Understanding the decisions and values of stakeholders in health information exchanges: experiences from Massachusetts

Am J Public Health. 2009 May;99(5):950-5. doi: 10.2105/AJPH.2008.144873. Epub 2009 Mar 19.


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.

MeSH terms

  • Access to Information
  • Decision Making*
  • Health Personnel*
  • Hospital Information Systems / organization & administration*
  • Hospital Information Systems / statistics & numerical data
  • Humans
  • Massachusetts
  • Medical Informatics / statistics & numerical data*
  • Medical Records Systems, Computerized / organization & administration*
  • Medical Records Systems, Computerized / statistics & numerical data
  • Pilot Projects
  • Quality of Health Care
  • Social Values*
  • Surveys and Questionnaires