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首页> 外文期刊>JMIR Medical Informatics >Barriers Over Time to Full Implementation of Health Information Exchange in the United States
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Barriers Over Time to Full Implementation of Health Information Exchange in the United States

机译：随着时间的流逝，美国全面实施健康信息交换的障碍

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Background Although health information exchanges (HIE) have existed since their introduction by President Bush in his 2004 State of the Union Address, and despite monetary incentives earmarked in 2009 by the health information technology for economic and clinical health (HITECH) Act, adoption of HIE has been sparse in the United States. Research has been conducted to explore the concept of HIE and its benefit to patients, but viable business plans for their existence are rare, and so far, no research has been conducted on the dynamic nature of barriers over time. Objective The aim of this study is to map the barriers mentioned in the literature to illustrate the effect, if any, of barriers discussed with respect to the HITECH Act from 2009 to the early months of 2014. Methods We conducted a systematic literature review from CINAHL, PubMed, and Google Scholar. The search criteria primarily focused on studies. Each article was read by at least two of the authors, and a final set was established for evaluation (n=28). Results The 28 articles identified 16 barriers. Cost and efficiency/workflow were identified 15% and 13% of all instances of barriers mentioned in literature, respectively. The years 2010 and 2011 were the most plentiful years when barriers were discussed, with 75% and 69% of all barriers listed, respectively. Conclusions The frequency of barriers mentioned in literature demonstrates the mindfulness of users, developers, and both local and national government. The broad conclusion is that public policy masks the effects of some barriers, while revealing others. However, a deleterious effect can be inferred when the public funds are exhausted. Public policy will need to lever incentives to overcome many of the barriers such as cost and impediments to competition. Process improvement managers need to optimize the efficiency of current practices at the point of care. Developers will need to work with users to ensure tools that use HIE resources work into existing workflows.
机译：背景信息尽管自布什总统在其2004年国情咨文中引入健康信息交流（HIE）以来，就已经存在，并且尽管2009年《经济和临床健康健康信息技术（HITECH）法案》指定了金钱激励措施，但采用HIE在美国一直很少。已经进行了研究以探索HIE的概念及其对患者的益处，但是关于其存在的可行的商业计划却很少，并且迄今为止，尚未进行关于障碍随时间变化的动态性质的研究。目的这项研究的目的是绘制文献中提到的障碍，以说明从2009年到2014年初有关HITECH法案讨论的障碍的影响（如有）。方法我们从CINAHL进行了系统的文献综述，PubMed和Google学术搜索。搜索标准主要集中在研究上。每篇文章至少要由两位作者阅读，并建立最终的评估集（n = 28）。结果28篇文章确定了16个障碍。在文献中提到的所有障碍中，成本和效率/工作流分别确定为15％和13％。 2010年和2011年是讨论障碍的最丰富的年份，分别列出了所有障碍的75％和69％。结论文献中提到的壁垒频率表明了用户，开发商以及地方和国家政府的正念。广泛的结论是，公共政策掩盖了某些障碍的影响，同时揭示了其他障碍。但是，当公共资金用尽时，可以推断出有害作用。公共政策将需要利用激励措施来克服许多障碍，例如成本和竞争障碍。流程改进经理需要在护理点优化当前实践的效率。开发人员将需要与用户合作，以​​确保使用HIE资源的工具可以在现有工作流程中使用。

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