Does directly integrating health information exchange (HIE) data with the electronic health record increase HIE use by clinicians in the emergency department?

ObjectiveDevelop and evaluate the effect of a Fast Healthcare Interoperability Resources (FHIR) app, Health Dart, integrating information from Indianas community health information exchange (HIE), the Indiana Network for Patient Care (INPC), directly with Cerner, an electronic health record (EHR) Materials and MethodsHealth Dart was implemented in 14 Indiana University Health emergency departments (ED) using a stepped-wedge study design. We analyzed rates of INPC use in 286,175 ED encounters between October 1, 2019 and December 31, 2020. Logistic regression was used to model the probability of INPC use given the implementation context, such as user interface (UI) enhancements and the COVID-19 pandemic. ResultsINPC use increased by 131% across all encounters (from 3.6% to 8.3%; p<0.001) after Health Dart implementation. INPC use increased by144% (from 3.6% to 8.8%; p<0.001) more than two months post-implementation. After UI enhancements, post-implementation INPC use increased 123% (from 3.5% to 7.8%) compared to 181% (from 3.6% to 10.1%; p<0.001) in post-implementation encounters that occurred before UI enhancements. During the pandemic, post-implementation INPC use increased by 135% (from 3.4% to 8.0%; p<0.001) compared to 178% (from 3.6% to 10%; p<0.001) in post-implementation encounters that occurred before the pandemic. Statistical significance was determined using 95% confidence intervals (=0.05). DiscussionDirect integration of HIE information into an EHR substantially increased frequency of HIE use, but the effect was weakened by the UI enhancements and pandemic. ConclusionHIE information integrated into EHRs in the form of dashboards can potentially make information retrieval more efficient and effective for clinicians.