Abstract
This study examines factors facilitating and delaying participation and use of the Health Information Exchange (HIE) in Louisiana. Semi-structured qualitative interviews were conducted with health care representatives throughout the state. Findings suggest that Meaningful Use requirements are a critical factor influencing the decision to participate in the HIE, specifically the mandate that hospitals be able to electronically transfer summary of care documents. Creating buy-in within a few large hospital networks legitimized the HIE and hastened interest in those markets. Fees charged by electronic health record (EHR) vendors to develop HIE interfaces have been prohibitive. Funding from the federal incentive program is intended to offset the costs associated with EHR implementation and increase the likelihood that HIEs can provide value to the population; however, costs and time delays of EHR interface development may be key barriers to fully integrated HIEs. State HIEs may benefit from targeted involvement of state health care leaders who can champion the potential value of the HIE.
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Blumenthal, D., Launching HITECH. N. Engl. J. Med. 362:382–5, 2010.
Williams, C., Mostashari, F., Mertz, K., Hogin, E., and Atwal, P., From the office of the national coordinator: the strategy for advancing the exchange of health information. Health Aff. (Millwood) 31:527–36, 2012.
Blumenthal, D., and Tavenner, M., The “meaningful use” regulation for electronic health records. N. Engl. J. Med. 363:501–4, 2010.
Adler-Milstein, J., Bates, D. W., and Jha, A. K., Operational health information exchanges show substantial growth, but long-term funding remains a concern. Health Aff. (Millwood) 32:1486–92, 2013.
Gold, M. R., McLaughlin, C. G., Devers, K. J., Berenson, R. A., and Bovbjerg, R. R., Obtaining providers’ ‘buy-in’ and establishing effective means of information exchange will be critical to HITECH’s success. Health Aff. (Millwood) 31:514–26, 2012.
Furukawa, M. F., Patel, V., Charles, D., Swain, M., and Mostashari, F., Hospital electronic health information exchange grew substantially in 2008–12. Health Aff. (Millwood) 32:1346–54, 2013.
Johnson, K. B., Unertl, K. M., Chen, Q., Lorenzi, N. M., Nian, H., Bailey, J., et al., Health information exchange usage in emergency departments and clinics: the who, what, and why. J. Am. Med. Inform. Assoc. 18:690–7, 2011.
Vest, J. R., Jasperson, S., Zhao, H., Gamm, L. D., and Ohsfeldt, R. L., Use of a health information exchange system in the emergency care of children. BMC Med. Inform. Decis. Making 11:78, 2011.
Vest, J. R., Zhao, H., Jasperson, J., Gamm, L. D., and Ohsfeldt, R. L., Factors motivating and affecting health information exchange usage. J. Am. Med. Inform. Assoc. 18:143–9, 2011.
Vest, J. R., and Jasperson, S., How are health professionals using health information exchange systems? Measuring usage for evaluation and system improvement. J. Med. Syst. 36:3195–204, 2012.
Patel, V., Abramson, E. L., Edwards, A., Malhotra, S., and Kaushal, R., Physicians’ potential use and preferences related to health information exchange. Int. J. Med. Inform. 80:171–80, 2011.
Pevnick, J. M., Claver, M., Dobalian, A., Asch, S. M., Stutman, H. R., Tomines, A., et al., Provider stakeholders’ perceived benefit from a nascent health information exchange: a qualitative analysis. J. Med. Syst. 36:601–13, 2012.
Ross, S. E., Schilling, L. M., Fernald, D. H., Davidson, A. J., and West, D. R., Health information exchange in small-to-medium sized family medicine practices: motivators, barriers, and potential facilitators of adoption. Int. J. Med. Inform. 79:123–9, 2010.
Vest, J. R., More than just a question of technology: factors related to hospitals’ adoption and implementation of health information exchange. Int. J. Med. Inform. 79:797–806, 2010.
Adler-Milstein, J., DesRoches, C. M., and Jha, A. K., Health information exchange among US hospitals. Am. J. Manag. Care 17:761–8, 2011.
Unertl, K. M., Johnson, K. B., and Lorenzi, N. M., Health information exchange technology on the front lines of healthcare: workflow factors and patterns of use. J. Am. Med. Inform. Assoc. 19:392–400, 2012.
Magnus, M., Herwehe, J., Gruber, D., Wilbright, W., Shepard, E., Abrams, A., et al., Improved HIV-related outcomes associated with implementation of a novel public health information exchange. Int. J. Med. Inform. 81:e30–8, 2012.
