Better than nothing, far from perfect: hospital and healthcare system leaders' perspectives on health information exchanges.

Objectives: Implementation and effective use of health information exchange (HIE) has the potential to transform health care and improve patient outcomes across the United States, yet HIEs remain underutilized nationally. The goal of this study was to develop an updated understanding of current barriers and facilitators to HIE implementation, adoption, and use from the perspective of hospital and healthcare leaders. Materials and Methods: Using semistructured interviews, hospital and healthcare leaders were recruited from 7 healthcare systems in Atlanta, GA. Recruitment ceased when saturation was reached. Interviews focused on current use of HIE at hospitals/healthcare systems, beliefs about the value of HIE to patients, clinicians, and health systems, barriers and facilitators of HIE implementation and use, and where HIE should go in the future. Thematic analysis was used to develop codes and group them into final themes. Results: Interviews were conducted with 20 hospital and healthcare system leaders; all hospitals used the same enterprise HIE, while some also participated in the state HIE or other HIEs. Five key themes were identified: HIEs are better than nothing, HIEs are far from perfect, policy determines HIE efficacy and useability, technological challenges, and future directions. Key subthemes included HIE-benefit patients/the health system; tensions between customization and standardization; system-/end-user-level barriers; patient understanding of HIE; government, institutional, and vendor policies; and data quality, security, and technological/training capacity. Conclusion: Participants identified numerous barriers that decrease the effectiveness of HIE, some of which are modifiable. As HIE becomes more widely available, attention must shift toward addressing the barriers and understanding the facilitators of HIE use at the point of care, rather than HIE implementation.