title: Impact of Health Information Exchange on Emergency Medicine Clinical Decision Making.
abstract: BACKGROUND
  The objective of the study was to understand the immediate utility of health information exchange (HIE) on emergency department (ED) providers by interviewing them shortly after the information was retrieved. Prior studies of physician perceptions regarding HIE have only been performed outside of the care environment.
  
  
  METHODS
  Trained research assistants interviewed resident physicians, physician assistants and attending physicians using a semi-structured questionnaire within two hours of making a HIE request. The responses were recorded, then transcribed for qualitative analysis. The transcribed interviews were analyzed for emerging qualitative themes.
  
  
  RESULTS
  We analyzed 40 interviews obtained from 29 providers. Primary qualitative themes discovered included the following: drivers for requests for outside information; the importance of unexpected information; historical lab values as reference points; providing context when determining whether to admit or discharge a patient; the importance of information in refining disposition; improved confidence of provider; and changes in decisions for diagnostic imaging.
  
  
  CONCLUSIONS
  ED providers are driven to use HIE when they're missing a known piece of information. This study finds two additional impacts not previously reported. First, providers sometimes find additional unanticipated useful information, supporting a workflow that lowers the threshold to request external information. Second, providers sometimes report utility when no changes to their existing plan are made as their confidence is increased based on external records. Our findings are concordant with previous studies in finding exchanged information is useful to provide context for interpreting lab results, making admission decisions, and prevents repeat diagnostic imaging.
authors.affiliation: HealthPartners Institute for Education and Research, Bloomington, Minnesota; University of Minnesota Medical School, Academic Health Center, Minneapolis, Minnesota.
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Gordon
authors.affiliation: Advocate Christ Medical Center, Chicago, Illinois.
authors.forename: Kyle
authors.initials: K
authors.lastname: Bernard
authors.affiliation: Critical Care Research Center, Regions Hospital, Saint Paul, Minnesota.
authors.forename: Josh
authors.initials: J
authors.lastname: Salzman
authors.affiliation: University of St. Thomas, School of Social Work, Saint Paul, Minnesota.
authors.forename: Robin R
authors.initials: RR
authors.lastname: Whitebird
mesh_terms: D001291:Attitude of Health Personnel; D000066491:Clinical Decision-Making / Q000379:methods*; D004635:Emergency Medicine; D004638:Emergency Treatment / Q000379:methods*; D066275:Health Information Exchange / Q000706:statistics & numerical data*; D006801:Humans; D011446:Prospective Studies