Clinicians' use of Health Information Exchange technologies for medication reconciliation in the U.S. Department of Veterans Affairs: a qualitative analysis.

Autor: Snyder ME; College of Pharmacy, Purdue University, West Lafayette, IN, USA.; Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, U.S. Department of Veterans Affairs (VA), Veterans Health Administration, Richard L. Roudebush VA Medical Center, 1481 West 10th Street (11H), Indianapolis, IN, 46202, USA.; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.; Center for Health Services Research, Regenstrief Institute, Inc, Indianapolis, IN, USA., Nguyen KA; Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, U.S. Department of Veterans Affairs (VA), Veterans Health Administration, Richard L. Roudebush VA Medical Center, 1481 West 10th Street (11H), Indianapolis, IN, 46202, USA.; College of Pharmacy, University of Florida, Gainesville, FL, USA., Patel H; Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, U.S. Department of Veterans Affairs (VA), Veterans Health Administration, Richard L. Roudebush VA Medical Center, 1481 West 10th Street (11H), Indianapolis, IN, 46202, USA., Sanchez SL; Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, U.S. Department of Veterans Affairs (VA), Veterans Health Administration, Richard L. Roudebush VA Medical Center, 1481 West 10th Street (11H), Indianapolis, IN, 46202, USA., Traylor M; Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, U.S. Department of Veterans Affairs (VA), Veterans Health Administration, Richard L. Roudebush VA Medical Center, 1481 West 10th Street (11H), Indianapolis, IN, 46202, USA., Robinson MJ; Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, U.S. Department of Veterans Affairs (VA), Veterans Health Administration, Richard L. Roudebush VA Medical Center, 1481 West 10th Street (11H), Indianapolis, IN, 46202, USA., Damush TM; Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, U.S. Department of Veterans Affairs (VA), Veterans Health Administration, Richard L. Roudebush VA Medical Center, 1481 West 10th Street (11H), Indianapolis, IN, 46202, USA.; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.; Center for Health Services Research, Regenstrief Institute, Inc, Indianapolis, IN, USA., Taber P; Information, Decision Enhancement and Analytics Center of Innovation, U.S. Department of Veteran Affairs, Veteran Health Administration, Salt Lake City, UT, USA.; Department of Biomedical Informatics, Decision Enhancement and Analytics Sciences 2.0 Center of Innovation VA, University of Utah, Salt Lake City, UT, USA., Mixon AS; Geriatric Research, Education, and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA.; School of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA., Fan VS; VA Puget Sound Health Care System, Seattle, WA, USA.; School of Medicine, University of Washington, Seattle, WA, USA., Savoy A; Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, U.S. Department of Veterans Affairs (VA), Veterans Health Administration, Richard L. Roudebush VA Medical Center, 1481 West 10th Street (11H), Indianapolis, IN, 46202, USA.; Center for Health Services Research, Regenstrief Institute, Inc, Indianapolis, IN, USA.; Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA., Dismore RA; Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, U.S. Department of Veterans Affairs (VA), Veterans Health Administration, Richard L. Roudebush VA Medical Center, 1481 West 10th Street (11H), Indianapolis, IN, 46202, USA., Porter BW; Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, U.S. Department of Veterans Affairs (VA), Veterans Health Administration, Richard L. Roudebush VA Medical Center, 1481 West 10th Street (11H), Indianapolis, IN, 46202, USA.; University of Tennessee Health Sciences Center, Memphis, TN, USA., Boockvar KS; Birmingham VA Medical Center, Geriatrics Research Education & Clinical Center, Birmingham, AL, USA.; Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA., Haggstrom DA; Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, U.S. Department of Veterans Affairs (VA), Veterans Health Administration, Richard L. Roudebush VA Medical Center, 1481 West 10th Street (11H), Indianapolis, IN, 46202, USA.; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.; Center for Health Services Research, Regenstrief Institute, Inc, Indianapolis, IN, USA., Locke ER; VA Puget Sound Health Care System, Seattle, WA, USA., Gibson BS; Information, Decision Enhancement and Analytics Center of Innovation, U.S. Department of Veteran Affairs, Veteran Health Administration, Salt Lake City, UT, USA.; Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT, USA., Byerly SH; Geriatric Research, Education, and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA.; School of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA., Weiner M; Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, U.S. Department of Veterans Affairs (VA), Veterans Health Administration, Richard L. Roudebush VA Medical Center, 1481 West 10th Street (11H), Indianapolis, IN, 46202, USA. mw@cogit.net.; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. mw@cogit.net.; Center for Health Services Research, Regenstrief Institute, Inc, Indianapolis, IN, USA. mw@cogit.net., Russ-Jara AL; College of Pharmacy, Purdue University, West Lafayette, IN, USA.; Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, U.S. Department of Veterans Affairs (VA), Veterans Health Administration, Richard L. Roudebush VA Medical Center, 1481 West 10th Street (11H), Indianapolis, IN, 46202, USA.; Center for Health Services Research, Regenstrief Institute, Inc, Indianapolis, IN, USA.; Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USA.
Jazyk: angličtina
Zdroj: BMC health services research [BMC Health Serv Res] 2024 Oct 08; Vol. 24 (1), pp. 1194. Date of Electronic Publication: 2024 Oct 08.
DOI: 10.1186/s12913-024-11690-w
Abstrakt: 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.
(© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)
Databáze: MEDLINE
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