Rudin, R. S., Volk, L., Simon, S., and Bates, D., What affects Clinicians’ usage of health information exchange? Appl. Clin. Inform. 2:250–62, 2011.
Herwehe, J., Wilbright, W., Abrams, A., Bergson, S., Foxhood, J., Kaiser, M., et al., Implementation of an innovative, integrated electronic medical record (EMR) and public health information exchange for HIV/AIDS. J. Am. Med. Inform. Assoc. 19:448–52, 2012.
Glaser, B. G., and Strauss, A. L., The discovery of grounded theory: strategies for qualitative research. Aldine, Chicago, 1967.
Wright, A., Soran, C., Jenter, C. A., Volk, L. A., Bates, D. W., and Simon, S. R., Physician attitudes toward health information exchange: results of a statewide survey. J. Am. Med. Inform. Assoc. 17:66–70, 2010.
Bailey, J. E., Wan, J. Y., Mabry, L. M., Landy, S. H., Pope, R. A., Waters, T. M., et al., Does health information exchange reduce unnecessary neuroimaging and improve quality of headache care in the emergency department? J. Gen. Intern. Med. 28:176–83, 2013.
Frisse, M. E., Johnson, K. B., Nian, H., Davison, C. L., Gadd, C. S., Unertl, K. M., et al., The financial impact of health information exchange on emergency department care. J. Am. Med. Inform. Assoc. 19:328–33, 2012.
Tzeel, A., Lawnicki, V., and PEemble, K. R., The business case for payer support of a community based health information exchange: a Humana pilot evaluating its effectiveness in cost control for plan members seeking emergency department care. Am. Health Drug Benefits 4:207–15, 2011.
Edwards, A., Hollin, I., Barry, J., and Kachnowski, S., Barriers to cross–institutional health information exchange: a literature review. J. Healthc. Inf. Manag. 24:22–34, 2010.
Clayton, P. D., Narus, S. P., Huff, S. M., Pryor, T. A., Haug, P. J., Larkin, T., et al., Building a comprehensive clinical information system from components. The approach at intermountain health care. Methods Inf. Med. 42:1–7, 2003.
Paulus, R. A., Davis, K., and Steele, G. D., Continuous innovation in health care: implications of the Geisinger experience. Health Aff. (Millwood) 27:1235–45, 2008.
Buntin, M. B., Burke, M. F., Hoaglin, M. C., and Blumenthal, D., The benefits of health information technology: a review of the recent literature shows predominantly positive results. Health Aff. (Millwood) 30:464–71, 2011.
McClellan, M., McKethan, A. N., Lewis, J. L., Roski, J., and Fisher, E. S., A national strategy to put accountable care into practice. Health Aff. (Millwood) 29:982–90, 2010.
Vest, J. R., Campion, T. R., Jr., Kaushal, R., and Investigators, H., Challenges, alternatives, and paths to sustainability for health information exchange efforts. J. Med. Syst. 37:9987, 2013.
Miller, R. H., Satisfying patient-consumer principles for health information exchange: evidence from California case studies. Health Aff. (Millwood) 31:537–47, 2012.
Tripathi, M., Delano, D., Lund, B., and Rudolph, L., Engaging patients for health information exchange. Health Aff. (Millwood) 28:435–43, 2009.
Dimitropoulos, L., and Rizk, S., A state-based approach to privacy and security for interoperable health information exchange. Health Aff. (Millwood) 28:428–34, 2009.
Nembhard, I. M., All teach, all learn, all improve?: the role of interorganizational learning in quality improvement collaboratives. Health Care Manag. Rev. 37:154–64, 2012.
Acknowledgments
The Louisiana Health Care Quality Forum (LHCQF), a nonprofit entity comprised of a diverse group of stakeholders across the Louisiana healthcare delivery and public health sectors, was awarded a grant in 2010 from the Office of the National Coordinator (ONC) to implement a statewide Health Information Exchange in Louisiana (LaHIE). The authors of this paper were contracted with funds from this grant to provide an external evaluation of these efforts. Findings from this evaluation are included in this paper.
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The authors declare that they have no conflicts of interest to report.
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This article is part of the Topical Collection on Systems-Level Quality Improvement
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Yeager, V.A., Walker, D., Cole, E. et al. Factors Related to Health Information Exchange Participation and Use. J Med Syst 38, 78 (2014). https://doi.org/10.1007/s10916-014-0078-1
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DOI: https://doi.org/10.1007/s10916-014-0078-1