title: Barriers and facilitators to exchanging health information: a systematic review.
abstract: OBJECTIVE
  We conducted a systematic review of studies assessing facilitators and barriers to use of health information exchange (HIE).
  
  
  METHODS
  We searched MEDLINE, PsycINFO, CINAHL, and the Cochrane Library databases between January 1990 and February 2015 using terms related to HIE. English-language studies that identified barriers and facilitators of actual HIE were included. Data on study design, risk of bias, setting, geographic location, characteristics of the HIE, perceived barriers and facilitators to use were extracted and confirmed.
  
  
  RESULTS
  Ten cross-sectional, seven multiple-site case studies, and two before-after studies that included data from several sources (surveys, interviews, focus groups, and observations of users) evaluated perceived barriers and facilitators to HIE use. The most commonly cited barriers to HIE use were incomplete information, inefficient workflow, and reports that the exchanged information that did not meet the needs of users. The review identified several facilitators to use.
  
  
  CONCLUSIONS
  Incomplete patient information was consistently mentioned in the studies conducted in the US but not mentioned in the few studies conducted outside of the US that take a collective approach toward healthcare. Individual patients and practices in the US may exercise the right to participate (or not) in HIE which effects the completeness of patient information available to be exchanged. Workflow structure and user roles are key but understudied.
  
  
  CONCLUSIONS
  We identified several facilitators in the studies that showed promise in promoting electronic health data exchange: obtaining more complete patient information; thoughtful workflow that folds in HIE; and inclusion of users early in implementation.
authors.affiliation: Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. Electronic address: edenk@ohsu.edu.
authors.forename: Karen B
authors.initials: KB
authors.lastname: Eden
authors.affiliation: Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Annette M
authors.initials: AM
authors.lastname: Totten
authors.affiliation: Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: Kassakian
authors.affiliation: Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Paul N
authors.initials: PN
authors.lastname: Gorman
authors.affiliation: Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Marian S
authors.initials: MS
authors.lastname: McDonagh
authors.affiliation: Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; University of Washington, Pharmaceutical Outcomes Research and Policy Program, Box 357630, Seattle, WA 98195-7630, USA.
authors.forename: Beth
authors.initials: B
authors.lastname: Devine
authors.affiliation: Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Miranda
authors.initials: M
authors.lastname: Pappas
authors.affiliation: Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Monica
authors.initials: M
authors.lastname: Daeges
authors.affiliation: Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Veterans Affairs Maine Healthcare System, 1 VA Center, Augusta, ME 04330, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Woods
authors.affiliation: Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA; Department of Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Hersh
mesh_terms: D001291:Attitude of Health Personnel; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D066275:Health Information Exchange / Q000706:statistics & numerical data*; D006801:Humans; D057188:Workflow
keywords: Attitude to computers; Barriers; Health information exchange; Users perceptions