Table 2.

Organizational Lessons

Themes	Barriers	Solutions	Implications
Trust	Organizations are protective of their data and are often reluctant to exchange data electronically.	Utilizing community-based clinical transformation partners is an effective tool to build trust.	HIEs need to build trust before tackling the technical issues.
Complexity	Interface development is a slow and tedious process with many vendors.	HIEs need to carefully explain that the process takes time and effort.	Overpromising the benefits to get organizations to participate leads to frustrations.
Workflow	Staff members are typically more comfortable continuing their existing routines rather than using new technology.	New workflows need to be developed to integrate HIE into patient care. Utilizing community-based clinical transformation partners is an effective tool in dissemination of successful workflow solutions.	The workflow redesign cannot be underestimated when promoting HIE usage. It is important to share lessons across the community in order to help other practices adopt and use HIE.
Resources	Each organization has its unique own set of circumstances including resource limitations, availability of expertise, priorities, and time limitations.	Expansion of HIEs requires flexibility in scheduling and resource allocation—one practice may need more help with technical issues while another may need more time on workflow.	HIEs need to analyze resources in each organization and establish scopes of work based on the practice capabilities. Establishing rigid deadlines at the start of a communitywide roll out is likely to fail.