Emily Gill1, Patricia C Dykes2, Robert S Rudin3, Marianne Storm4, Kelly McGrath5, David W Bates6. 1. Brigham and Women's Hospital and Harvard Medical School, Division of General Internal Medicine and Primary Care, 1620 Tremont Street, 3rd Floor, Boston, 02120-1613, USA. Electronic address: emily.gill@auckland.ac.nz. 2. Brigham and Women's Hospital and Harvard Medical School, Division of General Internal Medicine and Primary Care, 1620 Tremont Street, 3rd Floor, Boston, MA 02120-1613, USA. Electronic address: pdykes@bwh.harvard.edu. 3. Boston Office RAND Corporation, 20 Park Plaza, 9th Floor, Suite 920, Boston, MA 02116, USA. Electronic address: Robert_Rudin@rand.org. 4. Faculty of Health Sciences, Department of Public Health, The University of Stavanger, P.O. Box 8600 Forus, N-4036 Stavanger, Norway. Electronic address: marianne.storm@uis.no. 5. Clearwater Valley Orofino Health Center, 1055 Riverside Ave, Orofino, ID 83544, USA. Electronic address: kelly.mcgrath@smh-cvhc.org. 6. Brigham and Women's Hospital and Harvard Medical School, Division of General Internal Medicine and Primary Care, 1620 Tremont Street, 3rd Floor, Boston, MA 02120-1613, USA. Electronic address: dbates@bwh.harvard.edu.
Abstract
BACKGROUND: Health is poorer in rural areas and a major challenge is care coordination for complex chronic conditions. The HITECH and 21st Century Cure Acts emphasize health information exchange which underpins activities required to improve care coordination. OBJECTIVE AND METHODS: Using semi-structured interviews and surveys, we examined how providers experience electronic health information exchange during care coordination since these Acts were implemented, with a focus on rural settings where health disparities exist. We used a purposive sample that included primary care, acute care hospitals, and community health services in the United States. FINDINGS: We identified seven themes related to care coordination and information exchange: 'insufficient trust of data'; 'please respond'; 'just fax it'; 'care plans'; 'needle in the haystack'; 're-documentation'; and 'rural reality'. These gaps were magnified when information exchange was required between unaffiliated electronic health records (EHRs) about shared patients, which was more pronounced in rural settings. CONCLUSION: Policy and incentive modifications are likely needed to overcome the observed health information technology (HIT) shortcomings. Rural settings in the United States accentuate problems that can be addressed through international medical informatics policy makers and the implementation and evaluation of interoperable HIT systems.
BACKGROUND: Health is poorer in rural areas and a major challenge is care coordination for complex chronic conditions. The HITECH and 21st Century Cure Acts emphasize health information exchange which underpins activities required to improve care coordination. OBJECTIVE AND METHODS: Using semi-structured interviews and surveys, we examined how providers experience electronic health information exchange during care coordination since these Acts were implemented, with a focus on rural settings where health disparities exist. We used a purposive sample that included primary care, acute care hospitals, and community health services in the United States. FINDINGS: We identified seven themes related to care coordination and information exchange: 'insufficient trust of data'; 'please respond'; 'just fax it'; 'care plans'; 'needle in the haystack'; 're-documentation'; and 'rural reality'. These gaps were magnified when information exchange was required between unaffiliated electronic health records (EHRs) about shared patients, which was more pronounced in rural settings. CONCLUSION: Policy and incentive modifications are likely needed to overcome the observed health information technology (HIT) shortcomings. Rural settings in the United States accentuate problems that can be addressed through international medical informatics policy makers and the implementation and evaluation of interoperable HIT systems.
Keywords:
Continuity of patient care; Electronic health records; Health information Exchange; Health information technology; Primary health care; Rural health
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