1. PHYSICIAN SENSEMAKING TOWARDS HEALTH INFORMATION EXCHANGE ACCEPTANCE Michele L. Heath Dr. Lori T. Peterson Cleveland State University Monte Ahuja College of Business Southern Management Association – Savannah - November 12, 2014

2. Health Information Exchange 2 Southern Management Association 2014

3. Introduction Despite two decades of Health Information Exchange (HIE) failures across the country, the United States government has incorporated HIE into Meaningful Use Stage 2, which in turn, has sparked renewed physicians interest in health information exchange. We theorize that competition, revenue decrease, data integrity and lack of trust can be mediated by sensemaking which leads to HIE acceptance. 3 Southern Management Association 2014

4. Problem Statement The fragmented and competitive US health care system provides few offsetting incentives for sharing clinical data (Fontaine, 2010). 4 Southern Management Association 2014

5. Research Question What factors do physicians make sense of as they move toward HIE acceptance? Is there is a statistically significant relationship between competition, revenue changes, data integrity and lack of trust? 5 Southern Management Association 2014

6. Sense Making Theory  Organization could be…. In a complex and unpredictable environment  The job of the organization Making sense of the environment  How? Through interaction or situation 6 Southern Management Association 2014

7. Situation / Event Happen Interpreted in Different Way Reduce the Difference Sense Making 7 Situation Person A Person D Person C Person B Sense Making Theory Southern Management Association 2014

8. Retrospective Sense Making 8 Southern Management Association 2014 People think…Weick says… They plan first Act according to their plan People act First Examine their action Becomes “REALITY”

9. End State…. New Way of Thinking Less Connection Less Relying More Flexibility More Success Old Way of Thinking Less Connection Between Co-worker Less Success 9 Southern Management Association 2014

10. Physician Perspective 10 Competition can create conflict and misalignment of incentives that become a barrier to communitywide HIE (Marchibroda, 2007). Competition There are off-setting considerations for organizations that are truly committed, and HIE services must be considered as an “opportunity” in a farsighted revenue model (HIMSS, 2013). Revenue Changes The assumption is that more information to make medical decisions does not ensure that the information is accurate or complete (Sillence, Briggs and Harris, 2006). Data Integrity Friedman and Iakovidis (2009) highlights the need for cultural and organizational changes, emphasizing that communities of users and healthcare professionals must be established and that trust is required if communication and exchange are to be achieved. Lack of Trust

11. Research Model 11 Southern Management Association 2014

12. Implications for Research However, many investigations of HIE have a limited scope, as they focus on economical, interoperability, and rational factors. Scholars focus on benefits and challenges of HIE and specific reasons for low adoption rate (Blumenthal, 2009) rather than a comprehensive look at how physicians perceive HIE. Gain a more in-depth understanding physician’s perceived consequences of HIE acceptance. 12 Southern Management Association 2014

13. Implications for Practice To help hospitals understand why HIE participation is not at the forefront of physician minds. To help hospitals understand the need to identify the right stakeholders for active participation in the HIE. Hospitals must understand and address physician perceptions towards HIE, in order for hospitals to comply with Meaningful Use Stage 2 13 Southern Management Association 2014

14. Limitations and Future Research The study of HIE is in the infancy stage and we have only address physician consequences: Future research should focus on developing a case study of several model HIEs. Future evaluation activities should assess the relationship between specific models and state progress in realizing their individual program goals. Future research should address why hospitals are spending a huge amount of money on IT systems and then abandon the system, or fail to continue with meaningful use standards that then abandon a year later. 14 Southern Management Association 2014

15. Final thoughts There is no question that providers recognize the importance of HIE, and realize that in combination with EHR, the HIE will transform the practice of medicine. However, physicians and hospitals may not be prepared to face the challenges and obstacles related to sharing patient data through HIE. 15 Southern Management Association 2014

16. Thank you! Michele L. Heath Department of Computer and Information Science m.heath@vikes.csuohio.edu Dr. Lori T. Peterson Department of Management l.t.peterson66@csuohio.edu Cleveland State University Monte Ahuja College of Business 16

17. Appendix Supplemental Information 17 Southern Management Association 2014

18. References Adler-Milstein, J., Bates, D. W., & Jha, A. K. (2011). A survey of health information exchange organizations in the United States: implications for meaningful use. Annals of Internal Medicine, 154(10), 666-671.Kuperman, G. J. (2011). Health-information exchange: why are we doing it, and what are we doing?. Journal of the American Medical Informatics Association, 18(5), 678-682. Solomon, M. R. (2007). Regional health information organizations: a vehicle for transforming health care delivery?. Journal of Medical Systems, 31(1), 35- 47. Sittig, D. F., & Joe, J. C. (2010). Toward a statewide health information technology center (abbreviated version). Southern Medical Journal, 103(11), 1111-1114. Weick, K.. E. and Bougon, M. G. (1986). 'Organizations as cause maps'. In Sims, H. P.Jr. and Gioia, D. A. (Eds.), Social Cognition in Organizations, 102-35. San Francisco: Jossey-Bass. Weick, K. E., Sutcliffe, K. M., & Obstfeld, D. (2005). Organizing and the process of sensemaking and organizing. Organization Science, 16(4), 409– 421. 18 Heath and Peterson Southern Management Association 2014