University of Nebraska Medical Center

Lina Lander, ScD: Assessing Perspectives on Health Information Exchange in Nebraska

source: dhhs.ne.gov

source: dhhs.ne.gov

Spotlight on Research at COPH – The Nebraska Health Information Initiative (NeHII) is Nebraska’s state-designated Health Information Exchange (HIE) and the statewide integrator of electronic health information. Participating providers can exchange health information to make more complete information available at the point of patient care. As of February 2014, more than 2.7 million patients, 1,388 physician providers, and 2,186 health care providers participate in NeHII. Dr. Lina Lander and colleagues have recently completed a comprehensive assessment of Nebraska health care providers’ and consumers’ perspectives on HIE.

What do health care providers think about HIE?

Dr. Lander and her colleagues surveyed 5,618 Nebraska physicians, physician assistants, and advanced practice registered nurses in 2013 and received 615 completed questionnaires (11% participation).

Providers who have used HIE reported that it improved patient care and facilitated receiving and sending information in the referral network. Respondents indicated that cost and loss of productivity were the major barriers to HIE adoption. HIE features important to those surveyed included accessing comprehensive lists of patients’ medications and allergies, and viewing lab results and clinical notes.

The survey findings led the research team to conclude that streamlining HIE access through integration with electronic medical records to minimize workflow interruption, and keeping costs reasonably low for providers, may increase participation, as would emphasizing more efficient access to laboratory values and medication information.

What do consumers think about HIE?

Consumer satisfaction is a crucial component of HIE utilization, as high satisfaction is expected to increase HIE utilization among providers and allow consumers to become full participants in their own health care management. The research team conducted 8 focus groups with a total of 67 participants in 7 towns and cities across Nebraska to identify consumer perspectives and concerns about HIE.

Participants expressed concern about privacy and security of medical information, decreases in quality of care, inconsistent provider participation, and potential cost. Participants gave positive feedback regarding accuracy and completeness of information, and improved communication, coordination, and access to information among health care providers.

Focus group findings revealed both significant perceived barriers and benefits to consumer adoption of HIE and related services. Improvements in patient care were expected due to easy physician access to consolidated information across providers as well as speed of sharing and availability of information in an emergency. In addition, participants were optimistic about patient empowerment in convenient access to and control of personal health data.


HIE gives providers quick access to patient information, allows providers to share patient information confidentially, and may be especially beneficial to patients seeking care in different locations. In emergency situations, immediate access to health information may eliminate the need to fax necessary documents. For public health professionals, HIE can become a platform to share vaccination and laboratory results. Once privacy and security guards are in place, quick and efficient access to health information can allow comparative effectiveness research to identify practices that will best serve Nebraska residents.


1. Morien M. Health information exchange important to public health? The GroundBreaker, Public Health in the National News. 2013;3(1). https://blog.unmc.edu/publichealth/2013/01/15/health-information-exchange-important-to-public-health/

2. http://www.connectnebraska.net/

Lina Lander, ScD, is an associate professor in the UNMC COPH Department of Epidemiology.

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