title: Understanding the decisions and values of stakeholders in health information exchanges: experiences from Massachusetts.
abstract: OBJECTIVE
  We studied how health information exchange systems are established by examining the decisions (and thus, indirectly, the values) of key stakeholders (health care providers) participating in a health information exchange pilot project in 3 Massachusetts communities. Our aim was to understand how these kinds of information exchanges can be made viable.
  
  
  METHODS
  We used semistructured interviews to assess health care providers' decision-making processes in selecting technical architectures and vendors for the pilot projects to uncover their needs, expectations, and motivations.
  
  
  RESULTS
  Our interviews indicated that, after extensive evaluations, health care providers in all 3 communities eventually selected a hybrid architecture that included a central data repository. However, the reasons for selecting this architecture varied considerably among the 3 communities, reflecting their particular values. Plans to create a community patient portal also differed across communities.
  
  
  CONCLUSIONS
  Our findings suggest that, to become established, health information exchange efforts must foster trust, appeal to strategic interests of the medical community as a whole, and meet stakeholder expectations of benefits from quality measurements and population health interventions. If health information exchange organizations cannot address these factors, sustainability will remain precarious.
authors.affiliation: Partners Healthcare System Inc, Boston, MA, USA. bobrudin@mit.edu
authors.forename: Robert S
authors.initials: RS
authors.lastname: Rudin
authors.forename: Steven R
authors.initials: SR
authors.lastname: Simon
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Volk
authors.forename: Micky
authors.initials: M
authors.lastname: Tripathi
authors.forename: David
authors.initials: D
authors.lastname: Bates
mesh_terms: D022126:Access to Information; D003657:Decision Making; D006282:Health Personnel; D006751:Hospital Information Systems / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D008404:Massachusetts; D008490:Medical Informatics / Q000706:statistics & numerical data*; D016347:Medical Records Systems, Computerized / Q000458:organization & administration* / Q000706:statistics & numerical data; D010865:Pilot Projects; D011787:Quality of Health Care; D012945:Social Values; D011795:Surveys and Questionnaires