Participation by Primary Care Practices in Health Information Exchange (HIE) in Colorado

Widespread participation in health information exchange (HIE) is needed to optimize the value of health information technology (IT). While small-to-medium sized ambulatory practices, those with 20 or fewer clinicians, provide much of the Nation’s care, they are underrepresented in these projects. To increase adoption, HIE’s value proposition in these settings must be thoroughly understood. This project researched the perspectives of clinical and administrative leaders in small-to-medium sized ambulatory practices regarding their desired HIE functions, key motivators for adopting HIE, barriers to adoption, and potential incentives for adoption. Mixed quantitative and qualitative methods were used with a case study approach.  Nine practices in Colorado participated: three that used paper records only ("NO-EMR"), two that used an electronic medical record (EMR) only ("EMR-ONLY"), and four that participated in a community-wide HIE ("CW HIE"). Of the four CW HIE practices, two used paper records, and two used an EMR.

The main objectives of the project were to:

• Develop a report using published research and commentary on factors influencing stakeholder participation in community-wide HIE.
• Collect and analyze qualitative and quantitative data from nine primary care practices in three categories ("NO-EMR," "EMR-ONLY," and "CW HIE") to assess perceived benefits of, readiness to engage in, and barriers to HIE participation.
• Based on this analysis, determine the relative strengths and weaknesses of different strategies for encouraging small- to medium-sized practices to participate in HIE.

The analysis showed that practices want HIEs to have the function of allowing users to look up test results anywhere and at any time, and to consolidate the delivery of results. The least desired function was HIE-generated quality reporting. Practices were motivated to adopt HIE in order to improve the quality and efficiency of care and those practices with strong professional and social networks appeared to be the most favorable settings for adoption. The groups indicated that technical assistance and support during and after implementation would be the greatest facilitator of adoption. While indicating that they would find financial incentives valuable, the practices did not anticipate financial gains from adoption. Trust of HIE partners was cited as a major issue.  The project team concluded that these findings will be of use to policymakers in their promotion of HIE among small-to-medium sized ambulatory practices.