Institutional factors affecting the electronic health information exchange by ambulatory providers

Objective: Electronic exchange of health information by health entities along the care continuum can vastly improve patient health outcomes as well as reduce costs. To realize the national goal of a health information highway, it is important for a large pool of ambulatory providers to engage in health information exchange (HIE) to share clinical information with affiliated and unaffiliated providers. Applying institutional theory, this research seeks to examine the key institutional factors that influence the HIE use by ambulatory practices. Material and Methods: Data was gathered through a web-based survey of 320 ambulatory providers in the US state of Illinois. Partial least squares approach to structural equation modeling was used to examine the influence of five institutional factors viz. government, patients, peers, affiliates and technology vendors on the use of HIE by ambulatory providers to share clinical information with (i) affiliated providers, and (ii) external, unaffiliated providers. Findings: We found positive and significant influence of government initiatives, patients, peers and affiliates on ambulatory providers' HIE with affiliated providers (R-2 = 0.347) and unaffiliated providers (R-2 = 0.328). Peer influence was positive and significant for HIE with unaffiliated providers only. No significant influence of technology vendors on HIE use by ambulatory practices was found. Conclusion: Addressing a critical gap in our knowledge of how ambulatory providers engage in HIE, we provide compelling evidence for the influence of institutional factors on ambulatory providers' electronic HIE with both affiliated and unaffiliated providers. Policy makers and healthcare leaders need to pay attention to the institutional factors and frame appropriate programs to augment and promote the use of HIE by ambulatory providers.