Table 3.

Lessons learned from challenges and successes by dimension (technical, organizational, and governance).

Lessons learned	Challenges	Successes
Technical	Determine the most efficient environment for testing, decoupled from decision processes, actions, and dependencies from other stakeholders.	Willingness to develop workarounds to unexpected software challenges, such as incompatible EHR versions.
	Provide oversight and follow-up to increase technical understanding of appropriate on-boarding guides across all stakeholders.	Gain commitment from implementation site to set high priority on HIE implementation.
	Use an EHR system specific CCD for validation, not a vendor supplied CCD template.
	Conduct testing and implementation in clearly communicated iterations.
	Articulate goals and priorities with vendors.
	Understand roles and required resources in order to minimize time gaps and maximize efficiency.
Organizational	Account for competing IT priorities across organizations.	Participation of health system leadership.
	Understand, communicate, and appreciate varying stakeholder value proposition/motivations.	Timely and accurate communication, especially by and between the HIE and the health system.
		Allocate appropriate human resources at the outset.
Governance	Ensure governance is in place, including policies, procedures, guidelines, and oversight across all organizations.	Project champion possesses decision-making power, or, as needed delegates appropriate decision making power to others.
	Obtain commitments from governance body early on to facilitate project continuity.