Module 8: Health Information Technology and Health Information Exchange (HIT/HIE)

Multi-stakeholder Community Inventory Modules

Community quality collaboratives are community-based organizations of multiple stakeholders, including health care providers, purchasers (employers, employer coalitions, Medicaid and others), health plans, and consumer advocacy organizations, that are working together to transform health care at the local level. The Agency for Healthcare Research and Quality offers these organizations many tools to assist in their efforts.

Your Goals in This Inquiry

  • Identify the Health Information Technology/Health Information Exchange (HIT/HIE) initiatives, their status, and results.
  • Identify if any local initiatives have used health IT or HIE to measure and report on the quality and cost of care.
  • Assess whether there is a common HIT/HIE vision and strategy across multiple stakeholders, the degree of "buy-in," and awareness of this vision.
  • Assess the degree of involvement and consideration for diverse stakeholders including health systems, physicians, labs, pharmacies, health plans, public health agencies, QIOs, local HIE organizations or initiatives, and consumers.
  • Brainstorm with the individuals contacted about how a coordinated and aligned HIT/HIE strategy and initiatives could be developed and accelerated.
  • Brainstorm with individuals contacted about how HIT/HIE could support achieving goals in the Community Quality Collaborative's other focus areas.
  • Identify individuals, resources, and expertise that can be used to build knowledge and support related to HIT/HIE in your community.
  • Identify groups that may have unique challenges in adopting HIT/HIE.
  • Identify what their organization could contribute to such an effort, and explore their interest and willingness to support the Community Quality Collaborative in its goals.

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Information You May Want to Gather

  • State legislation, executive orders, and regulations related to HIT/HIE.
  • Recipients of AHRQ HIT grant funding in your State
  • Recipients of funding from other Federal agencies related to HIT/HIE such as health information network (HIN) development, EHR adoption, CDC public health surveillance, or others.
  • Recipients of funding from state or regional agencies related to HIT/HIE.
  • Communitywide initiatives related to HIT/HIE.
  • Key sponsors of any local HIT/HIE initiatives.
  • Status of local QIO's Doctor's Office Quality — Information Technology (DOQ—IT)program and progress.
  • Market analyses of provider adoption of electronic health records (EHRs).
  • Position of purchasers, private employers, Medicaid, and business coalitions related to HIT/HIE.
  • Health plans' initiatives related to adoption of HIT/HIE such as pay-for-performance programs for adoption and use, subsidizing purchase of technology, or financial support for purchase of and training on software.
  • Public health agencies' activities such as disease and immunization registries, immunizations.
  • Initiatives focused on developing a health information exchange (HIE) or regional health information organization (RHIO).
  • Details on specific HIT/HIE initiatives that warrant further inquiry.

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Key Individuals to Contact

  • Recipients of AHRQ HIT grant funding in your State.
  • Health care systems, physician groups, hospitals, IPAs who have implemented HIT/HIE programs or have been leaders in this area.
  • Health plan representatives who have initiated or supported HIT/HIE initiatives.
  • Purchasers including public and private employers, and business coalitions who have an interest in accelerating adoption of HIT/HIE.
  • Consumer advocacy groups with strong positions related to HIT/HIE including privacy, security, and confidentiality of electronic health information.
  • Individuals within QIOs responsible for local DOQ-IT initiatives.

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Other Individuals to Consider Contacting

  • Academic institutions' health informatics departments.
  • State medical associations or specialty societies, particularly for family medicine and internal medicine.
  • Hospital associations.
  • State government regulators responsible for implementing and regulating initiatives related to HIT/HIE.
  • Key local vendors or suppliers of products and services related to HIT/HIE.
  • Medical group management organizations.
  • Local organizations or programs related to HIT/HIE, e.g., Health Information Management Systems Society (HIMSS).

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Suggested Questions

Communitywide Efforts to Build HIT/HIE Initiatives

  • Have there been coordinated, aligned, communitywide efforts, strategies, or plans related to HIT/HIE across multiple stakeholders in your community?
  • What are the goals of these initiatives and status of these goals?
  • Do any of the goals enable measurement of quality or cost of care?
  • Are there obstacles preventing them from proceeding? If so, what are they?
  • What would make them more successful?
  • Who are the key players and what are their capabilities and contributions?
  • If applicable, are rural areas included in HIT/HIE activities?
  • Are there geographic issues, such as distances, multiple market service areas, local jurisdictions, or other boundaries, that may pose challenges to implementing HIT/HIE?
  • Do you see any individual stakeholder as dominating this initiative, for example, purchasers, providers, or health plans? If so, how might that impede or support the Community Quality Collaborative's goals in building HIT/HIE strategy?

