Differing Strategies to Meet Information-Sharing Needs: Publicly Supported Community Health Information Exchanges Versus Health Systems' Enterprise Health Information Exchanges

Context: The United States has invested billions of dollars to encourage the adoption of and implement the information technologies necessary for health information exchange (HIE), enabling providers to efficiently and effectively share patient information with other providers. Health care providers...

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Bibliographic Details
Published in:	The Milbank quarterly Vol. 94; no. 1; pp. 77 - 108
Main Authors:	VEST, JOSHUA R., KASH, BITA A.
Format:	Journal Article
Language:	English
Published:	United States Blackwell Publishing Ltd 01.03.2016 Milbank Memorial Fund John Wiley and Sons Inc
Subjects:	Adoption of innovations Approaches Attitude of Health Personnel Biomedical technology Community Community health Community Health Services - methods Community Health Services - organization & administration Community Health Services - standards Community involvement Community participation Community structure Comparative analysis Computerized medical records Consumer health information Content clouds Data exchange Electronic health records Electronic Health Records - organization & administration Electronic Health Records - standards Executives Financing Funding Health care Health care expenditures Health care industry Health care organizations Health care policy Health information health information exchange Health Information Exchange - standards health information systems Health initiatives Health planning Health Policy Health promotion Health records Health services Hospitals Humans Information dissemination Information Dissemination - methods Information resources Information sharing Information systems Information technology integrated delivery systems Interfaces Interoperability Interviews as Topic Leadership Medical Informatics - methods Medical Informatics - organization & administration Medical Informatics - standards Medical personnel Medical records Money Networks Observer Variation Original Investigation Original Investigations Participation Patient information Patients Physicians Policy making Population policy Private networks Public good Public investment Qualitative analysis Qualitative Research Referrals Regulation Semistructured interviews Sharing Social networks Sustainability Technology Trading United States Vendors Vests United States United States > US health information exchange health information systems qualitative research integrated delivery systems
ISSN:	0887-378X, 1468-0009
Online Access:	Get full text
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Summary:	Context: The United States has invested billions of dollars to encourage the adoption of and implement the information technologies necessary for health information exchange (HIE), enabling providers to efficiently and effectively share patient information with other providers. Health care providers now have multiple options for obtaining and sharing patient information. Community HIEs facilitate information sharing for a broad group of providers within a region. Enterprise HIEs are operated by health systems and share information among affiliated hospitals and providers. We sought to identify why hospitals and health systems choose either to participate in community HIEs or to establish enterprise HIEs. Methods: We conducted semistructured interviews with 40 policymakers, community and enterprise HIE leaders, and health care executives from 19 different organizations. Our qualitative analysis used a general inductive and comparative approach to identify factors influencing participation in, and the success of, each approach to HIE. Findings: Enterprise HIEs support health systems' strategic goals through the control of an information technology network consisting of desired trading partners. Community HIEs support obtaining patient information from the broadest set of providers, but with more dispersed benefits to all participants, the community, and patients. Although not an either/or decision, community and enterprise HIEs compete for finite organizational resources like time, skilled staff, and money. Both approaches face challenges due to vendor costs and lessthan-interoperable technology. Conclusions: Both community and enterprise HIEs support aggregating clinical data and following patients across settings. Although they can be complementary, community and enterprise HIEs nonetheless compete for providers' attention and organizational resources. Health policymakers might try to encourage the type of widespread information exchange pursued by community HIEs, but the business case for enterprise HIEs clearly is stronger. The sustainability of a community HIE, potentially a public good, may necessitate ongoing public funding and supportive regulation.
Bibliography:	ark:/67375/WNG-TD065TQG-Q istex:545CAE0BEA32FE501B27AB8DEADC669F64C1BB18 ArticleID:MILQ12180 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23
ISSN:	0887-378X 1468-0009
DOI:	10.1111/1468-0009.12180