Adoption and implementation of Health Information Exchange (HIE): An interpretative review

Health Information Exchange (HIE) includes the process of electronic movement of patient-level clinical, demographic and health-related information across healthcare organizations. Although literature on HIE indicates the potential benefits of HIE in quality improvement as well as mortality and cost reduction, several studies mention various barriers to HIE adoption and implementation. The hindering factors can be classified into technological, organizational and environmental variables. A few studies have mentioned that adoption and implementation of HIE are different phenomena but the rest has used adoption and implementation interchangeably. Also, there is no comprehensive study to clearly delineate the difference between adoption and implementation process associated with HIE in United States. This study is aimed at reviewing the theories on adoption and implementation steps and explaining the differences between these two processes. This study attempts to distinguish the factors affecting adoption and implementation of HIE in the health care settings in United States. To do so, a literature review was conducted on both adoption and implementation of HIE. The related articles which were mainly available in Web of Sciences electronic databases reviewed and some additional articles accessed through Google Scholar. All the selected articles were published from 2008 to 2014. Eligibility criteria were HIE setting, English language, year of publication, and country setting. Articles were assessed against eligibility criteria and were coded into HIE awareness, HIE adoption and HIE implementation and HIE mixed to better identify the differences between different stages. The number of publications on HIE in United States significantly increased over time. Overall, twenty seven publications met the inclusion criteria. Based on the results, the study proposes a decision tree which includes all the possible stages to explain HIE adoption and implementation process. The decision tree analyzes the differences between adoption and implementation and clarifies factors affecting each process separately. Finally, the result shows five different types of decisions that can be made by health care institutes regarding adoption and implementation process of HIE. The findings provide a useful implication for researchers interested in HIE adoption and implementation. Also, the analysis can help the decision makers and policy developers in the health care setting to better understand factors affecting adoption decisions and implementation process.