Stakeholder-Specific Efforts to Build HIT/HIE Initiatives

  • What HIT/HIE initiatives are currently underway in your organization and stakeholder group?
  • What is the focus of your HIT/HIE initiative and how was it determined?
  • Do you have quantifiable goals for your initiatives and if so, what are they?
  • What are the qualitative goals of your initiatives?
  • What have been the results of your initiatives?
  • Do your organization and stakeholders' goals include consumer engagement through the use of Personal Health Records (PHRs) or other means?
  • Do your organization and stakeholders provide or endorse incentives for provider adoption of HIT?
  • Do your organization and stakeholders consider the role of health plans in your HIT/HIE goals?
  • Do your organization and stakeholders support the adoption of national standards in order to accelerate interoperability?
  • Are there significant concerns about privacy and security that may impede progress in HIT/HIE?
  • What are your goals and plans for the future re: HIT/HIE?
  • Within your organization, who are the key individuals in HIT/HIE initiatives and what are their roles?
  • What have you and others in your organization and stakeholder group done to coordinate and align HIT/HIE efforts across multiple organizations?
  • How do you see HIT/HIE supporting the Community Quality Collaborative's work in the other focus areas?
  • Are there specific actions that should be taken to develop strategies, align efforts, or access resources to support the other focus areas?
  • Who in your organization should be involved in the Community Quality Collaborative?

Future Community Quality Collaborative Efforts to Build HIT/HIE Initiatives

  • What could your organization contribute to the Community Quality Collaborative?
  • How do you and your organization envision being involved in the goals of the Community Quality Collaborative?
  • What opportunities do you see for accelerating adoption of HIT/HIE to improve quality, such as linking disparate efforts, creating synergies across efforts, etc.?
  • Who else in the community would you recommend we contact for this inventory?
  • How would you build HIT/HIE initiatives in your community if it were your job?

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Compiling Results

Tracking your activities and results of your inventory in a table similar to the one below will be useful for reporting activities to the Leadership Team.

HIT/HIE — Activities and Results
Interviewee NamePosition, OrganizationSummaryConclusions/Next Steps
    
    
    
    
    
    
After data have been gathered from all sources in the focus area, the Focus Area Team Leader and members may analyze the results by reviewing the goals identified at the beginning of this section and by identifying and summarizing the following aspects of the inventory findings with each other and with other Focus Area Team Leaders.
HIT/HIE — Analysis
Gaps 
Overlaps 
Opportunities for Alignment 
Challenges 
Lessons Learned 
Resources 
Leaders 

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Consensus Score Card

You may wish to develop a score for your Community Quality Collaborative's stage of development in each focus area to facilitate comparison of its stage of development across focus areas. You may discover differences in scores of individual key stakeholders for the same question. Identifying the degree of consensus among stakeholders will be useful in clarifying differing perceptions and goals and areas where consensus building may be useful for more effective collaboration.

If a quantitative approach doesn't fit in your situation, you may wish to use a more qualitative approach such as identifying areas of strengths and weaknesses or specific challenges and solutions.

  • Ask each team member to answer the following questions on a scale of 1-10 with 1 being the least developed and 10 being the most developed.
  • Average the scores of the team members, for each question, to get an average score per question.
  • Discuss any major differences between team members' scores to gain an understanding of each other's perspectives and knowledge.
  • Total the scores for all the questions and divide by the number of questions to get the score for this focus area.
  • Compare your Community Quality Collaborative's strength in this focus area to its strength in other focus areas in the overall Community Inventory Consensus Score Card when compiling and analyzing overall results from the tool.
HIT/HIE Consensus Score CardSCORE
(1-10)
1. Our state government supports advancing HIT/HIE through an executive order, legislation, or funding. 
2. Our community has a shared vision of how HIT/HIE can improve health and health care in our community. 
3. This shared vision supports the Community Quality Collaboratives goals in the other seven focus areas. 
4. Our community has adequate resources to build HIT/HIE initiatives to support this vision. 
5. There is a multi-stakeholder, communitywide effort to build HIT/HIE initiatives in our community. 
6. These initiatives have been successful. 
7. The right health care leaders in this community support HIT/HIE. 
8. The Community Quality Collaborative includes the right stakeholders to build and support the HIT/HIE vision. 
9. The individuals at the table are willing and able to advocate on behalf of the Community Quality Collaborative HIT/HIE goals in their respective organizations. 
10. Members of the Community Quality Collaborative share a common vision of how to use HIT/HIE to achieve its goals. 
11. Individuals are willing to share relevant knowledge about their HIT/HIE goals, activities, and plans openly. 
12. There is a plan to address potential obstacles such as concerns related to privacy, security, work-flow change, financial disincentives, and others to HIT/HIE adoption. 
13. The organizations involved are willing to contribute expertise and capabilities regarding HIT/HIE for the benefit of the community. 
14. The organizations are willing to provide resources, in-kind, financial or other, to support adoption and acceleration of HIT/HIE. 
15. There are sufficient resources for this Community Quality Collaborative to be successful in its HIT/HIE activities. 
16. The participants will devote adequate time and resources to the Community Quality Collaborative's HIT/HIE goals. 
Total Score 

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Current as of March 2009
Internet Citation: Module 8: Health Information Technology and Health Information Exchange (HIT/HIE): Multi-stakeholder Community Inventory Modules. March 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/value/cimodules/cimodules8.html