Clinicians' use of Health Information Exchange technologies for medication reconciliation in the U.S. Department of Veterans Affairs: a qualitative analysis.
Margie E Snyder, Khoa A Nguyen, Himalaya Patel, Steven L Sanchez, Morgan Traylor, Michelle J Robinson, Teresa M Damush, Peter Taber, Amanda S Mixon, Vincent S Fan, April Savoy, Rachel A Dismore, Brian W Porter, Kenneth S Boockvar, David A Haggstrom, Emily R Locke, Bryan S Gibson, Susan H Byerly, Michael Weiner, Alissa L Russ-Jara
{"title":"Clinicians' use of Health Information Exchange technologies for medication reconciliation in the U.S. Department of Veterans Affairs: a qualitative analysis.","authors":"Margie E Snyder, Khoa A Nguyen, Himalaya Patel, Steven L Sanchez, Morgan Traylor, Michelle J Robinson, Teresa M Damush, Peter Taber, Amanda S Mixon, Vincent S Fan, April Savoy, Rachel A Dismore, Brian W Porter, Kenneth S Boockvar, David A Haggstrom, Emily R Locke, Bryan S Gibson, Susan H Byerly, Michael Weiner, Alissa L Russ-Jara","doi":"10.1186/s12913-024-11690-w","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Medication reconciliation is essential for optimizing medication use. In part to promote effective medication reconciliation, the Department of Veterans Affairs (VA) invested substantial resources in health information exchange (HIE) technologies. The objectives of this qualitative study were to characterize VA clinicians' use of HIE tools for medication reconciliation in their clinical practice and to identify facilitators and barriers.</p><p><strong>Methods: </strong>We recruited inpatient and outpatient prescribers (physicians, nurse practitioners, physician assistants) and pharmacists at four geographically distinct VA medical centers for observations and interviews. Participants were observed as they interacted with HIE or medication reconciliation tools during routine work. Participants were interviewed about clinical decision-making pertaining to medication reconciliation and use of HIE tools, and about barriers and facilitators to use of the tools. Qualitative data were analyzed via inductive and deductive approaches using a priori codes.</p><p><strong>Results: </strong>A total of 63 clinicians participated. Over half (58%) were female, and the mean duration of VA clinical experience was 7 (range 0-32) years. Underlying motivators for clinicians seeking data external to their VA medical center were having new patients, current patients receiving care from an external institution, and clinicians' concerns about possible medication discrepancies among institutions. Facilitators for using HIE software were clinicians' familiarity with the HIE software, clinicians' belief that medication information would be available within HIE, and their confidence in the ability to find HIE medication-related data of interest quickly. Six overarching barriers to HIE software use for medication coordination included visual clutter and information overload within the HIE display; challenges with HIE interface navigation; lack of integration between HIE and other electronic health record interfaces, necessitating multiple logins and application switching; concerns with the dependability of HIE medication information; unfamiliarity with HIE tools; and a lack of HIE data from non-VA facilities.</p><p><strong>Conclusions: </strong>This study is believed to be the first to qualitatively characterize clinicians' HIE use with respect to medication reconciliation. Results inform recommendations to optimize HIE use for medication management activities. We expect that healthcare organizations and software vendors will be able to apply the findings to develop more effective and usable HIE information displays.</p>","PeriodicalId":9012,"journal":{"name":"BMC Health Services Research","volume":null,"pages":null},"PeriodicalIF":2.7000,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11460093/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Health Services Research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12913-024-11690-w","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Medication reconciliation is essential for optimizing medication use. In part to promote effective medication reconciliation, the Department of Veterans Affairs (VA) invested substantial resources in health information exchange (HIE) technologies. The objectives of this qualitative study were to characterize VA clinicians' use of HIE tools for medication reconciliation in their clinical practice and to identify facilitators and barriers.
Methods: We recruited inpatient and outpatient prescribers (physicians, nurse practitioners, physician assistants) and pharmacists at four geographically distinct VA medical centers for observations and interviews. Participants were observed as they interacted with HIE or medication reconciliation tools during routine work. Participants were interviewed about clinical decision-making pertaining to medication reconciliation and use of HIE tools, and about barriers and facilitators to use of the tools. Qualitative data were analyzed via inductive and deductive approaches using a priori codes.
Results: A total of 63 clinicians participated. Over half (58%) were female, and the mean duration of VA clinical experience was 7 (range 0-32) years. Underlying motivators for clinicians seeking data external to their VA medical center were having new patients, current patients receiving care from an external institution, and clinicians' concerns about possible medication discrepancies among institutions. Facilitators for using HIE software were clinicians' familiarity with the HIE software, clinicians' belief that medication information would be available within HIE, and their confidence in the ability to find HIE medication-related data of interest quickly. Six overarching barriers to HIE software use for medication coordination included visual clutter and information overload within the HIE display; challenges with HIE interface navigation; lack of integration between HIE and other electronic health record interfaces, necessitating multiple logins and application switching; concerns with the dependability of HIE medication information; unfamiliarity with HIE tools; and a lack of HIE data from non-VA facilities.
Conclusions: This study is believed to be the first to qualitatively characterize clinicians' HIE use with respect to medication reconciliation. Results inform recommendations to optimize HIE use for medication management activities. We expect that healthcare organizations and software vendors will be able to apply the findings to develop more effective and usable HIE information displays.
背景:用药调节对于优化用药至关重要。为了促进有效的用药协调,退伍军人事务部(VA)在健康信息交换(HIE)技术方面投入了大量资源。这项定性研究的目的是了解退伍军人事务部临床医生在临床实践中使用 HIE 工具进行药物协调的情况,并找出促进因素和障碍:我们在四个地理位置不同的退伍军人医疗中心招募了住院和门诊处方人员(医生、执业护士、医生助理)以及药剂师,对他们进行了观察和访谈。我们观察了参与者在日常工作中与 HIE 或药物调节工具进行互动的过程。对参与者进行了访谈,内容涉及与药物调节和使用 HIE 工具相关的临床决策,以及使用这些工具的障碍和促进因素。采用先验代码,通过归纳和演绎方法对定性数据进行分析:共有 63 名临床医生参与。超过半数(58%)为女性,退伍军人事务部临床经验的平均持续时间为 7 年(0-32 年不等)。临床医生寻求退伍军人医疗中心外部数据的根本原因是有新病人、现有病人正在接受外部机构的治疗,以及临床医生担心各机构之间可能存在用药差异。使用 HIE 软件的促进因素包括临床医生对 HIE 软件的熟悉程度、临床医生对 HIE 中提供药物信息的信念,以及临床医生对快速找到 HIE 药物相关数据的能力的信心。使用 HIE 软件进行用药协调的六大障碍包括:HIE 显示屏的视觉混乱和信息过载;HIE 界面导航的挑战;HIE 与其他电子病历界面之间缺乏整合,导致需要多次登录和切换应用程序;对 HIE 用药信息可靠性的担忧;对 HIE 工具的不熟悉;以及缺乏来自非退伍军人医疗机构的 HIE 数据:这项研究被认为是第一项定性描述临床医生使用 HIE 进行药物对账的研究。研究结果为优化 HIE 在药物管理活动中的应用提供了建议。我们希望医疗机构和软件供应商能够应用研究结果来开发更有效、更实用的 HIE 信息显示。
期刊介绍:
BMC Health Services Research is an open access, peer-reviewed journal that considers articles on all aspects of health services research, including delivery of care, management of health services, assessment of healthcare needs, measurement of outcomes, allocation of healthcare resources, evaluation of different health markets and health services organizations, international comparative analysis of health systems, health economics and the impact of health policies and regulations.