title: Health information exchange and information gaps in referrals to a pediatric emergency department.
abstract: OBJECTIVE
  to assess the extent of information gaps between three information sources available at admission to a pediatric Emergency Department (ED): Health Information Exchange (HIE) system, physicians' referral letters and information collected from patients/parents at admission to the ED (patient's medical history).
  
  
  METHODS
  A retrospective cohort study of 170 medical records of children aged 6 months to 18 years referred to a pediatric ED for a common childhood disease. Each record was reviewed for information on lab and imaging tests, vaccinations, allergies, previous diagnoses, recent and chronic medical treatment in the HIE system and referral letter, or from the patient's medical history taken on admission to the ED. The percent overlap between information sources and information gaps was assessed.
  
  
  RESULTS
  The most informative source, in terms of addressing all key areas, was the patient's medical history, with an average of 73.5% indication of each information key area. Next was the HIE system, with 54.1% indication of each key area; the least informative was the referral letter (43.9%). The overall overlap in data availability among all information sources occurred on average in 23% of the cases. HIE's ability to provide data missing from other routinely available sources was mainly in the area of chronic medication dosages (37% of cases).
  
  
  CONCLUSIONS
  Each of the three major information sources available at admission to a pediatric ED lack important data and each makes its own unique contribution. Improving documentation in electronic health records, on which HIE systems feed from can narrow significant information gaps at the most critical time-point-admission to a pediatric ED.
authors.affiliation: The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, Haifa University, Mount Carmel 31905, Israel; Pediatric Emergency Department, The Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa 31096, Israel. Electronic address: mimi.bakh@gmail.com.
authors.forename: Marta Chacour
authors.initials: MC
authors.lastname: Bahous
authors.affiliation: The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, Haifa University, Mount Carmel 31905, Israel.
authors.forename: Efrat
authors.initials: E
authors.lastname: Shadmi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D066275:Health Information Exchange / Q000706:statistics & numerical data*; D063005:Health Information Systems / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D018579:Patient Selection; D010372:Pediatrics; D011787:Quality of Health Care; D012017:Referral and Consultation
keywords: Emergency department; Information gaps; Integrated health information technology; Pediatrics; Transitional care