Clinicians' use of Health Information Exchange technologies for medication reconciliation in the U.S. Department of Veterans Affairs: a qualitative analysis

doi:10.1186/s12913-024-11690-w

. 2024 Oct 8;24(1):1194.

doi: 10.1186/s12913-024-11690-w.

Clinicians' use of Health Information Exchange technologies for medication reconciliation in the U.S. Department of Veterans Affairs: a qualitative analysis

Margie E Snyder^{1

2

3

4}, Khoa A Nguyen^{2

5}, Himalaya Patel², Steven L Sanchez², Morgan Traylor², Michelle J Robinson², Teresa M Damush^{2

3

4}, Peter Taber^{6

7}, Amanda S Mixon^{8

9}, Vincent S Fan^{10

11}, April Savoy^{2

4

12}, Rachel A Dismore², Brian W Porter^{2

13}, Kenneth S Boockvar^{14

15}, David A Haggstrom^{2

3

4}, Emily R Locke¹⁰, Bryan S Gibson^{6

16}, Susan H Byerly^{8

9}, Michael Weiner^{17

18

19}, Alissa L Russ-Jara^{1

2

4

20}

Affiliations

¹ College of Pharmacy, Purdue University, West Lafayette, IN, USA.
² Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, U.S. Department of Veterans Affairs (VA), Veterans Health Administration, Richard L. Roudebush VA Medical Center, 1481 West 10th Street (11H), Indianapolis, IN, 46202, USA.
³ Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
⁴ Center for Health Services Research, Regenstrief Institute, Inc, Indianapolis, IN, USA.
⁵ College of Pharmacy, University of Florida, Gainesville, FL, USA.
⁶ Information, Decision Enhancement and Analytics Center of Innovation, U.S. Department of Veteran Affairs, Veteran Health Administration, Salt Lake City, UT, USA.
⁷ Department of Biomedical Informatics, Decision Enhancement and Analytics Sciences 2.0 Center of Innovation VA, University of Utah, Salt Lake City, UT, USA.
⁸ Geriatric Research, Education, and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA.
⁹ School of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
¹⁰ VA Puget Sound Health Care System, Seattle, WA, USA.
¹¹ School of Medicine, University of Washington, Seattle, WA, USA.
¹² Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
¹³ University of Tennessee Health Sciences Center, Memphis, TN, USA.
¹⁴ Birmingham VA Medical Center, Geriatrics Research Education & Clinical Center, Birmingham, AL, USA.
¹⁵ Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA.
¹⁶ Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT, USA.
¹⁷ Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, U.S. Department of Veterans Affairs (VA), Veterans Health Administration, Richard L. Roudebush VA Medical Center, 1481 West 10th Street (11H), Indianapolis, IN, 46202, USA. [email protected].
¹⁸ Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. [email protected].
¹⁹ Center for Health Services Research, Regenstrief Institute, Inc, Indianapolis, IN, USA. [email protected].
²⁰ Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USA.

PMID: 39375765
PMCID: PMC11460093
DOI: 10.1186/s12913-024-11690-w

Clinicians' use of Health Information Exchange technologies for medication reconciliation in the U.S. Department of Veterans Affairs: a qualitative analysis

Margie E Snyder et al. BMC Health Serv Res. 2024.

. 2024 Oct 8;24(1):1194.

doi: 10.1186/s12913-024-11690-w.

Authors

Affiliations

¹ College of Pharmacy, Purdue University, West Lafayette, IN, USA.
² Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, U.S. Department of Veterans Affairs (VA), Veterans Health Administration, Richard L. Roudebush VA Medical Center, 1481 West 10th Street (11H), Indianapolis, IN, 46202, USA.
³ Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
⁴ Center for Health Services Research, Regenstrief Institute, Inc, Indianapolis, IN, USA.
⁵ College of Pharmacy, University of Florida, Gainesville, FL, USA.
⁶ Information, Decision Enhancement and Analytics Center of Innovation, U.S. Department of Veteran Affairs, Veteran Health Administration, Salt Lake City, UT, USA.
⁷ Department of Biomedical Informatics, Decision Enhancement and Analytics Sciences 2.0 Center of Innovation VA, University of Utah, Salt Lake City, UT, USA.
⁸ Geriatric Research, Education, and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA.
⁹ School of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
¹⁰ VA Puget Sound Health Care System, Seattle, WA, USA.
¹¹ School of Medicine, University of Washington, Seattle, WA, USA.
¹² Purdue School of Engineering and Technology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.
¹³ University of Tennessee Health Sciences Center, Memphis, TN, USA.
¹⁴ Birmingham VA Medical Center, Geriatrics Research Education & Clinical Center, Birmingham, AL, USA.
¹⁵ Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA.
¹⁶ Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, UT, USA.
¹⁷ Center for Health Information and Communication, Health Services Research and Development Service CIN 13-416, U.S. Department of Veterans Affairs (VA), Veterans Health Administration, Richard L. Roudebush VA Medical Center, 1481 West 10th Street (11H), Indianapolis, IN, 46202, USA. [email protected].
¹⁸ Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. [email protected].
¹⁹ Center for Health Services Research, Regenstrief Institute, Inc, Indianapolis, IN, USA. [email protected].
²⁰ Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USA.

PMID: 39375765
PMCID: PMC11460093
DOI: 10.1186/s12913-024-11690-w

Abstract

Background: Medication reconciliation is essential for optimizing medication use. In part to promote effective medication reconciliation, the Department of Veterans Affairs (VA) invested substantial resources in health information exchange (HIE) technologies. The objectives of this qualitative study were to characterize VA clinicians' use of HIE tools for medication reconciliation in their clinical practice and to identify facilitators and barriers.

