Participation by Primary Care Practices in Health Information Exchange in Minnesota

Minnesota’s e-Health Law, passed in 2007, mandated electronic health record (EHR) and health information exchange (HIE) participation by all clinics and hospitals, including small primary care practices. This project assessed factors that influenced the participation of small- and medium-sized primary care practices in Minnesota in community-wide electronic HIE, defined as the electronic exchange of information among multiple stakeholders such as hospitals, laboratories, ambulatory practices, and quality assurance organizations. Assessments focused on both the perceived benefits and barriers to HIE participation.

The specific objectives of the project were as follows:

• Conduct a systematic literature review of HIE, with emphasis on application to primary care practices.
• Determine the motivation and barriers to primary care practice participation in HIE.
• Create a report that integrates the factors that affect participation in a community-based electronic HIE.

Key informants described the motivation for and anticipated benefits of their practices’ decision to adopt an EHR. Most practices cited Minnesota’s e-Health Law, which required interoperable EHRs by 2015, as a motivating factor. For some, e-prescribing was the first step toward broader electronic data sharing. More than half the sites were involved in quality reporting initiatives, which were a frequently mentioned motivation for establishing HIE. Replacing labor-intensive medical record reviews with an electronic process in meeting quality reporting requirements had significant cost implications. Immediate access to outside records improved the quality and safety of patient care and saved time that would have been spent requesting records, waiting for them to arrive, and scanning them into the EHR system.

Lack of interoperability was a barrier for all practices. Informants with information technology (IT) backgrounds observed that while interoperability was not technically difficult, there was limited political willpower to bring appropriate resources to that goal. In addition, cost was a significant and overlapping barrier to HIE adoption. Funding EHRs was usually the first cost hurdle, but ongoing license fees and IT support also limited implementation, especially in settings where resources were scarce.

While strong leadership, a strategic plan, and physician involvement from the beginning of the EHR selection process seemed to promote success, none of the practices were engaged in the community-wide HIE. However, as an important incremental step toward HIE, practices in the northeast region of the State worked with a regional health information organization to create a patient record locator service.