Table 2.

Themes and primary subthemes in the technology domain.

Theme and primary subtheme			Representative quote
Implementation challenges
	Maintaining growing number of applications	“There’s been an explosion of health IT [information technology] applications, vendors and products over the past decade, many of whom overlap and functionality intersect in ways that don’t really allow for great interoperability, so just the challenge of sort of how do you meet all the needs, using all the various products out there, and still have a cohesive, reliable, safe experience is a challenge.” [Hospital representative #15]
	Integrating diverse sources of data into unified medical record	“Our community health centers are on a lot of different EHR [electronic health record] platforms, and those platforms don’t talk to each other, and so the interoperability that we all desire is still not really there. So, we...are utilizing a health population, a population health tool that can sit over any EHR [electronic health record] platform, and that is allowing us to get some of the data aggregated, in spite of the lack of interoperability and communication between different EHRs.” [Primary care provider #22]
Interoperability capabilities
	Connecting to state-hosted registries and databases (ie, state immunization registry)	“Every hospital has this issue, is that there’s not really a good way to leverage the data being collected by the state vital statistic[s] for our use...We really get no automatic notification that a patient has died. They die elsewhere, and the state finds out because there’s a death certificate somewhere, but our HIM [health information management] department is sort of stuck almost to the point of reading obituaries trying to figure out what patients to mark...It’s really hard, from our perspective to reach out to a family with an appointment reminder about a patient who died, and it’s just, not only is it horrible customer service and patient experience or family experience to do that...I think more connection points with actually the state for some of this basic stuff like birth records and death records and marriage certificates where names are changing and that information’s sitting there, but it seems to be behind this kind of either bureaucratic or policy firewall.” [Hospital representative #15]
	Exchanging data across the continuum of care	“In our long-term care systems, it would be nice for us to be able to exchange information about those patients, especially with medications, make sure their medications are set up and they know everything that the patient’s on. One thing, too, is provide our providers with information, a little bit more timely from the long-term care facilities to keep them from being readmitted or admitted to the hospital. So that’s something we’d like to be able to do. Another thing would be the merging of medical records for both mental health and their regular healthcare.” [Primary care provider #6]
	Reliance on regional HIEsa for data exchange	“I see a lot of potential for us to be able to really be part of that health information exchange network, and use our EHR [electronic health record] system to do a lot of that in the background, as opposed to currently what we are doing is we have access to [regional HIE] portal to get the community health record, the information, but that takes staff time. You know, a lot of training, and so it’s not really fully integrated into our EHR [electronic health record], and it’s not fully integrated into our clinical practice processes.” [Behavioral health provider #17]
Opportunities
	Using new population health software to improve interoperability	“That’s the beauty of it. So, I...mentioned computer visionb, so what that’s compared to if you wanted to do that in the past, you would have had to have a pretty labor-intensive interface between the platform and each individual practice’s EHR [electronic health record], right. And that’s a huge level of effort that most people can’t really get to, and that’s why the computer vision piece of that really makes sense. You don’t have to have that, well, it’s still fancy, it’s fancy in a different way, you don’t need a fancy interface, you’re using the computer visiona to match the patients.” [Hospital representative #21]
	Integrating care coordination programs to improve social needs referrals	“Back to the social determinants...the opportunity to connect to external things like Aunt Bertha or NowPow or Healthify, one of those products that helps kind of do closed loop referral, and whether we’ll do that within Epic...I think those...are helping us kind of reach our goals around reducing health disparities.” [Primary care provider #14]
	Using FHIRc-based applications to advance interoperability	“We are just implementing our FHIR [Fast Healthcare Interoperability Resources] layer right now. What I will tell you is while FHIR [Fast Healthcare Interoperability Resources] is definitely a direction of the future, it is not broadly deployed in the marketplace and not broadly deployed in the workflow or business applications to great extent. But it is, definitely will be an important factor as we move into the future. But it also will not be the silver bullet that everybody’s hoping it was going to be.” [HIE representative #8]

^aHIE: health information exchange.

^bComputer vision is a field of technology that enables devices such as smart cameras to acquire, process, analyze, and interpret text, images, and videos.

^cFHIR: Fast Healthcare Interoperability Resources.