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Robert S. Rudin, SM, Steven R. Simon, MD, MPH, Lynn A. Volk, MHS, Micky Tripathi, PhD and David Bates, MD, MSc

At the time of the study, Robert S. Rudin was with Partners Healthcare System Inc, Boston, MA, and was a graduate student in the Engineering Systems Division, Massachusetts Institute of Technology, Cambridge, MA. Steven R. Simon is with the Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston. Lynn A. Volk is with Partners Healthcare System Inc, Boston. Micky Tripathi is with the Massachusetts eHealth Collaborative, Waltham, MA. David W. Bates is with Brigham and Women's Hospital, Boston, Partners Healthcare System Inc, Boston, and the Department of Medicine, Harvard Medical School, Boston.

Correspondence: Requests for reprints should be sent to Robert S. Rudin, SM, Massachusetts Institute of Technology, MIT CSAIL, 32 Vassar St #250, Cambridge, MA 02139 (e-mail: bobrudin{at}mit.edu).

Objectives. We studied how health information exchange systems are established by examining the decisions (and thus, indirectly, the values) of key stakeholders (health care providers) participating in a health information exchange pilot project in 3 Massachusetts communities. Our aim was to understand how these kinds of information exchanges can be made viable.

Methods. We used semistructured interviews to assess health care providers' decision-making processes in selecting technical architectures and vendors for the pilot projects to uncover their needs, expectations, and motivations.

Results. Our interviews indicated that, after extensive evaluations, health care providers in all 3 communities eventually selected a hybrid architecture that included a central data repository. However, the reasons for selecting this architecture varied considerably among the 3 communities, reflecting their particular values. Plans to create a community patient portal also differed across communities.

Conclusions. Our findings suggest that, to become established, health information exchange efforts must foster trust, appeal to strategic interests of the medical community as a whole, and meet stakeholder expectations of benefits from quality measurements and population health interventions. If health information exchange organizations cannot address these factors, sustainability will remain precarious.