Health Care Worker Usage of Large-Scale Health Information Exchanges in Japan: User-Level Audit Log Analysis Study

Area of Science:

• Health Informatics
• Health Services Research
• Digital Health

Background:

• Japan has over 200 operational health information exchanges (HIEs).
• The primary function of HIEs is remote, on-demand access to aggregated patient health data.
• Current usage patterns of this feature by individual users and institutions are largely unknown.

Purpose of the Study:

• To investigate the utilization of the on-demand patient data viewing feature in large-scale HIEs.
• To analyze usage by individual healthcare workers and institutions in Japan.

Main Methods:

• Conducted audit log analyses of large-scale HIEs (over 100 institutions, 10,000+ patients).
• Collected health care worker profiles and HIE audit log data.
• Performed analyses including active use days per doctor, monthly institutional usage, monthly active institution ratios by facility type, and comparisons across HIEs and user types.

Main Results:

• Analyzed data from 7 out of 24 candidate HIEs.
• 93.5% of hospital doctors did not use HIEs in FY2021/22; only 19 used them frequently.
• Significant variations in usage were observed across facility types (hospitals, medical clinics, dental clinics) and individual HIEs.

Conclusions:

• Overall usage of the on-demand patient data viewing feature in Japanese HIEs is low.
• Large disparities in HIE utilization exist among healthcare workers, institutions, and facility types.
• Further research is needed to understand these disparities and inform the design of comprehensive audit logs.