{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:20:16Z","timestamp":1760955616187,"version":"3.37.3"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"1","funder":[{"name":"US Department of Veterans Affairs (VA) Health Services Research and Development (HSR&D) Service","award":["IIR 11-058"],"award-info":[{"award-number":["IIR 11-058"]}]},{"DOI":"10.13039\/100007217","name":"VA HSR&D","doi-asserted-by":"crossref","award":["CIN 13-416"],"award-info":[{"award-number":["CIN 13-416"]}],"id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,1,1]]},"abstract":"<jats:p>Objective: To characterize patients who voluntarily enrolled in an electronic health information exchange (HIE) program designed to share data between Veterans Health Administration (VHA) and non-VHA institutions.<\/jats:p><jats:p>Materials and Methods: Patients who agreed to participate in the HIE program were compared to those who did not. Patient characteristics associated with HIE enrollment were examined using a multivariable logistic regression model. Variables selected for inclusion were guided by a health care utilization model adapted to explain HIE enrollment. Data about patients\u2019 sociodemographics (age, gender), comorbidity (Charlson index score), utilization (primary and specialty care visits), and access (distance to VHA medical center, insurance, VHA benefits) were obtained from VHA and HIE electronic health records.<\/jats:p><jats:p>Results: Among 57\u2009072 patients, 6627 (12%) enrolled in the HIE program during its first year. The likelihood of HIE enrollment increased among patients ages 50\u201364, of female gender, with higher comorbidity, and with increasing utilization. Living in a rural area and being unmarried were associated with decreased likelihood of enrollment.<\/jats:p><jats:p>Discussion and Conclusion: Enrollment in HIE is complex, with several factors involved in a patient\u2019s decision to enroll. To broaden HIE participation, populations less likely to enroll should be targeted with tailored recruitment and educational strategies. Moreover, inclusion of special populations, such as patients with higher comorbidity or high utilizers, may help refine the definition of success with respect to HIE implementation.<\/jats:p>","DOI":"10.1093\/jamia\/ocw058","type":"journal-article","created":{"date-parts":[[2016,6,7]],"date-time":"2016-06-07T02:34:40Z","timestamp":1465266880000},"page":"96-105","source":"Crossref","is-referenced-by-count":12,"title":["Which veterans enroll in a VA health information exchange program?"],"prefix":"10.1093","volume":"24","author":[{"given":"Brian E","family":"Dixon","sequence":"first","affiliation":[{"name":"Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN"},{"name":"Richard M. Fairbanks School of Public Health, Indiana University"},{"name":"Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN"}]},{"given":"Susan","family":"Ofner","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, School of Medicine, Indiana University"}]},{"given":"Susan M","family":"Perkins","sequence":"additional","affiliation":[{"name":"Richard M. Fairbanks School of Public Health, Indiana University"},{"name":"Department of Biostatistics, School of Medicine, Indiana University"}]},{"given":"Laura J","family":"Myers","sequence":"additional","affiliation":[{"name":"Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN"},{"name":"Department of General Internal Medicine and Geriatrics, School of Medicine, Indiana University"}]},{"given":"Marc B","family":"Rosenman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children\u2019s Health Services Research, Indiana University"},{"name":"Center for Health Services Research, Regenstrief Institute, Indianapolis, IN"}]},{"given":"Alan J","family":"Zillich","sequence":"additional","affiliation":[{"name":"Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN"},{"name":"Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, IN"}]},{"given":"Dustin D","family":"French","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL,"},{"name":"Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN"}]},{"given":"Michael","family":"Weiner","sequence":"additional","affiliation":[{"name":"Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN"},{"name":"Department of General Internal Medicine and Geriatrics, School of Medicine, Indiana University"},{"name":"Center for Health Services Research, Regenstrief Institute, Indianapolis, IN"}]},{"given":"David A.","family":"Haggstrom","sequence":"additional","affiliation":[{"name":"Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, Indianapolis, IN"},{"name":"Department of General Internal Medicine and Geriatrics, School of Medicine, Indiana University"},{"name":"Center for Health Services Research, Regenstrief Institute, Indianapolis, IN"}]}],"member":"286","published-online":{"date-parts":[[2016,6,6]]},"reference":[{"issue":"12","key":"2020110612374418900_ocw058-B1","doi-asserted-by":"crossref","first-page":"2437","DOI":"10.1377\/hlthaff.2011.0923","article-title":"New 2011 survey of patients with complex care needs in eleven countries finds that care is often poorly coordinated","volume":"30","author":"Schoen","year":"2011","journal-title":"Health Affairs (Project Hope)."