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: 17.33). 04/2010; 170(7):622-9. DOI: 10.1001/archinternmed.2010.54
Source: PubMed


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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    • "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.
    No preview · Article · Mar 2015 · Information Systems Research
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    • "A study of nine organizations in the state of Colorado identified several hypothetically important HIE functions and means of facilitating adoption in small physician practices, including technical support and financial assistance [28]. A second study of nine primary-care practices in the state of Minnesota identified leadership and financial support as important facilitators of HIE adoption and use by small practices [35]. However both of these studies were conducted prior to the availability of HI-TECH Act incentives for HIE use. "
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    ABSTRACT: Background: Health information exchange (HIE) is an important tool for improving efficiency and quality and is required for providers to meet Meaningful Use certification from the United States Centers for Medicare and Medicaid Services. However widespread adoption and use of HIE has been difficult to achieve, especially in settings such as smaller-sized physician practices and federally qualified health centers (FQHCs). We assess electronic data exchange activities and identify barriers and benefits to HIE participation in two underserved settings. Methods: We conducted key-informant interviews with stakeholders at physician practices and health centers. Interviews were recorded, transcribed, and then coded in two waves: first using an open-coding approach and second using selective coding to identify themes that emerged across interviews, including barriers and facilitators to HIE adoption and use. Results: We interviewed 24 providers, administrators and office staff from 16 locations in two states. They identified barriers to HIE use at three levels-regional (e.g., lack of area-level exchanges; partner organizations), inter-organizational (e.g., strong relationships with exchange partners; achieving a critical mass of users), and intra-organizational (e.g., type of electronic medical record used; integration into organization's workflow). A major perceived benefit of HIE use was the improved care-coordination clinicians could provide to patients as a direct result of the HIE information. Utilization and perceived benefit of the exchange systems differed based on several practice- and clinic-level factors. Conclusions: The adoption and use of HIE in underserved settings appears to be impeded by regional, inter-organizational, and intra-organizational factors and facilitated by perceived benefits largely at the intra-organizational level. Stakeholders should consider factors both internal and external to their organization, focusing efforts in changing modifiable factors and tailoring HIE efforts based on all three categories of factors. Collective action between organizations may be needed to address inter-organizational and regional barriers. In the interest of facilitating HIE adoption and use, the impact of interventions at various levels on improving the use of electronic health data exchange should be tested.
    Full-text · Article · Sep 2014 · BMC Health Services Research
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