Systematic Review of Health Information Exchange in Primary Care Practices

Patricia Fontaine, MD, MS; Stephen E. Ross, MD; Therese Zink, MD, MPH; Lisa M. Schilling, MD, MSPH


J Am Board Fam Med. 2010;23(5):655-670. 

In This Article

Abstract and Introduction


Background: Unprecedented federal interest and funding are focused on secure, standardized, electronic transfer of health information among health care organizations, termed health information exchange (HIE). The stated goals are improvements in health care quality, efficiency, and cost. Ambulatory primary care practices are essential to this process; however, the factors that motivate them to participate in HIE are not well studied, particularly among small practices.
Methods: We conducted a systematic review of the literature about HIE participation from January 1990 through mid-September 2008 to identify peer-reviewed and non–peer-reviewed publications in bibliographic databases and websites. Reviewers abstracted each publication for predetermined key issues, including stakeholder participation in HIE, and the benefits, barriers, and overall value to primary care practices. We identified themes within each key issue, then grouped themes and identified supporting examples for analysis.
Results: One hundred and sixteen peer-reviewed, non–peer-reviewed, and web publications were retrieved, and 61 met inclusion criteria. Of 39 peer-reviewed publications, one-half reported original research. Among themes of cost savings, workflow efficiency, and quality, the only benefits to be reliably documented were those regarding efficiency, including improved access to test results and other data from outside the practice and decreased staff time for handling referrals and claims processing. Barriers included cost, privacy and liability concerns, organizational characteristics, and technical barriers. A positive return on investment has not been documented.
Conclusions: The potential for HIE to reduce costs and improve the quality of health care in ambulatory primary care practices is well recognized but needs further empiric substantiation.


Health information technology (IT) shows great promise for improving the efficiency, quality, and safety of medical care.[1–3] The American Recovery and Reinvestment Act (ARRA) of 2009 reflects the Federal government's unprecedented interest in increasing the use of health IT to optimize our health care system.[4] The ARRA devotes approximately $19 billion to increasing participation in health information exchange (HIE); that is, the electronic sharing of health-related information according to nationally recognized standards for interoperability, privacy, and data security.[5] The goal is to create regional health information organizations (RHIOs) that will ultimately be linked to form a Nationwide Health Information Network.[6]

Adoption of electronic health records (EHRs) and HIE has lagged in primary care, where the majority of patient encounters occur.[1] Currently only 21% of primary care physicians report having EHRs in their practices,[1] and fewer still participate in HIEs. A fuller understanding of the factors associated with HIE adoption by primary care practices is needed to achieve the ambitious goal of nationwide HIE. This article is a systematic review of literature related to the adoption of HIE by ambulatory primary care practices, with an emphasis on benefits, barriers, and the overall value to the practice.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: