Background:Health information exchange (HIE) is frequently cited as an important objective of health information technology investment because of its potential to improve quality, reduce cost, and increase patient satisfaction. In this paper we examine the status and practices of HIE in six countries, drawn from a range of higher and lower income regions. Methods:For each of the countries represented - China, England, India, Scotland, Switzerland, and the United States - we describe the state of current practice of HIE with reference to two scenarios: transfer of care and referral. For each country we discuss national objectives, barriers and plans for further advancing clinical information exchange. Results:The countries vary widely in levels of adoption of EHRs, availability of health information in electronic form suitable for HIE, and in the information technology infrastructure to be used for transmission. Common themes emerged, however, including an expectation that information will be exchanged rather than gathered anew, the need for incentives to promote information exchange, and concerns about data security and patient confidentiality. Conclusions:Although the ability to transfer health information to where it is most needed is nearly always mentioned as an advantage of HIE adoption, there are wide differences in the degree to which this has been achieved to support the scenarios used in this study. Nevertheless, these differences indicate varying stages of progress along a comparable pathway, with similar barriers being identified in the countries described. In some cases, these have been partially surmounted while elsewhere work is needed. We reflect on contextual factors influencing the status and direction of HIE efforts in different global regions and their implications for progress.

译文

背景:健康信息交换(HIE)经常被认为是健康信息技术投资的重要目标,因为它具有提高质量,降低成本和提高患者满意度的潜力。在本文中,我们从六个高收入和低收入地区中考察了六个国家中HIE的现状和实践。
方法:对于代表的每个国家(中国,英格兰,印度,苏格兰,瑞士和美国),我们参考两种情况描述了HIE的当前实践状况:护理转移和转诊。对于每个国家,我们都讨论了进一步推进临床信息交换的国家目标,障碍和计划。
结果:各国在采用电子病历的水平,适用于HIE的电子形式的健康信息的可获得性以及用于传输的信息技术基础设施方面差异很大。然而,出现了共同的主题,包括期望交换信息而不是重新收集信息,对促进信息交换的激励措施的需求以及对数据安全性和患者机密性的担忧。
结论:尽管几乎总是提到将健康信息传输到最需要的地方的能力,这是采用HIE的优势,但在支持本研究中所用方案的程度上却存在很大差异。然而,这些差异表明,在可比的道路上,进展阶段各不相同,在上述国家中也发现了类似的障碍。在某些情况下,这些已被部分覆盖,而其他地方则需要进行工作。我们思考影响全球不同地区HIE努力的状态和方向的背景因素及其对进展的影响。

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