Table 3.

Summary of Findings: Community Contextual Factors

Model	Hybrid-Federated Form 1	Hybrid-Federated Form 2	Centralized
Description	HIE participants maintain separate control of their data & share it via the HIE infrastructure upon request	Hybrid-federated model combined with—or designed to achieve the functionality of—a normalized central data repository	Data shared by HIE participants are normalized, housed in and accessed from a central data repository
Communities	Western New York*	Central Indiana, Greater Cincinnati, Keystone	Bangor, Inland Northwest, Greater Tulsa
Contextual Factors Influencing HIE Technical Architecture Decisions
Trust and Cooperation	Balance cooperation & autonomy: participants share data on request but maintain control over sources	Facilitate access to distributed data while building trust & readiness for comprehensive data sharing	Cooperative norms (“trust fabric”) promote community custodianship of comprehensive shared clinical data
Health IT Context & Approach	Accommodate disparate EHR systems & varied stakeholder objectives for health IT	Provide a flexible approach at the cost of increased technical complexity	Leverage common EHR systems or centralized HIE infrastructure to create a “supra-EHR” capability
Cost & Timing	Build incrementally to meet community needs & funding flows as the value of HIE is demonstrated	Similar to federated model (with added cost for central repository)	Realize long-term vision & cost-efficient implementation (may require larger initial investment)

Source: Authors’ analysis of case study findings.

Note:

^*At the time of the case study, Western New York planned to add a central data repository to become Hybrid-Federated Form 2; Cincinnati had already done so.