Perceptions of and barriers to health information exchange use among emergency medicine and inpatient internal medicine clinicians in the Atlanta, Georgia metropolitan region

Background: Health information exchanges (HIE), tools that electronically share clinical data across healthcare organizations, provide the opportunity to improve patient care. While widely available, HIE is utilized in only 2%-10% of patient encounters. Few studies have explored current barriers to use. The goal of this study was to evaluate current clinician perspectives on HIE and barriers to use at the point of care. Methods: We conducted a population-based survey of internal medicine (IM) and emergency medicine (EM) physicians, physician assistants, and nurse practitioners at 8 health systems in the Atlanta area. Survey responses were analyzed overall and by specialty. Results: Of 1239 clinicians who were invited to participate, 276 (22.3%) responded, with 65.6% of respondents working in inpatient IM and 32.6% in EM. 80.4% of respondents reported using HIE at least once a day, while 4.8% reported never using HIE. Most clinicians used HIE at least daily to access lab results (80.2%), clinical notes (81.9%), imaging reports (74.0%), and medication lists (71.2%). The most reported barriers to HIE utilization included unavailability of needed information (66.4%), adding time to patient care (45.5%), and ease of simply reordering tests (31.6%). HIE use and reported barriers to use were similar across IM and EM providers. Conclusions: Of those responding to the survey, daily access of HIE was common. We identified several barriers to HIE use, which can be used to develop targeted interventions to improve utilization and patient care. Approaches to reach survey non-responders are also needed.