Changes in Health Information Exchange Use Behavior After Introduction of a Fast Healthcare Interoperability...

Area of Science:

• Health Informatics
• Clinical Information Systems
• Healthcare Technology Adoption

Background:

• Health Information Exchange (HIE) is crucial for coordinated patient care.
• The implementation of Fast Healthcare Interoperability Resources (FHIR) applications aims to improve HIE accessibility and usability.
• Understanding clinician adoption and usage patterns of new HIE tools is essential for optimizing their impact.

Purpose of the Study:

• To characterize the diverse patterns of HIE utilization among emergency department clinicians.
• To analyze HIE use behaviors following the integration of a FHIR application.
• To identify clinician characteristics associated with different HIE engagement levels.

Main Methods:

• Longitudinal electronic health record log data from September 2019 to February 2023 were analyzed.
• Clinician HIE use was categorized into four distinct patterns: no use, web viewer only, FHIR app only, or mixed modality.
• Hierarchical agglomerative clustering was employed to identify patterns and associated clinician characteristics.

Main Results:

• Four primary HIE usage patterns were identified among clinicians.
• "Lagging" users (46.1%) showed sporadic HIE engagement over time.
• "Late adopters" (22.4%) demonstrated consistent HIE usage.
• "Legacy users" (17.5%) predominantly used the web viewer, while "mixed modality users" (14.0%) frequently switched access methods.

Conclusions:

• Clinician adoption of HIE, including FHIR applications, is heterogeneous.
• Distinct user profiles (sporadic, late adopters, legacy, mixed) highlight varied engagement with HIE technologies.
• Future interventions should consider these diverse patterns to promote effective HIE use in emergency departments.