Seeking Input: Evidence Report for Health Information Exchange

Last fall, I reported that the Pacific Northwest Evidence-based Practice Center (EPC), housed in the Department of Medical Informatics & Clinical Epidemiology (DMICE) at Oregon Health & Science University (OHSU), had been awarded a contract from the Agency for Healthcare Research & Quality (AHRQ) to carry out an evidence report (also known as a systematic review) on the topic of health information exchange (HIE). I am Principal Investigator of the project.

AHRQ has a process in its Effective Healthcare Program for insuring public input into its evidence reports. The first step is called "topic refinement," and the investigators develop draft key questions that the systematic review will address that are derived from the AHRQ Scope of Work for the project. The next step is to have a public comment period for the draft key questions before the actual systematic review process begins. We have reached the public comment period in our project, which will remain open through February 26, 2014. The draft key questions and forms for commenting will be available during the open comment period at the following URL:
http://www.effectivehealthcare.ahrq.gov/research-available-for-comment/comment-key-questions/?pageaction=displayquestions&topicid=572&questionset=250

Please comment at the AHRQ site and not as a reply to this posting. We encourage constructive comments and suggestions on the draft questions, which are listed below for convenience. After the topic refinement begins, we will begin the work of the systematic review that will aim to both identify where evidence currently exists as well as define gaps where further research is required.

Draft Key Questions

1. Is health information exchange (HIE) effective in improving clinical (e.g., mortality and morbidity), economic (e.g., costs and resource use, the value proposition for HIE) and population (e.g., syndromic surveillance) outcomes?
Does effectiveness vary by type of HIE?
Does effectiveness vary by health care settings and systems?
Does effectiveness vary by IT system characteristics?
What evidence exists that the lack of HIE leads to poorer outcomes?

2. What harms have resulted from HIE? (e.g., violations of privacy, errors in diagnosis or treatment from too much, too little or inaccurate information, or patient or provider concerns about HIE)
Do harms vary by type of HIE?
Do harms vary by health care settings and systems?
Do harms vary by the IT system characteristics?

3. Is HIE effective in improving intermediate outcomes such as patient and provider experience, perceptions or behavior; health care processes; or the availability, completeness, or accuracy of information?
Does effectiveness in improving intermediate outcomes vary by type of HIE?
Does effectiveness in improving intermediate outcomes vary by health care settings and systems?
Does effectiveness in improving intermediate outcomes vary by IT system characteristics?
What evidence exists that the lack of HIE leads to poorer intermediate outcomes?

4. What is the current level of use and primary uses of HIE?
Do level of use and primary uses vary by type of HIE?
Do level of use and primary uses vary by health care settings and systems?
Do level of use and primary uses vary by IT system characteristics?

5. How does the usability of HIE impact effectiveness or harms for individuals and organizations?
How usable are various types of HIE?
What specific usability factors impact the effectiveness or harms from HIE?

6. What facilitators and barriers impact implementation of HIE?
Do facilitators and barriers that impact implementation vary by type of HIE?
Do facilitators and barriers that impact implementation vary by health care settings and systems?
Do facilitators and barriers that impact implementation vary by IT system characteristics?

7. What facilitators and barriers impact use of HIE?
Do facilitators and barriers that impact use vary by type of HIE?
Do facilitators and barriers that impact use vary by health care settings and systems?
Do facilitators and barriers that impact use vary by IT system characteristics?

8. What factors influence sustainability of HIE?