Table 2.

Key components of the Regional Health Information Ecology.

Component	Component characteristics
System	Multiple competing health care organizations in the region
	Multiple clinical sites within each organization
	Need for data exchange within organizations and among competitors to support continuity of patient care
	Transfers in responsibility for patient care among inpatient and outpatient environments
	Information flow mediated by patient involvement
Locality	Overall local region
	Health care community within the region
	Organizations within the health care community
	Individual sites within organizations
	Specific departments at each site (ie, ED, specialty clinic)
Diversity	Many formal and informal roles involved in information exchange:
	Patients and caregivers: report visits to other hospitals/clinics
	Physicians: ask nurses and administrative staff to obtain external records
	Resident physicians: informal sources of patient health information
	Nurses: obtain formal consent for information exchange from patients
	Administrative staff: collect records from other organizations
	Records clerks: locate records and fax to other organizations
Keystone species	Information consumers: nurses, nurse practitioners, physicians, individuals who need information from other sites as part of the medical decision-making process
	Information exchange facilitators: people with knowledge of who to contact at other organizations and of procedures/requirements of other organizations
	Information reservoirs, informal: resident physicians contacted by resident physicians at other locations, patients discussing visits to other hospitals
	Information reservoirs, formal: patients bringing medical records from other sites, information repositories such as electronic health records and paper charts
Coevolution	Constantly shifting process for obtaining health information, related to:
	Organizational policies
	Information repositories at different institutions
	Changes in staffing
	Resource shifts
	Technology availability and accessibility