1. Overcoming Barriers to Expanding HIE

2. Health Information Exchange Hospita ls 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 Payers Labs Outpatient RX Physician office Ambulatory centersPublic health

3. Most Difficult Challenges for 42 Operational HIEs Challenge Very Difficult Challenge Moderately Difficult ChallengeTotal Developing a sustainable business model15 30 Addressing technical aspects including architecture, applications and connectivity42529 Defining the value that accrues to users141529 Engaging practicing clinicians in your coverage area029 Addressing privacy and confidentiality issues - HIPAA and other32427 Securing upfront funding101626 eHealth Initiative 2008 Survey on Health Information Exchange

4. 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

5. 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

6. © Regenstrief Institute, Inc.

7. Block Randomized Sampling Initial Sample Total INPC participant Total previously contacted Total not previously contacted Small Hospitals 4351627 Small Physician Groups 3900 Large Physician Groups 4061129

8. 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

9. Data Collection Telephone Contact E-mail packet Web Survey Telephone Interview (a)HIE description and definition; (b)description of the INPC, (c)Survey information

11. 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.

12. 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

13. 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

14. 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

15. 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