Table 4 Listing of constructs, definitions, anecdotal evidence, and count for issues with current HIEs

EHR-focused exchange

The extent to which existing HIE systems are functional depending on EHR systems

“Many EHRs are used by various healthcare providers. If the EHR of sender or receiver is down, the exchange will be disrupted.”

32

Centralized mechanism

The extent to which existing HIE systems are centralized

“HIE systems are mainly centralized, meaning that an organization has the final decision-making authorities.”

29

Care coordination

The extent to which existing HIE systems may not support care coordination among multiple entities

“Current HIE mechanisms could take some beneficiaries out of the loop, such as patients.”

25

Transparency of exchange platforms

The extent to which existing HIE mechanisms and their policies may not be transparent

“Sometimes, it is not clear why certain personal health information should be shared.”

23

Privacy and security

The extent to which existing HIE may not use technical security measures to protect health information

“Security safeguards of current HIE cannot 100% guarantee the privacy and confidentiality of data.”

21

Data quality

The extent to which existing HIE systems may not maintain the quality of healthcare data

“Lots of medical records in HIE databases are not useful because they are not current data or they may have missing values.”

20

Trusting relationships

The extent to which existing HIE systems rely on shaped trust in networks

“Now, sharing health information through HIE needs a huge amount of trust in recipients.”

16

Mutability of data

The extent to which health data can be altered and manipulated in existing HIE systems

“It is possible that the content of a health record is changed during sharing process with no notification.”

14