Overcoming Barriers to Expanding HIE
Health Information Exchange
Hospitals
Primary care
physician
Specialty physician
Ambulatory center (e.g.
imaging centers)
Payors
Pharmacy
Laboratory
Public health
Current system fragments patient information and creates redundant,
inefficient efforts
Future system will consolidate information and provide a foundation
for unifying efforts
Hospital
Data repository
Health Information Exchange
Network applications
Server
Payers
Labs
Outpatient RX
Physician office
Ambulatory centers Public health
Most Difficult Challenges for 42 Operational HIEs
Challenge
Very Difficult
Challenge
Moderately Difficult Challenge Total
Developing a sustainable business model 15 15 30
Addressing technical aspects including architecture, applications and connectivity 4 25 29
Defining the value that accrues to users 14 15 29
Engaging practicing clinicians in your coverage area 0 29 29
Addressing privacy and confidentiality issues - HIPAA and other 3 24 27
Securing upfront funding 10 16 26
eHealth Initiative2008 Survey on
Health Information Exchange
Center for Studying Health System Change. Creating Sustainable Local Health Information Exchanges: Can Barriers to Stakeholder Participation be Overcome? Research Brief No. 2, February 2008
HIE Barriers*
• Weigh benefits, upfront and ongoing costs of the business, legal and technical issues
• Concerns– Data will be used for marketing purposes– Patients will be redirected to other providers– Use of data for hospital performance measurement– HIE data policies would make them non-compliant
with federal patient privacy requirements• Balance competitive strategies with playing good
corporate citizen role*Center for Studying Health System Change.
Creating Sustainable Local Health Information Exchanges: Can Barriers to Stakeholder Participation be Overcome? Research Brief No. 2, February 2008
Block Randomized Sampling
Initial Sample
Total INPC
participant
Total previously contacted
Total not previously contacted
Small Hospitals
43 5 16 27
Small Physician Groups
39 0 0 39
Large Physician Groups
40 6 11 29
Survey and Interview Guide Development
• Literature review and brainstorming to identify potential barriers
• Expert review and feedback• Pilot with nine organizations• Revised survey• OMB review• Final survey
Data Collection(a) HIE description
and definition; (b) description of the
INPC,(c) Survey
information
Analytical Methods• A grounded theory approach will be used to identify
emergent themes• Grounded means “based on and connected to the context-
dependent observations and perceptions of the social scene;” so the informants’ own words will guide development of codes*
• Two individuals will independently review the field notes, annotating important themes in the margins
• Two other researchers will carefully review the documentation and note major themes
• The team will meet up to four times to reach consensus on identifying and naming the patterns and themes
*Crabtree BF, Miller WL. Doing Qualitative Research. Newbury Park, CA, Sage, 1992.
Rural Hospital Informant’s Words
• Rural hospital in Lawrence Co near Bloomington – Already have an interface from hospital system to their employed
physicians’ EMR which provides most of the benefit to be received from an HIE
– Costs– Physicians not thrilled with change
• Rural hospital in Gibson Co in southwest IN – Not sure they understand the difference between and EMR and HIE?– Need to upgrade bandwidth for communication– Need help financially (grants)– Need available IT staff– Older MDs want paper – need to be sold
Rural Hospital Informant’s Words
• Rural hospital between Ft Wayne and Muncie in Northwest IN– Not sure they understand difference between EMR and HIE– Bandwidth is the largest issue
Physician Informant’s Words
• Large specialty urban physician group in central IN– Physicians must see the benefit to THEM– MDs “hold data close”– Strategic IT projects are being addressed
• Large specialty urban physician group in central IN– No buy-in from the MDs
• Small specialty physician practice in southeastern IN– No buy-in from the MDs