Managing Technology and Standards: Best Practices

Wisconsin Health Information Exchange

As HIEs progress from early to advanced stages, many discover that implementation of an infrastructure for connectivity does not guarantee adoption by local practitioners.  'It's a common mistake to believe that if you build it, they will come," said Seth Foldy, MD, principal investigator for the Wisconsin Health Information Exchange and member of the eHealth Initiative board of directors. Widespread use of new systems require that HIEs provide support functions as well.  Clinicians at the point of care need information that is accessible, understandable, and highly useful.

"Accessibility means that physicians are getting information using the same pathways they're used to using," Foldy said.  'For example, in Wisconsin, our pilot project isn't to exchange newly available information, but to allow people to log onto multiple networks simultaneously and to use those networks with a single log on." Accessibility includes ensuring that information flow is immediate.  'As a primary care physician, I often have just 10 minutes to see many patients.  So I probably won't use a system that takes 10 or even 15 minutes to give me an answer to a question.  Turnaround time in health information exchange is part of the holy grail," he said.

Understandable systems require immediate help desk functions as well.  'If a very busy clinician is going to use new stuff, they're going to need to have their questions answered in a hurry.  You also need to have a very intuitive interface so physicians can adopt new practices without large amounts of training."  Foldy said his group adopted the AZYXXI interface because of its reputation for ease of use among clinicians.

Creating a system that is perceived as highly useful, is perhaps the most difficult component to achieve. 'Clinicians aren't going to take much time to seek incomplete information--we learned that with immunization registries.  Clinicians weren't sure it was worth their while to download partial information."  Foldy said it will be a challenge for HIEs to provide sufficient volume and completeness of information to make using the system worth the clinician's time.

Support functions play a role in improving patient safety and healthcare quality both at the point of care and over time through analysis of statistical profiles to determine best practices and workflow patterns.  "It all has to fit into the workflow of the fast-paced medical care operation for maximum effect."