Health information exchange: Participation by Minnesota primary care practices

Department of Family Medicine and Community Health, Medical School, University of Minnesota, Minneapolis, MN 55455, USA.
Archives of internal medicine (Impact Factor: 13.25). 04/2010; 170(7):622-9. DOI: 10.1001/archinternmed.2010.54
Source: PubMed

ABSTRACT The American Recovery and Reinvestment Act of 2009 will provide $36 billion to promote electronic health records and the formation of regional centers that foster community-wide electronic health information exchange (HIE) with the ultimate goal of a nationwide health information network. Minnesota's e-Health Law, passed in 2007, mandates electronic health record and HIE participation by all clinics and hospitals. To achieve these goals, small primary care practices must participate. Factors that motivate or prevent them from doing so are examined.
From November 10, 2008, through February 20, 2009, we gathered data (through questionnaires and interviews) from 9 primary care practices in Minnesota with fewer than 20 physicians and with varying degrees of electronic health records and HIE involvement.
No practice was fully involved in a regional HIE, and HIE was not part of most practices' short-term strategic plans. External motivators for HIE included state and federal mandates, payer incentives, and increasing expectations for quality reporting. Internal motivators were anticipated cost savings, quality, patient safety, and efficiency. The most frequently cited barriers were lack of interoperability, cost, lack of buy-in for a shared HIE vision, security and privacy, and limited technical infrastructure and support.
Currently, small practices do not have the means or motivation to fully participate in regional HIEs, but many are exchanging health data in piecemeal arrangements with stakeholders with whom they are not directly competing for patients. To achieve more comprehensive HIE, regional health information organizations must provide leadership and financial incentives for community-wide meaningful use of interoperable electronic health records.

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Available from: Therese Zink, Aug 15, 2015
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    • "Previous research reveals different barriers to HIE expansion. These barriers include financial factors (Fontaine et al. 2010), competition between healthcare providers (Grossman et al. 2006), lack of stakeholder buy-in (Malepati et al. 2007), distrust in other HIE members (Ross et al. 2010), and security concerns (Edwards et al. 2010). Although these studies shed light on our understanding of HIE diffusion, significant lacunae exist in this body of literature. "
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    ABSTRACT: Health Information Exchanges (HIE) are becoming integral parts of the national healthcare reform efforts, chiefly because of their potential impact on cost reduction and quality enhancement in healthcare services. However, the potential of an HIE platform can only be realized when its multiple constituent users actively participate in using its variety of services. In this research, we model HIE systems as multisided platforms that incorporate self-service technologies whose value to the users depends on both user-specific and network-specific factors. We develop a model of adoption, use, and involvement of clinical practices in the coproduction of the HIE services. This model is grounded in social network theory, service operations theory, and institutional isomorphism theory. A longitudinal study of actual adoption and use behaviors of 2,054 physicians within 430 community medical practices in Western New York over a three-year period has been carried out to evaluate the proposed model. This study has been supported by HEALTHeLINK, the Regional Health Information Organization of Western New York, which has an extensive database comprising over half a million transactions on patient records by the HIE users. We extracted panel data on adoption, use, and service coproduction behaviors from this database and carried out a detailed analysis using metrics derived from the foundational theories. Positioning practices within two distinct but interrelated networks of patients and practitioners, we show that adoption, use, and service coproduction behaviors are influenced by the topographies of the two networks, isomorphic effects of large practices on the smaller ones, and practice labor inputs in HIE use. Our findings provide a comprehensive view of the drivers of HIE adoption and use at the level of medical practices. These results have implications for marketing and revenue management of HIE platforms, as well as public health and national/regional healthcare policy making.
    Information Systems Research 03/2015; 26(1):1-18. DOI:10.1287/isre.2014.0547 · 2.15 Impact Factor
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    ABSTRACT: Health information exchange (HIE) - the electronic exchange of health information among healthcare institutions - has been projected to hold enormous promise as an antidote to the fragmented healthcare delivery system in the United States. After decades of mostly failed attempts, we still do not know how to make HIE work. This thesis is the beginning of a systematic understanding of HIE, focusing on the clinical users and the context in which the users and the technology interact. It uses a systems approach to understand HIE from the perspectives of the core stakeholders including healthcare providers, patients, health IT vendor companies, public policy, and the HIE organizations that supply data exchange services. The core contributions of the thesis are contained in four studies. Values of healthcare providers as stakeholders in HIE In a stud y of three communities, healthcare provider organizations were found to expect regional HIE organizations to bring them benefits from the ability to measure care quality. However, one relatively larger community placed greater value on the strategic interests of its individual provider institutions, whereas two smaller communities valued the interests of the communities as a whole. Factors that affect clinicians' usage of HIE. In a study of clinician-users of an operational HIE, usage factors were categorized as motivators and moderators. Motivators for individual clinicians' usage of HIE included improving care quality and time savings. Moderators were numerous and included gaps in data, workflow complexity and usability issues. Several policy options and implications are discussed including: requiring HIE organizations to report metrics of HIE contributions and accesses; certifying HIE vendor companies to provide standardized usage metrics; and creating incentives for clinicians as well as HIE organizations and regional health IT extension centers to meet HIE usage targets. Analysis of opportunities to use HIE. In one community, 51% of visits involved "care transitions" among individual providers, and 36-41% involved care transitions between medical groups. The percentage of a provider's visits which involved care transitions varied considerably by clinical specialty and even within specialties. Within primary care, individual clinicians' "transition percentages" varied from 32% to 95%. This study discusses how policies designed to foster HIE usage should take this variation into account. Analysis of mergers and provider recruitment on HIE value. In a simulation study of patient visit patterns in 10 communities, the results suggest that even after substantial consolidation of medical groups, an HIE would still have considerable value as measured by the number of opportunities for data exchange. However, in each community a small number of medical groups were key: if absent from a community HIE, these groups would reduce the value by 50%. Conversely, if they were the only groups participating, the HIE's value would only achieve 10-20% of its value with all groups participating. The results of these studies suggest that HIE will be needed even in the event of the expected large-scale consolidation of healthcare providers. However, efforts will be needed to recruit medical groups to join HIE organizations, to improve HIE technology, and to train clinicians to integrate HIE into their workflows.
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