UCLA CTSI and University of Minnesota Cross-Institutional Award Projects Principal Investigators: Hector Rodriguez (UCLA) and William Riley (University of Minnesota) Large-scale federal investments in health information technology (HIT) are intended to spur health care providers and organizations to share patient information to better coordinate and improve quality of care. However, the uptake of HIT has lagged in ambulatory care settings that care for high proportions of low-income patients. Our pilot study seeks to generate knowledge about facilitators and barriers to the spread of electronic health information exchange (HIE) for improving quality of care among underserved populations. We have established partnerships with two health care organizations: Citrus Valley Health Partners (CVHP), a provider network serving many underserved patients in the East San Gabriel Valley, Calf., and the Federally Qualified Health Center Urban Health Network (FUHN), a group of ten clinic organizations serving the Minneapolis-St. Paul area. We are conducting key informant interviews of physicians, front office staff, IT personnel, and executives. Through these interviews, we are learning about the barriers to electronic exchange of health information within the clinics and practices, between these sites, and at city-wide or regional levels. This multi-level framework elucidates the opportunities and challenges for ambulatory care practices serving underserved populations in adopting and sustaining HIT.

1. Co-PIs: Hector Rodriguez, PhD, MPH
William Riley, PhD
Project Manager: Mac McCullough, MPH
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2.  Health information exchange (HIE) is a central feature of
the Affordable Care Act
◦ Many believe HIE will yield improvements in quality and decreases
in costs
◦ For providers, HIE is necessary to show “Meaningful Use” of Health
IT in order to receive additional reimbursement/avoid penalties
 Currently, use of HIE in the U.S. lags, and there is even
evidence of differential adoption of HIE across care
settings
◦ Involvement of small- and medium-sized primary care practices
has lagged relative to hospitals and large ambulatory settings
◦ FQHCs face similar potential barriers to adoption, though this area
has not be specifically studied
◦ This trend may especially problematic as these two settings serve
a disproportionate number of traditionally-underserved
individuals
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3.  The purpose of this pilot study is to generate
knowledge about facilitators and barriers to the
spread of HIE in underserved populations.
 Key domains of interest for study:
◦ Practitioner/informant’s conceptualization of HIE
◦ Clinic/practice decision-making structure
◦ Current use of Health IT at clinic/practice
◦ Current exchange of clinical information (electronic &
non)
◦ Community partnerships
◦ Patient considerations
◦ Motivators, barriers, and incentives for adoption of HIE
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4. Our project would not be possible without our
community partner organizations:
 Citrus Valley Health Partners, a provider
network serving many underserved patients
in the East San Gabriel Valley
 West Side Community Health Services, the
largest FQHC in Minnesota.
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5.  After lit review, develop interview guides in close
collaboration with partner organizations
◦ Want to ensure that the information collected is maximally
relevant and valuable to us, our partner organizations, and
interviewees
 Conduct key informant interviews with community
partners
◦ Interviewees to include clinicians, practice managers, and other
key stakeholders
◦ Working with partners to develop final sample for targeted
recruitment
◦ Anticipate conducting approximately 30 interviews total
 Record interviews, transcribe, and analyze using Atlas.ti
(qualitative data analysis software)
 Assemble findings for dissemination and next steps
◦ Presentation to study participants and partner organizations
◦ Scholarly publication in support of grant application for next
phases
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6.  Anticipated outcomes from the qualitative
interviews study are:
◦ New hypotheses about the use of HIE in small- and
medium-sized primary care practices and FQHCs.
◦ Specifically we are interested in identifying potential
facilitators of and barriers to use
◦ We hope to identify facilitators and barriers and use
subsequent work to explore the transferability and
replicability in other settings
 In addition, we plan to use findings from the
qualitative interviews to inform a (separate)
next phase of work
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7.  Aim 1: Promote bidirectional knowledge exchange between community
and academia.
◦ Our qualitative study is largely Inductive research, placing our community partners in
the role of informing us about the “on-the-ground” reality of a potential disparity.
◦ We have shaped deliverables to maximize value to both partner organizations and
researchers.
 Aim 2: Build community and academic infrastructure for sustainable
partnered research & Aim 3: Drive innovation in community engagement
that accelerates the volume and impact of partnered research in diverse
communities.
◦ The project has enabled both co-PIs the potential expand their network to both
community partner organizations, enabling potential future partnership.
◦ CTSI funding also enabled UCLA-UMN researchers to provide small stipends for both
partners, both as a sign of appreciation and to offset some of the administrative
costs inherent in study participation
 Aim 4 – Build Health Services Research (HSR) methods into partnerships
to accelerate design, production, and adoption of evidence-based
interventions.
◦ Using formal qualitative research methods represents a substantial improvement over
less intensive methods sometimes used (informal requests for feedback or the
‘squeaky wheel’ getting attention)
◦ Making these data and experiences available through presentations or publications
should also enable others to benefit from this rigor
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8. Q1
Apr, May, Jun
Q2
Jul, Aug, Sep
Q4
Jan, Feb, Mar
Q3
Oct, Nov, Dec
Assemble pilot
results &
submit grant
(Aim 3)
Dissemination
of pilot findings
(papers,
conferences)
Conduct Key Informant Interviews with
small- and medium-sized primary care
practices (clinicians, staff, and
administrators )
Collaborate with
CVHP to identify key
informants
Develop & pilot test
interview guides for
key informant
interviews
Transcribe interviews & Analyze content
Conduct Key Informant Interviews with
FQHC (clinicians, staff, and
administrators )
Collaborate with
CVHP to identify key
informants
Pilot test survey
Develop clinician
survey to assess
readiness for HIE,
perceived barriers, etc.
Evaluate survey –
analyze psychometric
properties and cognitive
interviews of pilot survey
informants (Aim 2)
Identify barriers & facilitators
to HIE in smaller-sized
practices & FQHCs (Aim 1)
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9.  CTSI funding has been transformational in the
scope of work envisioned for the project
◦ Originally, one graduate student would have
performed only a few interviews in PCP setting
◦ Funding enabled addition of FQHCs to the study, as
well as a more complete sample of interviewees
 With expanded scope of study and range of
interviews, pilot data are much more likely to
be useful for successful pursuit of next phase
work
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10.  Remainder of the project:
◦ Complete interviews and data analysis
◦ Summarize findings through deliverables
 Presentations to clinic leadership, working groups, and
others
 Scholarly publication of findings to reach wider
audience
 Potential presentation at conferences or other venues
 Follow-on work
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