Sustainability Strategies for Regional Health Information Organization Startups

Objectives: Similar to other Western healthcare systems, the U.S. has sought to build a national infrastructure to enable widespread electronic health information exchange (HIE). The 2009 U.S. HITECH Act׳s State HIE Cooperative Agreement Program (SHIECAP) was a short-term catalyst for bottom-up HIE initiatives by states and regional health information organizations (HIOs). Given the high failure rates of regional U.S. HIOs in the past, our primary objective is to identify the key characteristics of HIO startups that became operational and demonstrated sustainability with non-renewable SHIECAP funding in a state environment with very minimal prior HIE activities.
Methods: Based on interview data we collected from 22 stakeholders in New Jersey (NJ) at the state, HIO, and hospital levels, we apply grounded theory techniques to identify cross-case similarities and differences.
Results: Although the three NJ HIOs that became operational during the SHIECAP grant period faced similar startup challenges, the two HIOs that demonstrated sustainability pursued distinct technology and sustainability strategies to develop HIE capabilities to fit their very different regional needs: an HIE capability to improve the population health of an underserved urban population, and an HIE capability to enable the transition to a healthcare landscape that rewards care coordination across suburban hospitals and physician practices.
Conclusions: We propose two models of technology and sustainability strategies for developing bottom-up HIE capabilities for different regional populations. Future research within and beyond U.S. contexts needs to take into account these key characteristics to improve our understanding of effective policy levers and government funding mechanisms.