Attachment E -- Phone Interview Guide 7-7-2009

Blue Text: notes for Interviewer Attachment E

‘‘Overcoming Barriers to Expanded Health Information Exchange (HIE) Participation in Indiana’’

The Agency for Healthcare Quality and Research or AHRQ, through its contractor, the Regenstrief Institute at Indiana University, is trying to understand the barriers that organizations like yours may see to participation in health information exchange (HIE) and how they could be overcome. This project is being conducted pursuant to AHRQ’s statutory mandates to conduct and support research, evaluations and initiatives to advance information systems for health care improvement and to promote innovations in evidence-based health care practices and technologies by conducting and supporting research on the development, diffusion, and use of health care technology. Health information exchange or the ability to securely and privately share a patient’s electronic health information between healthcare providers may improve the quality, safety and efficiency of a patient’s care.

Health Information Exchange or HIE is different from adopting an electronic health record (EHR) or electronic medical record (EMR). EHRs or EMRs provide information to and receive information from HIEs. In order to realize these improvements, it is important that physician practices, hospitals, laboratories and others participate in this information sharing. Healthcare providers may see a number of barriers or hurdles to participating in health information exchange. This survey is designed to help AHRQ understand what these barriers are and how they can be overcome.

If your organization currently participates in health information exchange we hope that you can help us identify the challenges you faced in participating and how your organization overcame them. If your organization does not participate in health information exchange, we hope that you can help us understand why not and what it might take to overcome these barriers.

Phone Interview Guide

• Confirm that you have reached the intended party for the interview and that now is still a convenient time. If you have not reached the intended individual, determine whether it is still appropriate to complete the interview. If the time is no longer convenient, reschedule the interview.

Check Type of Organization

Organization: ______________________________________ Hospital Small Practice Large Practice

Name of individual: _________________________________

Organizational role:

CIO	Director of Technology	Practice Manager	Administrative Team
CFO	IT Manager	Board of Directors	Other:
CMO	IT Team	Physicians

• Reassure interviewee that this survey is not a marketing ploy and they will not receive a call from anyone.

• Remind interviewee that we will not share any of their responses with anyone except the research team. We will aggregate and summarize their responses with others in similar roles in similar organizations, but individual responses will not be reported.

• Thank the interviewee for their willingness to participate and remind them that you expect the total interview to take no more than 20 minutes.

• Read the statement of purpose and clarify any questions the interviewee may have.

• Tell the interviewee “If you are ready, we will get started”

Does your [hospital/practice] participate in any health information exchange?

• If they respond YES and we have not yet reached our limit of 25% of respondents being participants then skip to HIE Participant Section

HIE Non-Participants

Were you personally aware of the concept of health information exchange prior to receiving the information materials for this interview?

Yes No

• Verify that the interviewee understands that an EMR is not HIE but can be an “endpoint” in an HIE.

Has your organization been thinking about participating in health information exchange?

Yes No

Did you know that there are organizations actively trying to get [hospitals/practices] to participate in health information exchange?

Yes No

If their organization has not been thinking about participating or they are not aware of the concept then ask:

Even if you were not aware of the concept of health information exchange, we would be interested in your opinions about what issues or barriers might prevent your organization from participating.

• You may refer the interviewee to Table D for ideas if they are having difficulty identifying any barriers or concerns. List each concern in as close to the interviewee’s words as possible and what kinds of things would have to happen in order for them to overcome the barrier. For example, “If they list implementation costs with their vendor as a barrier you might ask them what would help reduce that barrier – if a government grant would pay for their implementation costs with the vendor would that overcome the barrier?”

If you personally had to make a recommendation to your organization whether or not to participate in a health information exchange, what would your recommendation be?

• Ask them to explain their rational, or to state what other information they would need to make a recommendation.

Barrier	Solution

We know that it can be difficult to clearly identify what barriers are preventing your organization from participating in health information exchange, but would appreciate it if you can share the issues or barriers that are preventing your organization from participating in health information exchange.

• You may refer the interviewee to Table D for ideas if they are having difficulty identifying any barriers or concerns. List each concern in as close to the interviewee’s words as possible and what kinds of things would have to happen in order for them to overcome the barrier. For example, “If they list implementation costs with their vendor as a barrier you might ask them what would help reduce that barrier – if a government grant would pay for their implementation costs with the vendor would that overcome the barrier?”

Barrier	Solution

HIE Participants

How does your organization participate in health information exchange?

• Find out what type of exchange they participate in – what services (Refer to Table A or find out what organization such as those in Table B they participate in which may help identify what service) and what types of data (Table C) they exchange. If you determine that they are not participating in HIE but just sharing data internally – providing an EMR for their employed physicians, for example, then move to the HIE non-participant section.

What is the name of the HIE you participate in, and for how long have you been participating?

• Find out which vendors they work with and how.

How did you select this HIE and the vendors?

• Find out more details, e.g., were they contacted by the HIE and vendors, or researched and made contact on their own.

How much has it cost your organization to participate in the HIE, in terms of time, dollars, training, etc? Was this more or less than you had expected it would cost?

• Try to identify total estimates of both time and dollar costs from inception to completion

What roles within your organization were critical to your organization’s decision to participate in health information exchange? Did you personally participate in making the decision for your organization to participate in health information exchange?

• Try to identify the two or three roles within their organization that were critical to their decision to participate in health information exchange. Were clinical leaders like Chief Medical Officers and Chief Nursing Officers the champions? Were Board Members insisting that the hospital participate? For physician practices, did one of the physicians decide it was important for the practice to participate and shepherd the decision forward?

What concerns arose within your organization while you were making the decision to participate in health information exchange and how did you overcome them?

• You may refer the interviewee to Table D for ideas if they are having difficulty identifying any barriers or concerns. List each concern in as close to the interviewee’s words as possible and after they have identified barriers explore solutions. What happened or what did they do to overcome the barrier – why were they able to move forward and participate in HIE despite the barrier?

Barrier	Solution

Were there issues or concerns that your organization had concerns about that proved to be non-issues?

• You may refer the interviewee to Table D for ideas. You are looking for barriers or issues that were discussed, that held up participation or that concerned some decision makers but then turned out not to be issues.

Barrier	Solution

What aspects of the implementation process for HIE worked well for your organization? What could have been better?

• Try to find more details about their expectations of the HIE implementation process.

Based on your experience implementing HIE what advice would you give to another organization to make their implementation easier or better?

• Ask whether the organization has identified crucial decisions they would make differently or processes you would manage differently.

What is your organization’s satisfaction with participation in health information exchange?

• Ask whether the organization has identified benefits from participating in the HIE, and if so, list them. If they not benefited why not? List these as well.

Would you modify anything about the HIE that you participate in?

Yes No

• If yes, ask them to provide examples of other services they think the HIE could or should provide (you may refer the interviewee to Table D for ideas). Tell them to make suggestions based on no financial limitations and/or licensing restrictions.

Would you recommend other organizations participate in your health information exchange? Why/Why not?

Yes No

• If they would not make such a recommendation to others, list the reasons why they would not.

What issues do smaller organizations who want to participate in the same HIE as you do face?

• Ask why or why not.

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