Joshua R. Vest, PhD, MPH, is Director, Center for Health Policy and Associate Professor, Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, and Scientist, Regenstrief Institute, Indianapolis, Indiana. E-mail:
Health Care Manage Rev. 2019 Oct/Dec;44(4):344-355. doi: 10.1097/HMR.0000000000000185.
Increasingly, health care providers need to exchange information to meet policy expectations and business needs. A variety of health information organizations (HIOs) provide services to facilitate health information exchange (HIE). However, the future of these organizations is unclear.
The aim of this study was to explore the environmental context, potential futures, and survivability of community HIOs, enterprise HIEs, and electronic health record vendor-mediated exchange using the population ecology theory.
Qualitative interviews with 33 key informants representing each type of HIE organization were analyzed using template analysis.
Community HIOs, enterprise HIEs, and electronic health record vendors exhibited a high degree of competition for resources, especially in the area of exchange infrastructure services. Competition resulted in closures in some areas. In response to environmental pressures, each organizational type was endeavoring to differentiate its services and unique use case, as well as pursing symbiotic relationships or attempting resource partitioning.
HIOs compete for similar resources and are reacting to environmental pressures to better position themselves for continued survival and success. Our ecological research perspective helps move the discourse away from situation of a single exchange organization type toward a view of the broader dynamics and relationships of all organizations involved in facilitating HIE activities.
HIOs are attempting to partition the environment and differentiate services. HIE options should not be construed as an "either/or" decision, but one where multiple and complementary participation may be required.
为满足政策期望和业务需求，医疗服务提供者越来越需要交换信息。各种健康信息组织（HIO）提供服务以促进健康信息交换（HIE）。然而，这些组织的未来尚不清楚。
本研究旨在使用种群生态学理论探讨社区 HIO、企业 HIE 和电子健康记录供应商中介交换的环境背景、潜在未来和生存能力。
对 33 名代表每种 HIE 组织类型的关键信息者进行了定性访谈，使用模板分析对访谈内容进行了分析。
社区 HIO、企业 HIE 和电子健康记录供应商在资源竞争方面表现出高度的竞争，特别是在交换基础设施服务方面。竞争导致一些地区的关闭。为了应对环境压力，每种组织类型都在努力使服务和独特用例差异化，并寻求共生关系或尝试资源划分。
HIO 为争夺相似资源而竞争，并对环境压力做出反应，以更好地定位自己以实现持续生存和成功。我们的生态研究视角有助于将讨论从单一交换组织类型的情况转移到促进 HIE 活动的所有组织的更广泛动态和关系的视角。
HIO 试图划分环境并区分服务。HIE 选项不应被视为“非此即彼”的决定，而应是需要多种互补参与的决定。
