Objective: Health information exchange (HIE) involves sharing information across organizations. Effective HIE gives providers across organizations a comprehensive view of the patient that can improve the accuracy of health information to support clinical care. We sought to understand how grantees funded by the Centers for Medicare and Medicaid Services Health Care Innovation Awards used HIE for community resource planning. We also sought to identify barriers and facilitators influencing the use of HIE within these interventions.
Methods: We analyzed three years of data collected in the course of the grant program, including progress reports, site visits, and notes from telephone interviews. We uploaded documentary data into qualitative analysis software, coded the data according to a literature-based codebook, and identified themes relevant to interoperability and to barriers and facilitators for HIE. Coders achieved a final kappa of 0.8, suggesting excellent interrater reliability.
Results: We found that community-based interventions required attention to HIE at the community (e.g., public health) and organizational (e.g., hospitals, laboratories, doctor’s offices) levels. Systems and processes included methods for incorporating information from HIE, managing errors, and staffing. At the community level, implementation guides and standard definitions were key components of guidance. At the organizational level, process and technical factors including stakeholder engagement, interoperability, and data standards affected HIE use.
Discussion and Conclusion: HIE can connect organizations in a community so that healthcare workers can share patient information to support coordinated care. However, communities must overcome challenges such as the impact of HIE on workflow and the variation of data standards across organizations to effectively use HIE. Planning for technical, organizational, and governance factors is required to realize the benefits of HIE in community interventions.
