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

© Regenstrief Institute, Inc.

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

Non-barriers

• Concerns about how their data will be used among hospitals– Competitive positioning– For quality measurement– For payment negotiations

• Patient privacy• Critical mass of data