},{"issue":"3","key":"2020110612374418900_ocw058-B2","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1007\/s11606-014-3100-x","article-title":"Challenges in referral communication between VHA primary care and specialty care","volume":"30","author":"Zuchowski","year":"2015","journal-title":"J Gen Intern Med."},{"issue":"11","key":"2020110612374418900_ocw058-B3","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.7205\/MILMED-D-13-00342","article-title":"Non-VA primary care providers' perspectives on comanagement for rural veterans","volume":"179","author":"Gaglioti","year":"2014","journal-title":"Military Med."},{"issue":"5","key":"2020110612374418900_ocw058-B4","first-page":"w595","article-title":"Health information exchange: \u2018lex parsimoniae.' Health Affairs (Project Hope)","volume":"26","author":"Overhage","journal-title":"2007"},{"key":"2020110612374418900_ocw058-B5","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.jbi.2014.03.011","article-title":"The long road to semantic interoperability in support of public health: experiences from two states","volume":"49","author":"Dixon","year":"2014","journal-title":"J Biomed Inform."},{"issue":"1","key":"2020110612374418900_ocw058-B6","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1197\/jamia.M3391","article-title":"Enhancing laboratory report contents to improve outpatient management of test results","volume":"17","author":"Chang","year":"2010","journal-title":"J Am Med Inform Assoc."},{"issue":"5","key":"2020110612374418900_ocw058-B7","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1136\/amiajnl-2011-000308","article-title":"Health information exchange usage in emergency departments and clinics: the who, what, and why","volume":"18","author":"Johnson","year":"2011","journal-title":"J Am Med Inform Assoc."},{"issue":"9","key":"2020110612374418900_ocw058-B8","doi-asserted-by":"crossref","first-page":"1672","DOI":"10.1377\/hlthaff.2014.0445","article-title":"Despite substantial progress in EHR adoption, health information exchange and patient engagement remain low in office settings","volume":"33","author":"Furukawa","year":"2014","journal-title":"Health Affairs (Project Hope)."},{"issue":"8","key":"2020110612374418900_ocw058-B9","doi-asserted-by":"crossref","first-page":"1486","DOI":"10.1377\/hlthaff.2013.0124","article-title":"Operational health information exchanges show substantial growth, but long-term funding remains a concern","volume":"32","author":"Adler-Milstein","year":"2013","journal-title":"Health Affairs (Project Hope)."},{"issue":"3","key":"2020110612374418900_ocw058-B10","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1377\/hlthaff.2014.0729","article-title":"Despite the spread of health information exchange, there is little evidence of its impact on cost, use, and quality of care","volume":"34","author":"Rahurkar","year":"2015","journal-title":"Health Affairs (Project Hope)."},{"issue":"11","key":"2020110612374418900_ocw058-B11","doi-asserted-by":"crossref","first-page":"803","DOI":"10.7326\/M14-0877","article-title":"Usage and effect of health information exchange: a systematic review","volume":"161","author":"Rudin","year":"2014","journal-title":"Ann Intern Med."},{"issue":"8","key":"2020110612374418900_ocw058-B12","doi-asserted-by":"crossref","first-page":"1346","DOI":"10.1377\/hlthaff.2013.0010","article-title":"Hospital electronic health information exchange grew substantially in 2008-12","volume":"32","author":"Furukawa","year":"2013","journal-title":"Health Affairs (Project Hope)."},{"issue":"8","key":"2020110612374418900_ocw058-B13","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/j.ijmedinf.2014.04.005","article-title":"The Department of Veterans Affairs' (VA) implementation of the Virtual Lifetime Electronic Record (VLER): findings and lessons learned from Health Information Exchange at 12 sites","volume":"83","author":"Byrne","year":"2014","journal-title":"Int J Med Inform."},{"key":"2020110612374418900_ocw058-B14","first-page":"51","article-title":"Toward a virtual lifetime electronic record: the department of veterans affairs experience with the nationwide health information network","volume":"2012","author":"Bouhaddou","year":"2012","journal-title":"AMIA Annu Symp Proc."