Abstract：
This study explores patient and context related factors associated with use of Australia\'s national personally controlled Health Information Exchange (HIE), My Health Record, by emergency department (ED) clinicians.
A retrospective analysis explored secondary routinely-collected data including all patients who presented (between August 2019-2021) to the ED at a not-for-profit hospital in Melbourne. Presentation data were linked to the HIE access log-data, and human resources data. The primary outcome indicated HIE access by an ED pharmacist, doctor or nurse, within 3 days of the patient presenting to the ED, or not. Nine variables were explored with logistic regression, representing patient (gender, age, diagnosis) and other factors (presentation time, arrival method, referral, acuity/triage, length of stay, admitted into hospital).
HIE is accessed in 17.43% of patient presentations to the ED, led by pharmacists (15.60%). Overall, as demonstrated in themultivariable analysis, increased HIE access was associated with increasing age, with the biggest effect for 75-84-year old\'s (odd\'s ratio 26.15; 95% confidence interval 15.37-44.50), when compared to < 4 years of age. HIE access was also significantly and positively associated with patients who were later admitted into hospital from theED (4.96; 4.61-5.34).
The results suggest users of HIE in the ED employ the system to meet their needs, but not for all patients. To maximise value derived from HIE use, clinicians should target system access for patients where the benefit of accessing the record outweighs the cost - this research suggests that is for patients who are older in age and are likely to be admitted, potentially linked to greater condition complexity. If the use of a HIE is to improve the provision of care in the ED, the key stakeholders governing patient information within the HIE need to focus on improving clinician recording behaviours for older people and those suffering from complex medical conditions. Doctors and nurses lag behind with respect to the use of the HIE by pharmacists. Therefore, a focus on encouraging HIE engagement across these clinician groups is drastically required.
A retrospective analysis explored secondary routinely-collected data including all patients who presented (between August 2019-2021) to the ED at a not-for-profit hospital in Melbourne. Presentation data were linked to the HIE access log-data, and human resources data. The primary outcome indicated HIE access by an ED pharmacist, doctor or nurse, within 3 days of the patient presenting to the ED, or not. Nine variables were explored with logistic regression, representing patient (gender, age, diagnosis) and other factors (presentation time, arrival method, referral, acuity/triage, length of stay, admitted into hospital).
HIE is accessed in 17.43% of patient presentations to the ED, led by pharmacists (15.60%). Overall, as demonstrated in themultivariable analysis, increased HIE access was associated with increasing age, with the biggest effect for 75-84-year old\'s (odd\'s ratio 26.15; 95% confidence interval 15.37-44.50), when compared to < 4 years of age. HIE access was also significantly and positively associated with patients who were later admitted into hospital from theED (4.96; 4.61-5.34).
The results suggest users of HIE in the ED employ the system to meet their needs, but not for all patients. To maximise value derived from HIE use, clinicians should target system access for patients where the benefit of accessing the record outweighs the cost - this research suggests that is for patients who are older in age and are likely to be admitted, potentially linked to greater condition complexity. If the use of a HIE is to improve the provision of care in the ED, the key stakeholders governing patient information within the HIE need to focus on improving clinician recording behaviours for older people and those suffering from complex medical conditions. Doctors and nurses lag behind with respect to the use of the HIE by pharmacists. Therefore, a focus on encouraging HIE engagement across these clinician groups is drastically required.
摘要：
本研究探讨了与使用澳大利亚国家个人控制的健康信息交换（HIE）相关的患者和背景相关因素，我的健康记录,由急诊科（ED）临床医生。
回顾性分析探索了次要常规收集的数据，包括在墨尔本一家非营利性医院（2019年8月至2021年）接受ED的所有患者。演示数据与HIE访问日志数据相关联，人力资源数据。主要结果表明由ED药剂师获得HIE，医生或护士,患者就诊后3天内，或者没有。用逻辑回归分析了九个变量，代表患者(性别，年龄,诊断)和其他因素(演示时间，到达方法，转介,敏锐度/分诊，逗留时间,入院)。
在17.43％的患者就诊中访问HIE，由药剂师领导（15.60%）。总的来说,正如在变量分析中所证明的，增加HIE访问与年龄增长有关，对75-84岁的人影响最大(奇数比26.15；95%置信区间15.37-44.50)，与<4岁相比。HIE通路与后来因ED入院的患者也呈显著正相关(4.96;4.61-5.34)。
结果表明，ED中的HIE用户使用该系统来满足他们的需求，但并不是所有的病人。为了最大化从HIE使用中获得的价值，临床医生应针对患者的系统访问，其中访问记录的好处大于成本-这项研究表明，这是针对年龄较大且可能入院的患者，可能与更大的条件复杂性有关。如果使用HIE是为了改善急诊室提供的护理，HIE中管理患者信息的主要利益相关者需要专注于改善老年人和患有复杂疾病的患者的临床医生记录行为.医生和护士在药剂师使用HIE方面落后。因此,非常需要在这些临床医师群体中重点鼓励HIE参与.
回顾性分析探索了次要常规收集的数据，包括在墨尔本一家非营利性医院（2019年8月至2021年）接受ED的所有患者。演示数据与HIE访问日志数据相关联，人力资源数据。主要结果表明由ED药剂师获得HIE，医生或护士,患者就诊后3天内，或者没有。用逻辑回归分析了九个变量，代表患者(性别，年龄,诊断)和其他因素(演示时间，到达方法，转介,敏锐度/分诊，逗留时间,入院)。
在17.43％的患者就诊中访问HIE，由药剂师领导（15.60%）。总的来说,正如在变量分析中所证明的，增加HIE访问与年龄增长有关，对75-84岁的人影响最大(奇数比26.15；95%置信区间15.37-44.50)，与<4岁相比。HIE通路与后来因ED入院的患者也呈显著正相关(4.96;4.61-5.34)。
结果表明，ED中的HIE用户使用该系统来满足他们的需求，但并不是所有的病人。为了最大化从HIE使用中获得的价值，临床医生应针对患者的系统访问，其中访问记录的好处大于成本-这项研究表明，这是针对年龄较大且可能入院的患者，可能与更大的条件复杂性有关。如果使用HIE是为了改善急诊室提供的护理，HIE中管理患者信息的主要利益相关者需要专注于改善老年人和患有复杂疾病的患者的临床医生记录行为.医生和护士在药剂师使用HIE方面落后。因此,非常需要在这些临床医师群体中重点鼓励HIE参与.
