Health information exchange system usage patterns in three communities: Practice sites, users, patients, and data

•We measured usage of a query-based health information exchange (HIE) system.•This study is among the first to quantify HIE usage across multiple communities.•Consent workflow may have contributed to higher HIE usage in one community.•Default patient data display may be a critical feature of query-based HIE systems.

ObjectivesPublic and private organizations are implementing systems for query-based health information exchange (HIE), the electronic aggregation of patient data from multiple institutions. However, existing studies of query-based HIE system usage have addressed a limited number of settings. Our goal was to quantify the breadth and depth of usage of a query-based HIE system implemented across multiple communities with diverse care settings and patient populations.MethodsWe performed a cross-sectional study in three communities in New York State using system access log files from January 2009 to May 2011 to measure usage patterns of a query-based HIE web portal system with respect to practice sites, users, patients, and data.ResultsSystem access occurred from 60% (n = 200) of practice sites registered to use the system in Community A, 59% (n = 156) in Community B, and 82% (n = 28) in Community C. In Communities A and B, users were primarily non-clinical staff in outpatient settings, while in Community C inpatient physicians were the main users. Across communities, proportions of patients whose data were accessed varied with 5% (n = 11,263) in Community A, 60% (n = 212,586) in Community B, and 1% (n = 1107) in Community C. In Community B, users updated patient consent through the HIE portal, whereas in the other communities, users updated patient consent through a separate system. Across communities, users most frequently accessed only patient summary data displayed by default followed by detailed laboratory and radiology data.ConclusionsThis study is among the first to illustrate large-scale usage of a query-based HIE system implemented across multiple communities. Patient summary data displayed by default may be an important feature of query-based HIE systems. User role, practice site type, and patient consent workflow may affect patterns of query-based HIE web portal system usage in the communities studied and elsewhere.