Sue S Feldman*, Central Virginia Health Network, University of South Carolina, Richmond, United States Benjamin L. Schooley, University of South Carolina, Columbia, United States Grishma Patel Bhavsar, University of South Carolina, Columbia, United States Track: Research Presentation Topic: Consumer empowerment, patient-physician relationship, and sociotechnical issues Presentation Type: Poster presentation Submission Type: Single Presentation Last modified: 2014-07-21

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Background: Much attention has been given to the proposition that the exchange of health information as an act, and Health Information Exchange (HIE), as an entity, are critical components of a framework for healthcare change, yet little has been studied to understand the value proposition of implementing health information exchange with a statewide HIE. Such an organization facilitates the exchange of health information across disparate systems, thus following patients as they move across different care settings and encounters, whether or not they share an organizational affiliation. A socio-technical systems approach and an interorganizational systems framework were used to examine implementation of a hospital system onto a statewide HIE, under a cooperative agreement with the Office of the National Coordinator for Health Information Technology, and its collaborating organizations.
Objective: This case study focuses on the implementation of a hospital system onto a statewide HIE. The goal is to understand the organizational motivations and value propositions apparent during HIE implementation. The objective is to provide insight into the technical, organizational, and governance aspects of a large private health system and the Virginia statewide HIE, organizations with the shared goal of exchanging health information.
Methods: This study used a formative evaluation methodology to investigate the first implementation of a hospital system onto the statewide HIE. Qualitative methods (direct observation (36 hours), informal information gathering, semi-structured interviews (N=12), and document analysis were used to gather data between August 12, 2012 and June 24, 2013. Derived from socio-technical concepts, a Blended Value Collaboration Enactment Framework guided the data gathering and analysis to understand organizational stakeholders’ perspectives across technical, organizational, and governance dimensions.
Results: This case study illuminated several challenges, successes, and lessons learned during the implementation of a hospital system to the statewide HIE. In terms of challenges, unread guides led to stakeholders who were unclear as to expectations and certain policies. The most significant perceived success was accomplishing the implementation, although many interviewees also underscored the value of a project champion with decision-making power. In terms of lessons learned, social reasons were found to be very significant motivators for early implementation, frequently outweighing economic motivations. It was clear that understanding the guides early in the project would have mitigated some of the challenges that emerged. Also critical was early communication with the electronic health record vendor so that they have a solid understanding of the undertaking. A framework for evaluating HIE implementations was found to be useful for assessing challenges, motivations, value propositions for participating, and success factors to consider for future implementations.
Conclusions: This case study illuminates five critical success factors for implementation of a hospital system onto a statewide HIE. Such factors include, understanding roles and resources, early vendor communication, understanding guides, involving the right people, and early identification of a projection champion. This study also reveals that organizations have varied motivations and value proposition perceptions for engaging in the exchange of health information – few of which, at this early stage, are economically driven.