Interoperable Electronic Health Records and Health Information Exchanges: Systematic Review

Background As the availability of interoperable electronic health records (iEHRs) or health information exchanges (HIEs) continues to increase, there is greater need and opportunity to assess the current evidence base on what works and what does not regarding the adoption, use, and impact of iEHRs. Objective The purpose of this project is to assess the international evidence base on the adoption, use, and impact of iEHRs. Methods We conducted a systematic review, searching multiple databases—MEDLINE, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL)—with supplemental searches conducted in Google Scholar and grey literature sources (ie, Google, Grey Literature Report, and OpenGrey). All searches were conducted in January and February 2017. Articles were eligible for inclusion if they were published in English, were published from 2006 to 2017, and were either an original research study or a literature review. In order to be included, articles needed to focus on iEHRs and HIEs across multiple health care settings, as well as on the impact and effectiveness of iEHR adoption and use. Results We included 130 articles in the synthesis (113 primary studies, 86.9%; 17 reviews, 13.1%), with the majority focused on the United States (88/130, 67.7%). The primary studies focused on a wide range of health care settings; the three most prevalent settings studied included acute care (59/113, 52.2%), primary care (44/113, 38.9%), and emergency departments (34/113, 30.1%). We identified 29 distinct measurement items in the 113 primary studies that were linked to 522 specific measurement outcomes. Productivity and quality were the two evaluation dimensions that received the most attention, accounting for 14 of 29 (48%) measurement items and 306 of 522 (58.6%) measurement outcomes identified. Overall, the majority of the 522 measurement outcomes were positive (298/522, 57.1%). We also identified 17 reviews on iEHR use and impact, 6 (35%) that focused on barriers and facilitators to adoption and implementation and 11 (65%) that focused on benefits and impacts, with the more recent reviews finding little generalizable evidence of benefit and impact. Conclusions This review captures the status of an evolving and active field focused on the use and impact of iEHRs. While the overall findings suggest many positive impacts, the quality of the primary studies were not evaluated systematically. When broken down by specific measurement item, the results directed attention both to measurement outcomes that were consistently positive and others that were mostly negative or equivocal.

[1]  Simon Hagens,et al.  The value of connected health information: perceptions of electronic health record users in Canada , 2016, BMC Medical Informatics and Decision Making.

[2]  J. McGowan,et al.  PRESS Peer Review of Electronic Search Strategies: 2015 Guideline Statement. , 2016, Journal of clinical epidemiology.

[3]  A. Sheikh,et al.  Barriers and facilitators to health information exchange in low- and middle-income country settings: a systematic review. , 2016, Health policy and planning.

[4]  Ara Darzi,et al.  A Patient-Centered Framework for Evaluating Digital Maturity of Health Services: A Systematic Review , 2016, Journal of medical Internet research.

[5]  Paul N. Gorman,et al.  Barriers and facilitators to exchanging health information: a systematic review , 2016, Int. J. Medical Informatics.

[6]  Michael Weiner,et al.  Health information exchanges - Unfulfilled promise as a data source for clinical research , 2016, Int. J. Medical Informatics.

[7]  Simon Hagens,et al.  Measuring interoperable EHR adoption and maturity: a Canadian example , 2016, BMC Medical Informatics and Decision Making.

[8]  Susan S. Woods,et al.  Outcomes From Health Information Exchange: Systematic Review and Future Research Needs , 2015, JMIR medical informatics.

[9]  Saurabh Rahurkar,et al.  Despite the spread of health information exchange, there is little evidence of its impact on cost, use, and quality of care. , 2015, Health affairs.

[10]  Paul G Shekelle,et al.  Usage and Effect of Health Information Exchange , 2014, Annals of Internal Medicine.

[11]  C. Kruse,et al.  Barriers Over Time to Full Implementation of Health Information Exchange in the United States , 2014, JMIR medical informatics.

[12]  J. Naaldenberg,et al.  Health information exchange in general practice care for people with intellectual disabilities--a qualitative review of the literature. , 2014, Research in developmental disabilities.

[13]  Francis Lau,et al.  Evaluation of a shared electronic health record. , 2014, Healthcare quarterly.

[14]  A. Hincapie,et al.  The Impact of Health Information Exchange on Health Outcomes , 2011, Applied Clinical Informatics.

[15]  J. Joshi,et al.  Clinical Value-Add for Health Information Exchange (HIE) , 2010 .

[16]  L. Schilling,et al.  Systematic Review of Health Information Exchange in Primary Care Practices , 2010, The Journal of the American Board of Family Medicine.

[17]  Joshua R. Vest,et al.  What should we measure? Conceptualizing usage in health information exchange , 2010, J. Am. Medical Informatics Assoc..

[18]  Kevin B. Johnson,et al.  Playing smallball: Approaches to evaluating pilot health information exchange systems , 2007, J. Biomed. Informatics.

[19]  Sarah Muttitt,et al.  A proposed benefits evaluation framework for health information systems in Canada. , 2007, Healthcare quarterly.

[20]  M Sandelowski,et al.  Qualitative Metasynthesis : Issues and Techniques , 1997 .

[21]  Andrea C. Tricco,et al.  Improving quality and efficiency in selecting, abstracting and appraising studies for rapid reviews , 2017 .

[22]  Simon Hagens,et al.  Valuing National Effects of Digital Health Investments: An Applied Method , 2015, ITCH.

[23]  Electronic tools for health information exchange: an evidence-based analysis. , 2013, Ontario health technology assessment series.

[24]  Cassandra Frazer,et al.  Managing eHealth Change: People and Processes , 2012, Nursing Informatics.

[25]  Ashley Edwards,et al.  Barriers to cross--institutional health information exchange: a literature review. , 2010, Journal of healthcare information management : JHIM.