},{"key":"2020110612374418900_ocw058-B15","first-page":"135","article-title":"The Department of Veterans Affairs, Department of Defense, and Kaiser Permanente Nationwide Health Information Network exchange in San Diego: patient selection, consent, and identity matching","author":"Bouhaddou","year":"2011","journal-title":"AMIA Annu Symp Proc."},{"author":"VLER Health","key":"2020110612374418900_ocw058-B16"},{"year":"2015","author":"Form No. 10-0485","key":"2020110612374418900_ocw058-B17"},{"issue":"1","key":"2020110612374418900_ocw058-B18","first-page":"1","article-title":"Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav","volume":"36","author":"Andersen","journal-title":"1995"},{"issue":"3 Pt 1","key":"2020110612374418900_ocw058-B19","first-page":"571","article-title":"Understanding the context of healthcare utilization: assessing environmental and provider-related variables in the behavioral model of utilization","volume":"33","author":"Phillips","year":"1998","journal-title":"Health Serv Res."},{"issue":"6","key":"2020110612374418900_ocw058-B20","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1007\/s11606-008-0561-9","article-title":"Differences in the patterns of health care system distrust between blacks and whites","volume":"23","author":"Armstrong","year":"2008","journal-title":"J Gen Intern Med."},{"issue":"5","key":"2020110612374418900_ocw058-B21","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1370\/afm.1396","article-title":"Health care consumers' preferences around health information exchange","volume":"10","author":"Dhopeshwarkar","year":"2012","journal-title":"Ann Fam Med."},{"issue":"6","key":"2020110612374418900_ocw058-B22","doi-asserted-by":"crossref","first-page":"\u00a01564","DOI":"10.1377\/hlthaff.26.6.1564","article-title":"Extending the P4P agenda, part 1: how Medicare can improve patient decision making and reduce unnecessary care","volume":"26","author":"Wennberg","year":"2007","journal-title":"Health Affairs (Project Hope)."},{"key":"2020110612374418900_ocw058-B23","doi-asserted-by":"crossref","first-page":"S81","DOI":"10.1097\/00124784-200411001-00013","article-title":"The Indiana network for patient care: an integrated clinical information system informed by over thirty years of experience","author":"Biondich","year":"2004","journal-title":"J Public Health Manag Pract."},{"issue":"Pt 1","key":"2020110612374418900_ocw058-B24","first-page":"\u00a0488","article-title":"Pulling back the covers: technical lessons of a real-world health information exchange","volume":"129","author":"Zafar","year":"2007","journal-title":"Stud Health Technol Inform."},{"key":"2020110612374418900_ocw058-B25","first-page":"36","article-title":"Lessons learned from the implementation of clinical messaging systems","author":"Barnes","year":"2007","journal-title":"AMIA Annu Symp Proc."},{"volume-title":"ADT Alerts for Reducing ED Admissions: A Case Study","year":"2013","author":"Indiana Health Information Exchange","key":"2020110612374418900_ocw058-B26"},{"key":"2020110612374418900_ocw058-B27","first-page":"259","article-title":"Analysis of a probabilistic record linkage technique without human review","author":"Grannis","year":"2003","journal-title":"AMIA Annu Symp Proc."},{"issue":"4","key":"2020110612374418900_ocw058-B28","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1007\/s10900-011-9523-y","article-title":"Factors associated with program utilization of radiation therapy treatment for VHA and Medicare dually enrolled patients","volume":"37","author":"French","year":"2012","journal-title":"J Commun Health."},{"issue":"3","key":"2020110612374418900_ocw058-B29","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1093\/biomet\/78.3.691","article-title":"A note on a general definition of the coefficient of determination","volume":"78","author":"Nagelkerke","year":"1991","journal-title":"Biometrika."},{"key":"2020110612374418900_ocw058-B30","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1007\/978-3-319-22753-5_19","article-title":"Consumer health informatics: engaging and empowering patients and families","volume-title":"Clinical Informatics Study Guide: Text and Review","author":"Nazi","year":"2016","edition":"1st ed."},{"issue":"12","key":"2020110612374418900_ocw058-B31","doi-asserted-by":"crossref","first-page":"805","DOI":"10.7326\/0003-4819-155-12-201112200-00002","article-title":"Patient interest in sharing personal health record information: a web-based survey","volume":"155","author":"Zulman","year":"2011","journal-title":"Ann Intern Med."},{"volume-title":"Veterans Access, Choice, and Accountability Act of 2014","key":"2020110612374418900_ocw058-B32"},{"issue":"4","key":"2020110612374418900_ocw058-B33","doi-asserted-by":"crossref","first-page":"\u00a0917","DOI":"10.1093\/jamia\/ocv019","article-title":"Implications for informatics given expanding access to care for veterans and other populations","volume":"22","author":"Dixon","year":"2015","journal-title":"J Am Med Inform Assoc."