Robert S. Rudin ^1*, Steven R. Simon ², Lynn A. Volk ³, Micky Tripathi ⁴, David Bates ⁵

¹ Massachusetts Institute of Technology
² Harvard Medical School and Harvard Pilgrim Health Care
³ Partners HealthCare System
⁴ Massachusetts eHealth Collaborative
⁵ Harvard Medical School and Harvard School of Public Health

^* To whom correspondence should be addressed. E-mail: bobrudin{at}mit.edu.

	Abstract

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.

Key Words: Health Policy, Quality of Care, Public Health Practice, Qualitative Research, Surveillance