Appl Clin Inform - A case report in health information exchange for inter-organizational patient transfers.

Tópicos

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Resumo

JECTIVE: To provide a case report of barriers and promoters to implementing a health information exchange (HIE) tool that supports patient transfers between hospitals and skilled nursing facilities.METHODS: A multi-disciplinary team conducted semi-structured telephone and in-person interviews in a purposive sample of HIE organizational informants and providers in New York City who implemented HIE to share patient transfer information. The researchers conducted grounded theory analysis to identify themes of barriers and promoters and took steps to improve the trustworthiness of the results including vetting from a knowledgeable study participant.RESULTS: Between May and October 2011, researchers recruited 18 participants: informaticians, healthcare administrators, software engineers, and providers from a skilled nursing facility. Subjects perceived the HIE tool's development a success in that it brought together stakeholders who had traditionally not partnered for informatics work, and that they could successfully share patient transfer information between a hospital and a skilled nursing facility. Perceived barriers included lack of hospital stakeholder buy-in and misalignment with clinical workflows that inhibited use of HIE-based patient transfer data. Participants described barriers and promoters in themes related to organizational, technical, and user-oriented issues. The investigation revealed that stakeholders could develop and implement health information technology that technically enables clinicians in both hospitals and skilled nursing facilities to exchange real-time information in support of patient transfers. User level barriers, particularly in the emergency department, should give pause to developers and implementers who plan to use HIE in support of patient transfers.CONCLUSIONS: Participants' experiences demonstrate how stakeholders may succeed in developing and piloting an electronic transfer form that relies on HIE to aggregate, communicate, and display relevant patient transfer data across health care organizations. Their experiences also provide insights for others seeking to develop HIE applications to improve patient transfers between emergency departments and skilled nursing facilities.

Resumo Limpo

jectiv provid case report barrier promot implement health inform exchang hie tool support patient transfer hospit skill nurs facilitiesmethod multidisciplinari team conduct semistructur telephon inperson interview purpos sampl hie organiz inform provid new york citi implement hie share patient transfer inform research conduct ground theori analysi identifi theme barrier promot took step improv trustworthi result includ vet knowledg studi participantresult may octob research recruit particip informatician healthcar administr softwar engin provid skill nurs facil subject perceiv hie tool develop success brought togeth stakehold tradit partner informat work success share patient transfer inform hospit skill nurs facil perceiv barrier includ lack hospit stakehold buyin misalign clinic workflow inhibit use hiebas patient transfer data particip describ barrier promot theme relat organiz technic userori issu investig reveal stakehold develop implement health inform technolog technic enabl clinician hospit skill nurs facil exchang realtim inform support patient transfer user level barrier particular emerg depart give paus develop implement plan use hie support patient transfersconclus particip experi demonstr stakehold may succeed develop pilot electron transfer form reli hie aggreg communic display relev patient transfer data across health care organ experi also provid insight other seek develop hie applic improv patient transfer emerg depart skill nurs facil

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