Summary of Eden et al’s Systematic Review

Eden and colleagues have published a systematic review on the barriers and facilitators for a Health Information Exchange. They identified 17 studies for inclusion in their review.

The research methodology is broadly outlined in Figure 1 which shows 22 selected papers out of the 5221 identified papers.

The authors defined the Health Information Exchange as

“the electronic sharing of clinical information among users to facilitate care coordination and transitions across settings”

The researchers rated the included studies according to the risk of bias. They identified

• 15 barriers
• 20 facilitators

The barriers and facilitators are organised according to the following three themes

• Completeness of information
• Organisation and workflow
• Technology and user needs

The barriers to organisation and workflow include the potential need for additional login details and additional support as well as considerations about free text. The facilitators include simplification of login details, training, user feedback, technical support, managing expectations and the architecture of the interface and workflow.

In terms of technology and user need, the barriers included the level of information provided as well as the standards. The facilitators included consideration of when to push and pull the data, pre-access reports and involvement of stakeholders in the development.

In terms of the completeness of information they found a number of factors which were both barriers and facilitators. Privacy and security were two factors and addressed with policy and training. Finding the right information could be a barrier and was addressed by using probabilistic matching algorithms. Consent issues were addressed by consideration of opt-in and opt-out approaches as well as consent at the time of registration together with online options for gaining consent.

The Context of a Health Information Exchange

Patient Records

Patient records are central to the delivery of healthcare and serve a number of functions including the recording of clinical assessments and interventions. Aggregated data is also utilised at a local and national level to inform commissioning.

Electronic Patient Records

The digitisation of patient records offers a number of advantages over paper based records. These advantages include automated backup of records, reduced use of physical storage space (since paper based notes are switched to servers), off-site access to records using mobile devices and the potential to develop analytical clinical support tools which use computers to process clinical data to help improve clinical decisions. Not all healthcare services have electronic patient records but most providers are moving in this direction.

Getting Electronic Patient Records to Talk to Each Other

When patients move between healthcare providers – for instance between primary care and the hospital – they may find that one provider does not have information that the other provider has. There are many providers and many electronic paper record systems. For two systems to talk to each other they have to solve a number of problems. When these problems are solved a patient can move between providers and healthcare information can be accessed by the different providers. A key solution to this problem of health information gaps is the Health Information Exchange (HIE).

The Health Information Exchange

There are many definitions of what a Health Information Exchange is. (Hersh et al, 2015) define a HIE as follows:

‘Health information exchange (HIE), the electronic sharing of clinical information across the boundaries of health care organizations’

Whilst this definition is simple, the process of sharing clinical information between healthcare organisations is technically complex and encompasses a range of software, hardware and governance issues. The process of helping systems to talk to each other is helped by the development of standards. A set of standards is outlined in the NHS interoperability framework.

Links to Other Posts in the Health Information Exchange Series

General Posts to Date on Health Information Exchanges

Posts on Examples of Health Information Exchanges

SNOMED CT®/ICD Mapping and Harmonisation Posts

SNOMED CT® Posts

ICD 1-10 Posts

ICD-11 Posts

Index: There are indices for the TAWOP site here and here

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