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System Analysis and Modeling of Electronic Health Information Exchange (HIE) Open Access

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The U.S. healthcare system is the largest and most complex system worldwide. Many aspects of it necessitate major reforming to improve the quality of care and efficiency, reduce redundancies, and to restructure the existing cost structure. The Health Information Exchange (HIE) was initiated in 2009 by the Health Information Technology for Economic and Clinical Health (HITECH) Act. HIE brings many benefits; reducing hospital readmissions, duplicative laboratory and radiology tests; improve care management and safety, avoid emergency department (ER) visits and adverse drug events. However, the HIE adoption is progressing slowly because of many barriers and challenges.The purpose of this research is to analyze the HIE system, examine barriers, challenges and influencing factors affecting the HIE adoption and design of new policy interventions. The main objective is to use the system thinking approach to analyze the HIE adoption cycle and to develop a framework that can be used by strategic thinkers in analyzing such a complex system. System dynamics (SD) methodology is utilized to develop qualitative and quantitative models along with statistical analysis. First, a qualitative causal loop model to understand the factors, variables and feedback loops affecting the HIE adoption. Second, a quantitative simulation model using real-world datasets to design policy interventions to accelerate HIE adoption and evaluate important HIE challenges graphically and statistically such as HIE financial value-added, sustainability, and return on investment. A case study in the State of Maryland’s HIE is introduced to validate the simulation model using the available datasets and the design experiments to address a set of research questions.

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