Policy initiatives for Health Information Technology: A qualitative study of U.S. expectations and Canada's experience

Objective: To investigate lessons learned from national policy initiatives in Canada and U.S. with respect to health information technical infrastructure, data standards, and interoperability; and to identify the implications of these lessons for other policy makers, as they guide the future of their own healthcare information technology initiatives. Materials and methods: We performed semi-structured interviews with key opinion leaders including health care professionals, chief information officers, and vendors - 29 in Canada and 31 in the U.S., regarding Health Information Technology policy. The informant sample was chosen to provide views from different stakeholder groups, and included both national and regional representation - three Canadian provinces and three U.S. states. A grounded theory approach was used to analyze the data gathered through the interviews. Results: The informants identified the following key components of successful health IT policy: (1) enables an iterative-incremental management approach to both technology and data standards, (2) addresses the issues around meaningful use and investment already made in existing legacy health IT systems; and (3) capitalizes on the value of data for use in performance and quality measures, public health and research. Conclusions: Our study has found that successful health information exchange depends on policies that set clear goals and outline intended effects of HIT implementation without being overly prescriptive, and defines frameworks for guiding policy improvement in a continual and systematic manner. The success of health information exchange also depends on the ability to manage an iterative-incremental approach to technology and data standards, starting from small data sets with high impact on specific care and then gradually expanding toward more comprehensive data sets with an increased emphasis on secondary uses of data.