A framework for systematic evaluation of health information infrastructure progress in communities
Journal of Biomedical Informatics
Reconceptualizing System Usage: An Approach and Empirical Test
Information Systems Research
Characterizing Web users' online information behavior
Journal of the American Society for Information Science and Technology
The United Hospital Fund meeting on evaluating health information exchange
Journal of Biomedical Informatics
Playing smallball: Approaches to evaluating pilot health information exchange systems
Journal of Biomedical Informatics
Qualitative evaluation of health information exchange efforts
Journal of Biomedical Informatics
Health Information Exchange and Healthcare Utilization
Journal of Medical Systems
Learning relational policies from electronic health record access logs
Journal of Biomedical Informatics
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Health information exchange (HIE) is an avenue to improving patient care and an important priority under the Meaningful Use requirements. However, we know very little about the usage of HIE systems. Understanding how healthcare professionals actually utilize HIE systems will provide practical insights to system evaluation, help guide system improvement, and help organizations assess performance. We developed a novel way of describing professionals' HIE usage from the log files of an operational HIE-facilitating organization. The system employed a webpage-style interface. The screen number, types, and variation served to cluster all sessions in to five categories of HIE usage: minimal usage, repetitive searching, clinical information, mixed information, and demographic information. This method reduced the 1,661 different patterns into five recognizable groups for analysis. Overall, most users engaged with the system in a minimal fashion. In terms of user characteristics, minimal usage was highest among physicians and the highest percentage of clinical information usage was among nurses. Usage also differed by organization with repetitive searching most common in settings with scheduled encounters and uncommon in the faster-paced emergency department. Lastly, usage also varied by timing of the patient encounter. Within a single HIE system, discernible types of users behavior existed and varied across jobs, organizations, and time. This approach relied on objective data and can be replicated. In addition, our approach demonstrates that substantial variation in user behaviors exists beyond the more simplistic measures of adoption/non-adoption or access/no-access applied in previous research. This approach can help leaders and evaluators assess their own and other organizations.