Methods: We recruited inpatient and outpatient prescribers (physicians, nurse practitioners, physician assistants) and pharmacists at four geographically distinct VA medical centers for observations and interviews. Participants were observed as they interacted with HIE or medication reconciliation tools during routine work. Participants were interviewed about clinical decision-making pertaining to medication reconciliation and use of HIE tools, and about barriers and facilitators to use of the tools. Qualitative data were analyzed via inductive and deductive approaches using a priori codes.

Results: A total of 63 clinicians participated. Over half (58%) were female, and the mean duration of VA clinical experience was 7 (range 0-32) years. Underlying motivators for clinicians seeking data external to their VA medical center were having new patients, current patients receiving care from an external institution, and clinicians' concerns about possible medication discrepancies among institutions. Facilitators for using HIE software were clinicians' familiarity with the HIE software, clinicians' belief that medication information would be available within HIE, and their confidence in the ability to find HIE medication-related data of interest quickly. Six overarching barriers to HIE software use for medication coordination included visual clutter and information overload within the HIE display; challenges with HIE interface navigation; lack of integration between HIE and other electronic health record interfaces, necessitating multiple logins and application switching; concerns with the dependability of HIE medication information; unfamiliarity with HIE tools; and a lack of HIE data from non-VA facilities.

Conclusions: This study is believed to be the first to qualitatively characterize clinicians' HIE use with respect to medication reconciliation. Results inform recommendations to optimize HIE use for medication management activities. We expect that healthcare organizations and software vendors will be able to apply the findings to develop more effective and usable HIE information displays.

Keywords: Health Information Exchange; Health Information Technology; Medical Informatics; Medication Reconciliation; Patient; Safety.

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Conflict of interest statement

The authors declare no competing interests.

Figures

**Fig. 1**
Emergent findings for decision-making, barriers, and facilitators mapped to SEIPS constructs

See this image and copyright information in PMC

References

1. Wing K, Bouhaddou O, Hsing N, Turvey C, Klein D, Nelson J, et al. Motivation and barriers to using the Veterans Health Information Exchange: a Survey of Veterans affairs Superusers. AMIA Annu Symp Proc. 2019;2019:913–22. - PMC - PubMed
1. One Hundred Fifteenth Congress of the United States of America. VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (VA MISSION Act), S.2372. 2018.
1. Linsky A, Simon SR. Medication discrepancies in integrated electronic health records. BMJ Qual Saf. 2013;22:103–9. 10.1136/bmjqs-2012-001301. - PubMed
1. Chrischilles EA, Helling DK, Booth BM, Lemke JH, Mustion AL. Documentation and appropriateness of prescribing for Veterans Administration ambulatory-care patients. Am J Hosp Pharm. 1988;45:2345–51. 10.1093/ajhp/45.11.2345. - PubMed
1. Mello MM, Adler-Milstein J, Ding KL, Savage L. Legal barriers to the growth of Health Information Exchange-boulders or pebbles? Milbank Q. 2018;96:110–43. 10.1111/1468-0009.12313. - PMC - PubMed

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[1] Wing K, Bouhaddou O, Hsing N, Turvey C, Klein D, Nelson J, et al. Motivation and barriers to using the Veterans Health Information Exchange: a Survey of Veterans affairs Superusers. AMIA Annu Symp Proc. 2019;2019:913–22. - PMC - PubMed

[2] Wing K, Bouhaddou O, Hsing N, Turvey C, Klein D, Nelson J, et al. Motivation and barriers to using the Veterans Health Information Exchange: a Survey of Veterans affairs Superusers. AMIA Annu Symp Proc. 2019;2019:913–22. - PMC - PubMed

[3] One Hundred Fifteenth Congress of the United States of America. VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (VA MISSION Act), S.2372. 2018.

[4] One Hundred Fifteenth Congress of the United States of America. VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (VA MISSION Act), S.2372. 2018.

[5] Linsky A, Simon SR. Medication discrepancies in integrated electronic health records. BMJ Qual Saf. 2013;22:103–9. 10.1136/bmjqs-2012-001301. - PubMed

[6] Linsky A, Simon SR. Medication discrepancies in integrated electronic health records. BMJ Qual Saf. 2013;22:103–9. 10.1136/bmjqs-2012-001301. - PubMed

[7] Chrischilles EA, Helling DK, Booth BM, Lemke JH, Mustion AL. Documentation and appropriateness of prescribing for Veterans Administration ambulatory-care patients. Am J Hosp Pharm. 1988;45:2345–51. 10.1093/ajhp/45.11.2345. - PubMed

[8] Chrischilles EA, Helling DK, Booth BM, Lemke JH, Mustion AL. Documentation and appropriateness of prescribing for Veterans Administration ambulatory-care patients. Am J Hosp Pharm. 1988;45:2345–51. 10.1093/ajhp/45.11.2345. - PubMed

[9] Mello MM, Adler-Milstein J, Ding KL, Savage L. Legal barriers to the growth of Health Information Exchange-boulders or pebbles? Milbank Q. 2018;96:110–43. 10.1111/1468-0009.12313. - PMC - PubMed

[10] Mello MM, Adler-Milstein J, Ding KL, Savage L. Legal barriers to the growth of Health Information Exchange-boulders or pebbles? Milbank Q. 2018;96:110–43. 10.1111/1468-0009.12313. - PMC - PubMed

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Clinicians' use of Health Information Exchange technologies for medication reconciliation in the U.S. Department of Veterans Affairs: a qualitative analysis

Affiliations

Clinicians' use of Health Information Exchange technologies for medication reconciliation in the U.S. Department of Veterans Affairs: a qualitative analysis

Authors

Affiliations

Abstract

Conflict of interest statement

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Abstract

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