by default followed by detailed laboratory and radiology data.
  
  
  CONCLUSIONS
  This study is among the first to illustrate large-scale usage of a query-based HIE system implemented across multiple communities. Patient summary data displayed by default may be an important feature of query-based HIE systems. User role, practice site type, and patient consent workflow may affect patterns of query-based HIE web portal system usage in the communities studied and elsewhere.
authors.affiliation: Division of Quality and Medical Informatics, Weill Cornell Medical College, New York, NY, United States. thc2015@med.cornell.edu
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Campion
authors.forename: Alison M
authors.initials: AM
authors.lastname: Edwards
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Johnson
authors.forename: Rainu
authors.initials: R
authors.lastname: Kaushal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019090:Case Management; D032962:Consent Forms; D003430:Cross-Sectional Studies; D003625:Data Collection; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D063005:Health Information Systems / Q000706:statistics & numerical data*; D006282:Health Personnel; D006801:Humans; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D018802:Patient-Centered Care / Q000639:trends*; D011787:Quality of Health Care; D014584:User-Computer Interface; D057188:Workflow; D055815:Young Adult
keywords: Community; Electronic health records; Evaluation studies; Health information exchange; Health information technology