},{"issue":"1","key":"2020110612374418900_ocw058-B34","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1136\/amiajnl-2012-001023","article-title":"Patients want granular privacy control over health information in electronic medical records","volume":"20","author":"Caine","year":"2013","journal-title":"J Am Med Inform Assoc."},{"issue":"2","key":"2020110612374418900_ocw058-B35","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1377\/hlthaff.28.2.435","article-title":"Engaging patients for health information exchange","volume":"28","author":"Tripathi","year":"2009","journal-title":"Health Affairs (Project Hope)."},{"issue":"6","key":"2020110612374418900_ocw058-B36","doi-asserted-by":"crossref","first-page":"1183","DOI":"10.1093\/jamia\/ocv086","article-title":"Drivers of information disclosure on health information exchange platforms: insights from an exploratory empirical study","volume":"22","author":"Yaraghi","year":"2015","journal-title":"J Am Med Inform Assoc."},{"key":"2020110612374418900_ocw058-B37","first-page":"418","article-title":"Qualitative study of patient consent for health information exchange in an HIV clinic","volume":"201","author":"Ramos","year":"2014","journal-title":"Stud Health Technol Inform."},{"issue":"9","key":"2020110612374418900_ocw058-B38","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1016\/j.ijmedinf.2013.05.001","article-title":"Health information exchange system usage patterns in three communities: practice sites, users, patients, and data","volume":"82","author":"Campion","year":"2013","journal-title":"Int J Med Inform."},{"issue":"4","key":"2020110612374418900_ocw058-B39","doi-asserted-by":"crossref","first-page":"e73","DOI":"10.2196\/jmir.1668","article-title":"Consumers' perceptions about and use of the internet for personal health records and health information exchange: analysis of the 2007 Health Information National Trends Survey","volume":"12","author":"Wen","year":"2010","journal-title":"J Med Internet Res."},{"key":"2020110612374418900_ocw058-B40","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/B978-0-12-803135-3.00005-0","volume-title":"Managing the business of health information exchange: towards sustainability","author":"Kansky","year":"2016"},{"key":"2020110612374418900_ocw058-B41","doi-asserted-by":"crossref","first-page":"S703","DOI":"10.1007\/s11606-013-2699-3","article-title":"Delivery of gender-sensitive comprehensive primary care to women veterans: implications for VA Patient Aligned Care Teams","volume":"29","author":"Yano","year":"2014","journal-title":"J Gen Intern Med."},{"key":"2020110612374418900_ocw058-B42","first-page":"313","volume-title":"Use of HIEs for value-based care delivery: a case study of Maryland's HIE","author":"Kharrazi","year":"2016","edition":"1st ed."},{"issue":"5","key":"2020110612374418900_ocw058-B43","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1177\/1077558709359007","article-title":"Review: electronic health records and the reliability and validity of quality measures: a review of the literature","volume":"67","author":"Chan","year":"2010","journal-title":"Med Care Res Rev."},{"issue":"6","key":"2020110612374418900_ocw058-B44","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1177\/003335491312800614","article-title":"Electronic health information quality challenges and interventions to improve public health surveillance data and practice","volume":"128","author":"Dixon","year":"2013","journal-title":"Public Health Rep."},{"issue":"4","key":"2020110612374418900_ocw058-B45","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1093\/jamia\/ocv035","article-title":"Informatics to support the IOM Social and Behavioral Domains and Measures","volume":"22","author":"Hripcsak","year":"2015","journal-title":"J Am Med Inform Assoc."}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/24\/1\/96\/34148741\/ocw058.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/24\/1\/96\/34148741\/ocw058.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,1]],"date-time":"2022-07-01T04:22:29Z","timestamp":1656649349000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/24\/1\/96\/2631456"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,6,6]]},"references-count":45,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2016,6,6]]},"published-print":{"date-parts":[[2017,1,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jamia\/ocw058","relation":{},"ISSN":["1067-5027","1527-974X"],"issn-type":[{"type":"print","value":"1067-5027"},{"type":"electronic","value":"1527-974X"}],"subject":[],"published-other":{"date-parts":[[2017,1]]},"published":{"date-parts":[[2016,6,6]]}}}