Methods: Using a self-administered questionnaire (n=398, 50% response-rate) within an Integrated Delivery System(IDS), we assessed use (percent of ambulatory visits with any use) of four functions: Data-Review, Documentation, Order-Entry, and Communication with patients and providers. Respondents also rated their HIT training and the level of HIT integration into their workflow. We used linear and ordinal logistic regression models to examine characteristics associated with responses.
Results: Mean levels of HIT use for Order-Entry, Data-Review, Communication, and Documentation, were 84%, 82%, 47%, and 35% of visits respectively. While all clinicians reported receiving basic training in these HIT tools, 74%, 67%, 62%, and 32% reported that the training was adequate for Order-Entry, Communication, Data-Review, and Documentation tools respectively. Several respondents reported that training was too basic with little follow-up, leaving many to learn “on the fly.” Overall, 46% reported incorporating HIT use into their clinical workflow. Respondents reported the speed of the HIT system as a frequent barrier to integration into clinical workflow. Multivariate analyses showed that providers with <5 years-in-the-IDS reported using Data-Review in more visits (p<0.01) than those with >10 years-in-the-IDS; providers with adequate training reported using Documentation and Order-Entry in more visits (p<0.01). Providers with <5 years-in-the-IDS were more likely to report incorporation of HIT into clinical workflow than those with >10 years-in-the-IDS (OR =1.69, 95% CI 1.07-2.65).
Conclusions: Despite the availability of ambulatory care HIT, clinicians report variable use of HIT functions, with use mostly for Data-Review and Order-Entry, but substantially less for Documentation or Communication. Only a moderate number of clinicians reported incorporating HIT into their clinical workflow. Additional work on how to facilitate integration of the information and tools available in HIT into patient care is critical to realizing the potential benefits of HIT.