Israel is a pioneer in the nationwide implementation of health information exchanges (HIEs), which facilitate the sharing across organizations of patient-level data on symptoms, diagnostic test results, diagnoses, and treatments. An HIE system was implemented in all hospitals and clinics belonging to the Clalit health plan over a decade ago, and recently this has been expanded to include all of Israel's hospitals and health plans.
The international literature suggests that HIE use can contribute to improved quality, safety and continuity of care while reducing costs. However, it also indicates that clinicians do not always make use of the data made available to them by HIEs, and that the extent of usage can depend on a broad range of contextual, technological and managerial factors.
The goal of the study was to explore how senior personnel in Israeli hospitals and health plans perceive the potential contributions of the HIE to key organizational objectives; what they perceive to be the facilitators and barriers to HIE use; what steps they have taken to promote HIE use; and the extent of actual HIE use.
Among the findings:
There is a consensus among Israeli healthcare leaders that the HIE already makes important contributions to care, that the contributions are likely to increase in the future, and that managers can play an important role in encouraging HIE use.
Substantial variation was found across health plans with regard to the extent of HIE implementation and the investment in encouraging use.
Substantial variation was found among hospitals in the extent of use of HIE data and the intensity with which HIE use is being encouraged. Moreover, hospital managers believe that HIE use levels should be greater than current levels.
The findings suggest that it will be important to crystallize an explicit consensus among managers and leading clinicians regarding the types of clinical cases for which HIE use could make a valuable contribution, monitor the extent of such use, and provide particular encouragement for HIE use in those cases.
The study was funded by the Israel National Institute for Health Policy Research.