The Health Information Exchange: Summary of (Kierkegaard et al, 2014)


Kierkegaard and colleagues have published an interesting paper in which they investigate Health Information Exchange usage with a qualitative study.

Themes in (Kierkegaard et al, 2014)

The researchers identify the following 8 themes in Table 4.

  • Purpose of Usage
  • Frequency of Usage
  • Availability of Information
  • Patient Consent
  • Healthcare Organisation Participation
  • Non-RHIO Related Exchange Mechanisms
  • Search Confidence
  • Usability

One of the themes is purpose of usage. The authors give examples of usage. The broader usage is in overcoming information gathering challenges. There are other individual examples also

  • Contextualising blood test results
  • Understanding health related behaviour
  • Understanding the rationale for medications

The researchers also identify the theme of frequency of usage. There were a number of factors which influenced the frequency of usage

  1. Profession. There were a number of professions utilising the HIE. Amongst physicians there were champion users.
  2. Location. The researchers looked at usage in primary care and A&E. Although the usage was higher in both, the usage was higher in primary care considering that information was pushed onto the HIE and pulled from the HIE.

Another theme they identified is the availability of information in the Health Information Exchange (HIE). The researchers note that the availability of information determines whether the HIE is utilised or other exchange mechanisms.

The researchers also looked at patient consent in the Health Information Exchange (HIE). This is a particularly interesting section in the paper. The researchers found differences in practice between community centres. Gaining consent for the HIE was more successful when frontline staff were able to communicate the benefits of a HIE. In this sense, consent for utilising data in a HIE is a function of training.

Participants in the study had commented on the number of health organisations participating in the HIE. Participants had commented on the benefits of a higher number of participating organisations and in one of the quoted comments, the benefits of a national exchange was identified.

One of the themes they identified is non-RHIO exchange mechanisms. This theme is mentioned very briefly in the paper and in the context of availability of information. The availability of information influenced the choice between the HIE and non-RHIO exchange mechanisms.

One of the themes they identified is search confidence. The researchers quote participants who state that finding the right information is a key driver in the use of a HIE. The researchers suggest that physicians typically use the HIE three or four times before making a decision. However what is interesting is that elsewhere in the paper the researchers report that the frequency of usage depends on the background of the user.

Usability varied according to the background of the user. Where time was pressured the login and response times were important factors. In other environments the use of automated updates impacted on usability as there would be large volumes of data presented which were often not clinically relevant. However the settings could be adjusted to manage this.


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.


How could Health Information Exchange Better Meet the Needs of Care Practitioners?
P. Kierkegaard, R. Kaushal, J.R. Vest. Appl Clin Inform. 2014; 5(4): 861–877. Published online 2014 Oct 15. doi: 10.4338/ACI-2014-06-RA-0055

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


ICD 1-10 Posts

ICD-11 Posts

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

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Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Conflicts of Interest: *For potential conflicts of interest please see the About section







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