The impact of transitioning from availability of outside records within electronic health records to integration of local and outside records within electronic health records.
OBJECTIVE
While there has been a substantial increase in health information exchange, levels of outside records use by frontline providers are low. We assessed whether integration between outside data and local data results in increased viewing of outside records, overall and by encounter, provider, and patient type.


MATERIALS AND METHODS
Using data from UCSF Health, we measured change in outside record views after integrating the list of local (UCSF) and outside (other health systems on Epic [Epic Systems, Verona, WI]) encounters on the Chart Review tab. Previously, providers only viewed records from outside encounters on a separate tab. We used an interrupted time series design (with outside record viewing event counts aggregated to the week level) to measure changes in the level and trend over a 1-year period.


RESULTS
There was a large increase in the level of outside record views of 22 920 per week (P < .001). The change in trend went from a weekly increase of 116 (P < .05) to a decrease of 402 (P = .08), reflecting a small effect decay. There were increases in the level of views for all provider and encounter types: attendings (n = 3675), residents (n = 3277), and nurses (n = 914); and inpatient (n = 1676), emergency (n = 487), and outpatient (n = 7228) (P < .001 for all). Results persisted when adjusted for total encounter volume.


DISCUSSION
While outside records were readily available before the encounter integration, the simple step of clicking on a separate tab appears to have depressed use.


CONCLUSIONS
User interface designs that comingle local and outside data result in higher levels of viewing and should be more broadly pursued.
['Adler-Milstein|Julia|J|', 'Wang|Michael D|MD|']
D000046:Academic Medical Centers D000328:Adult D066264:Datasets as Topic D019033:Delivery of Health Care, Integrated D057286:Electronic Health Records D005260:Female D066275:Health Information Exchange D000073892:Health Information Interoperability D006801:Humans D065186:Interrupted Time Series Analysis D008297:Male D008875:Middle Aged D012495:San Francisco D018511:Systems Integration D014584:User-Computer Interface
audit log data integration interoperability