Evaluation of a Health Information Exchange System for Geriatric Health Care in Rural Areas: Development and Technical Acceptance Study

Abstract

Background: Patients of geriatrics are often treated by several health care providers at the same time. The spatial, informational, and organizational separation of these health care providers can hinder the effective treatment of these patients.

Objective: This study aimed to develop a regional health information exchange (HIE) system to improve HIE in geriatric treatment. This study also evaluated the usability of the regional HIE system and sought to identify barriers to and facilitators of its implementation.

Methods: The development of the regional HIE system followed the community-based participatory research approach. The primary outcomes were the usability of the regional HIE system, expected implementation barriers and facilitators, and the quality of the developmental process. Data were collected and analyzed using a mixed methods approach.

Results: A total of 3 focus regions were identified, 22 geriatric health care providers participated in the development of the regional HIE system, and 11 workshops were conducted between October 2019 and September 2020. In total, 12 participants responded to a questionnaire. The main results were that the regional HIE system should support the exchange of assessments, diagnoses, medication, assistive device supply, and social information. The regional HIE system was expected to be able to improve the quality and continuity of care. In total, 5 adoption facilitators were identified. The main points were adaptability of the regional HIE system to local needs, availability to different patient groups and treatment documents, web-based design, trust among the users, and computer literacy. A total of 13 barriers to adoption were identified. The main expected barriers to implementation were lack of resources, interoperability issues, computer illiteracy, lack of trust, privacy concerns, and ease-of-use issues.

Conclusions: Participating health care professionals shared similar motivations for developing the regional HIE system, including improved quality of care, reduction of unnecessary examinations, and more effective health care provision. An overly complicated registration process for health care professionals and the patients' free choice of their health care providers hinder the effectiveness of the regional HIE system, resulting in incomplete patient health information. However, the web-based design of the system bridges interoperability problems that exist owing to the different technical and organizational structures of the health care facilities involved. The regional HIE system is better accepted by health care professionals who are already engaged in an interdisciplinary, geriatric-focused network. This might indicate that pre-existing cross-organizational structures and processes are prerequisites for using HIE systems. The participatory design supports the development of technologies that are adaptable to regional needs. Health care providers are interested in participating in the development of an HIE system, but they often lack the required time, knowledge, and resources.

Keywords: community-based participatory research; electronic health records; geriatrics; health information exchange; health information network; patient-centered care; postacute care; technical acceptance; usability.

Figure 1

(A) The status quo: unilateral exchange of health information between practitioners who are typically involved in geriatric care in the status quo (eg, by mail or telephone). (B) Multilateral exchange via the regional health information exchange system. The links between the practitioners represent potential communication processes to share patient health information.

Figure 2

Health information exchange (HIE) adoption by general practitioners (GPs) in the European Union (EU) [23]. The scores reflects the share of GPs (n=5,793) who indicated the following state of HIE use in their practice: 0=not aware; 1=do not have it; 2=have it but do not use it; 3=use it occasionally; 4=use it routinely. ICM-VC: Institute for Community Medicine, Section Epidemiology of Health Care and Community Health; N/A: not applicable, because not a member state of the EU or no data available (eg, the Netherlands).

Figure 3

Adapted and tested technology acceptance model for health ITs (HITs), own illustration, based on Steininger and Stiglbauer [41]. rHIE: regional health information exchange.

Figure 4

The three focus regions (A, B, and C) involved in the development of the regional health information exchange system. ICM-VC: Institute for Community Medicine, Section Epidemiology of Health Care and Community Health ; KV M-V: Association of Statutory Health Insurance Physicians in Mecklenburg-Western Pomerania; MV: Mecklenburg-Western Pomerania.

Figure 5

Technical infrastructure of the eHealth platform. Authorized users can exchange patient health information via electronic case report forms (eCRFs) or as digitized documents (eg, PDFs). IHE: Integrating the Healthcare Enterprise; rHIE: regional health information exchange. *New components of the rHIE system added to the pre-existing eHealth platform.