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Seminar: "Small ball" Evaluation -- The Memphis HIE Experience

Seminar Presentation

Cynthia Gadd

Cynthia S. Gadd, PhD, MBA, MS
Associate Professor and Director of Educational Program
Department of Biomedical Informatics
Vanderbilt University

Location: HSEB 4100B
Date: Oct. 6, 2011
Time: 4:15 - 5:15 pm


Health information exchange (HIE) systems are large, multimillion dollar efforts that are implemented despite initial institutional apprehension, with largely unanticipated effects on the clinical workflow, and with a primary goal of establishing a reason to sustain the effort. Traditional evaluation methods that rely on viewing HIE as generalizable tools that can be used to demonstrate impact are challenged by the realities of how HIE systems are created and the numerous systems they impact on the road to improved care. In short, it appears to be unrealistic to develop the definitive ‘‘home run’’ evaluation of this technology. Despite the existence of traditional approaches for large-scale evaluation, a more realistic approach may be a ‘‘small ball’’ model based on established IT implementation phases, with appropriate evaluation dimensions linked to each phase and strong consideration of sociotechnical and program evaluation perspectives throughout all phases of study development.

The MidSouth eHealth Alliance (MSeHA) HIE was rapidly deployed in a densely populated metropolitan region, supporting the basic principles of patient-centered use, autonomy for participating organizations, minimal cost, flexibility, and privacy safeguards. The implementation unfolded in networks of diverse and changing people, tools, roles, systems, processes, and within specific socio-political contexts in which the HIE is but one component. This complexity reinforced the need for the evaluation to address how the tools change practice and how practice shapes the tools, leading the MSeHA team to conduct a series of studies, including formative qualitative feedback from users, a usability survey study, multi-method workflow analysis, and an assessment of the financial impacts. The MSeHA “small ball” evaluation approach and its component studies will be described, in particular the probing of user perceptions using the Questionnaire for User Interaction Satisfaction (QUIS), an author-generated Trust scale, and user characteristic questions (e.g., age, weekly system usage time) in a cross-sectional survey of individuals given access to the HIE at participating organizations.


Dr. Gadd has been an Associate Professor of Biomedical Informatics and Director of Educational Programs in the Department of Biomedical Informatics at Vanderbilt University in Nashville, TN since 2005, following eight years at the Center for Biomedical Informatics at the University of Pittsburgh. Dr. Gadd earned her doctorate in Information Systems from the University of Pittsburgh in 1995 and her masters in Biomedical Engineering/Informatics from Duke University in 1998. Her primary areas of research are the development and evaluation of innovative approaches for biomedical informatics education and training to meet the needs of healthcare in the U.S. and globally; the implementation and evaluation of integrated clinical information systems, including electronic health records, health information exchanges, clinical documentation, and e-prescribing systems; and the evaluation of methods for increasing provider acceptance of information resources. She directs the Vanderbilt Biomedical Informatics Training Program, which is celebrating its 10th anniversary this year.