TABLE 2 •. Percentage of LHDs by Largest Challenges Related to Electronic Exchange of Health Information With Outside Organizations^a.

Challenges to Electronic Exchange of Information	All, %	Population Size, %				Governance Category, %
		<50 000	50 000-499 999	≥500 000	P	State	Local	Shared	P
HIPAA, privacy or legal concerns	40	40	41	37	.96	56	39	39	<.001
Lack of or access to technical support or expertise	37	40	35	26	<.001	25	41	17	<.001
Competing priorities	36	32	41	50	<.001	31	37	33	.20
Unclear about value of ROI on development of appropriate information systems	28	33	17	35	<.001	12	31	15	<.001
Do not know exchange partners' ability to electronically exchange health information	28	29	27	18	.21	25	28	23	.21
Subscription rates for exchange services are too high	22	25	18	17	<.001	11	25	8	<.001
Insufficient information on exchange options available (eg, exchange partners, transport mechanisms, and message formats)	22	23	19	28	.52	16	21	32	<.001
Lack of support from leadership (eg, at LHD, state, LBOH level)	22	24	18	17	<.001	24	20	34	<.001
Exchange partners do not have the ability, interest, or incentive to electronically exchange health information	20	17	22	33	<.001	27	19	21	.04
Inability of our organization's EHR system to generate/receive electronic messages/transactions in standardized format	15	14	15	18	.24	15	13	28	<.001
Limited broadband/internet access	9	10	10	0	.02	11	8	16	<.001

Abbreviations: EHR, electronic health record; HIPAA, Health Insurance Portability and Accountability Act; LBOH, local board of health; LHDs, local health department; ROI, return on investment.

^an = 277; P values for the population categories are based on Somer's D, and for governance category, based on χ². Italicized values show significance of subgroup differences at P ≤ .05.