Barriers Over Time to Full Implementation of Health Information Exchange in the United States

From Clinfowiki
Jump to: navigation, search


Background:Although health information exchanges (HIE) have existed since their introduction by President Bush in his 2004 State of the Union Address, and despite monetary incentives earmarked in 2009 by the health information technology for economic and clinical health (HITECH) Act, adoption of HIE has been sparse in the United States. Research has been conducted to explore the concept of HIE and its benefit to patients, but viable business plans for their existence are rare, and so far, no research has been conducted on the dynamic nature of barriers over time.

Objective:The aim of this study is to map the barriers mentioned in the literature to illustrate the effect, if any, of barriers discussed with respect to the HITECH Act from 2009 to the early months of 2014.

Methods:We conducted a systematic literature review from CINAHL, PubMed, and Google Scholar. The search criteria primarily focused on studies. Each article was read by at least two of the authors, and a final set was established for evaluation (n=28).

Results:The 28 articles identified 16 barriers. Cost and efficiency/workflow were identified 15% and 13% of all instances of barriers mentioned in literature, respectively. The years 2010 and 2011 were the most plentiful years when barriers were discussed, with 75% and 69% of all barriers listed, respectively.

Conclusions:The frequency of barriers mentioned in literature demonstrates the mindfulness of users, developers, and both local and national government. The broad conclusion is that public policy masks the effects of some barriers, while revealing others. However, a deleterious effect can be inferred when the public funds are exhausted. Public policy will need to lever incentives to overcome many of the barriers such as cost and impediments to competition. Process improvement managers need to optimize the efficiency of current practices at the point of care. Developers will need to work with users to ensure tools that use HIE resources work into existing workflows.[1]



The authors argue that even though HIE (Health Information Exchange) was introduced over 10 years ago, implementation has been slow to embrace and adopt into practice. HIE has the potential to decrease errors, reduce costs, and improve communication. Yet, some of the barriers like cost of implementation, disruption in workflow, and tech support remain as obstacles to practices adopting HIM.


The authors selected 28 articles to review studies on the barriers to HIE adoption. The articles included studies between Jan 2009-Mar 2014.


The authors classified identified 16 common barriers from the articles reviewed. They found that the barriers changed year to year. While cost and physician resistance were barriers in 2009, in 2010 the barriers included cost, disruption in workflow, lack of tech support, and privacy. Although some of the barriers were common in every year studied, there were some that arose and differed from the years before.


Of all the barriers that were described, cost, workflow, and lack of tech support were the most reported ones. The authors argue that because of these findings, the government will need to work on alleviating some of the costs associated with HIE implementation, disruption in workflow should be addressed by developers, and tech support should be addressed by Regional Extension Centers (RECs).


This is a good article review of barriers to implementation of HIE. I thought it was clever that the authors broke down the barriers by year and then related some of the findings with what was happening on a national level with government funding.


  1. Kruse, C.S., BS, MBA, MSIT, MHA, PhD, Regier, V., MHA, Rheinboldt, K.T., MSW, MEd (2014). Barriers Over Time to Full Implementation of Health Information Exchange in the United States. Journal of Medical Internet Research Journal, 2(2). Retrieved from