Using a Mixed Methods Approach to Understand Health Information Exchange Adoption From a Multilevel Perspective

• In Event: Using Mixed Methods in Translational Research: Methodological Advantages and Practical Applications

Abstract

As health care organizations are challenged to improve quality of care while containing costs, sharing information among various providers must become an essential practice. Many countries are adopting policies to foster Health Information Exchange (HIE), which is defined as the electronic transfer of data or information among health care organizations involved in the delivery of care. HIE is a complex phenomenon, and the literature reports contradictory evidence regarding its adoption and use in practice. This study aimed at investigating what factors affect HIE and its implementation in health care systems using a multilevel perspective (international, national, organizational). To successfully perform multilevel research with the purpose of enhancing knowledge translation, researchers need to integrate quantitative and qualitative methodologies to explore the studied phenomenon adequately. Therefore, this study adopted a mixed methods methodology, using a multi-phase sequential design.

Focusing on the international perspective, policy and the experiences surrounding the adoption of HIE in one country can be explained more comprehensively through a comparison of countries that have adopted similar policies. The goal of the first study phase was to identify a taxonomy of health systems and institutional and resource-based factors related to HIE adoption, and to understand how they differ in three main types of health systems. From an extensive comparative literature review, different factors were found to have similar and different influences on HIE, based on the type of health system. These factors were further tested in the second, quantitative phase to examine the relationship between the need for information, one of the factors identified to be common to all health systems, and HIE in the context of bundled payment reimbursement in the United States. Specifically, when hospitals participate in bundled payment models, it is necessary for them to collaborate with other providers to maximize reimbursement; hence they show a greater need for information. Two datasets of the American Hospital Association (AHA) were used: the Annual Survey and the IT supplement. Results revealed a significant association between participating in bundled payment models and HIE adoption, but did not provide support for a wider range of providers from which the hospital receives information or for a greater volume of information shared through HIE.

To better understand the results regarding national trends in HIE adoption, the third, qualitative phase explored what factors are relevant at the organizational level and how they influence HIE adoption in seven health care systems selected based on the quantitative results. Data sources included interviews with hospital administrators and open-ended comments from the AHA Annual Survey. The qualitative analysis revealed that internal factors such as trust, leadership, organizational culture, power, organization’s behavior, and technological readiness influence hospital’s use of HIE. The integrated conclusions from three study phases revealed multiple factors and their varied influences on HIE adoption across different health care systems. It also confirmed the necessity to perform mixed methods multilevel research to obtain a comprehensive understanding of complex phenomena such as HIE adoption and to enhance translation of evidence-based practice in improving health care access and cost.

Author

• Claudia Guerrazzi, Widener University