Understanding the Impact of Health Information Exchange Technology: Lessons From the MidSouth Ehealth Alliance

The emergence of health information technology (HIT) to support health information exchange (HIE) provides opportunities for improving healthcare cost and quality. However, workflow and context-specific factors complicate the introduction of a regional HIE system across multiple organizations and practice environments. Differences among organizational policies, cultures, work practices, and environments can create difficulties in transferring HIT implementations among clinical sites. Systems that work well in one type of setting, such as an emergency department, may conflict with workflow needs in other practice settings, such as ambulatory care. Designing a technology system to accommodate workflow needs across institutions and environments poses a daunting challenge. Using setting-specific knowledge to customize technology implementations may offer a solution to the challenges of integration and diffusion. This presentation discusses preliminary results of one portion of an ongoing multi-level evaluation of the MidSouth eHealth Alliance (MSeHA), a functioning state-of-the-art RHIO in southwestern Tennessee. This study focuses on how clinical workflow interacts with the HIE system. Three research questions motivated this study: 1. What types of categories (e.g. role, clinical context) describe workflow patterns in HIE-enabled environments? 2. How does HIE fit into the workflow of providers at different sites? What are the barriers and facilitators to its use? 3. What technological frames, or perspectives on technology, describe how end users view the HIE system compared across user groups, sites, and organizations? The presentation will explore issues surrounding implementation approaches, adoption and adaptation to HIE technology, factors relating to trust of patients and data, and contextual barriers and facilitators for health information exchange. Lessons learned in the MSeHA evaluation can be applied to other regional and national information exchange efforts to guide implementation and to promote adoption.