Health Information Exchange as a Multi-Sided Platform: Adoption, Usage and Practice Involvement in Service Co-Production

Abstract

Health Information Exchanges (HIE) are becoming integral parts of the national healthcare reform efforts, chiefly owing to their potential impact on cost reduction and quality enhancement in healthcare services. However, the potential of a HIE platform can only be realized when its multiple constituent users actively participate in using its variety of services. In this research, we model HIE systems as multisided platforms that incorporate self-service technologies whose value to the users depends on both user-specific and network-specific factors. We develop a model of adoption, usage and the involvement of clinical practices in the co-production of the HIE services. This model is grounded in social network theory, service operations theory, and institutional isomorphism theory. A longitudinal study of actual adoption and usage behaviors of 2054 physicians within 430 community medical practices in Western New York over a three year period has been carried out to evaluate the proposed model. This study has been supported by HEALTHeLINK, the Regional Health Information Organization of Western New York, with an extensive database comprising of over half a million transactions on patient records by the HIE users. We extracted panel data on adoption, usage and service co-production behaviors from this database and carried out a detailed analysis using metrics derived from the foundational theories. Positioning practices within two distinct but interrelated networks of patients and practitioners, we show that adoption, usage and service co-production behaviors are influenced by the topographies of the two networks, isomorphic effects of large practices on the smaller ones, and practice labor inputs in HIE usage. Our findings provide a comprehensive view of the drivers of HIE adoption and usage at the level of medical practices. These results have implications for marketing and revenue management of HIE platforms, besides public health and national/regional healthcare policy making.

Keywords: Health Information Exchange, Multi-sided Platforms, IT Diffusion and Adoption