Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)



Research Advisor

Michael A. Carter, DNSc, DNP


James E. Bailey, MD Patricia A. Cowan, PhD Diane Todd Pace, PhD Teeradache Viangteeravat, PhD


Health Information Exchange, Emergency Medicine, Healthcare Informatics, Electronic Health Record, Health Information Organization, Emergency Departments


Emergency physicians are key users of health information exchanges (HIE). Understanding their perspectives on the usability of HIE is important if the full potential of the HIE is to be achieved. The literature identified that emergency physician experiences with HIEs are unexplored areas requiring further studies. The purpose of this study using grounded theory methods was to understand the perspectives of emergency physicians concerning the usability of HIEs. The fundamental question was how do emergency physicians use the HIE in making clinical decisions?

Rich and thick data were collected from 15 emergency physicians in four urban hospitals in the mid-south using theoretical sampling and unstructured face-to face interviews. Concepts from the coded segments were developed into categories and an overarching theoretical scheme visualized in a conceptual framework. A substantive theory emerged that using the HIE among emergency physicians is the process of rationalizing non-use and reconciling challenges and benefits. The antecedent of usability was a typical day in the emergency department and why participants accessed the HIE and under what conditions. Six major themes emerged: using the HIE, influencing clinical decisions, struggling with challenges and barriers, recognizing benefits, current views, and rationalizing not using or reduced use of the HIE.

Emergency physicians gave good reasons why the HIE is not being used for the majority of patients while reconciling the challenges and benefits of using the HIE to explain the role of HIEs in making clinical decisions. There was a disconnect in the necessity of using the HIE to make clinical decisions and any negative outcomes that may occur in patients from not using the HIE. Generally, emergency physicians viewed the HIE as not being user-friendly and that they probably do not use the HIE as much as they could for making clinical decisions. The perspective of the emergency physicians was the emergency environment is too busy and because the HIE is less than user-friendly as needed by physicians to practice emergency medicine, the HIE disrupts workflow and is a deterrent to consistent usage in making clinical decisions.

A better understanding of how emergency physicians decided to use the HIE in making clinical decisions gives insights about how to achieve HIE usability. Satisfied end-users who view the HIE as effective and efficient should use the HIE more. However, this requires removing challenges and barriers while recognizing more benefits to using the HIE, and addressing the underlying reasons for not using the HIE. Understanding the complexities of using the HIE and providing solutions to increase usability of the HIE is necessary to influence greater use of the HIE in clinical decisions with demonstrated positive outcomes for patients.




One year embargo expired May 2012