Table 5.

Practical Considerations When Choosing to Set Up a Community HIE

Factors	Questions to Consider
Assess existing trust levels in your community	What is the potential to build trust over time? What are common interests that you can draw upon to find common purpose? What pitfalls or past negative experiences do you need be mindful of and overcome to build support?
Identify the strengths and weaknesses of health IT infrastructure in your community	How can you build on existing health IT infrastructure, and what gaps do you need to fill? How many EHR vendors will you need to engage, and what is their track record for supporting communitywide HIE?
Consider sources of funding and timing of investments	Is it more realistic for your community to make a series of incremental investments as you build support for HIE? Or can your community make a larger upfront investment to seek more immediate return?
Carefully evaluate HIE vendor capabilities	Will you need to depend on one vendor for a turnkey solution? Are you prepared to provide skilled in-house IT expertise to link together multiple components from different vendors?
Be prepared to engage with providers to standardize and normalize data	Will you work with providers to agree on common coding practices, and if so, how? How will you gain the cooperation of EHR vendors to fully support a common implementation of technical standards?
Assess the implications of privacy regulations and expectations in your locality	Will you follow an opt-in or an opt-out approach to patient consent? What effect will that approach likely have on your ability to collect data in a central data repository?

Source: Authors’ analysis.