Communications of the ACM

2015 for more than 180 hospitals across the state. We tested a structural model in which higher HIT investments would lead to increased adoption and use of EHR systems and HIEs that in turn would result in better health outcomes.d We tested the model using partial least squares software; for details, see the online appendix “ Research Methodology”; dl.acm.org/ citation.cfm?doid=3183583&picked= formats. In addition to our quantitative analyses, we conducted a series of semi-structured interviews with more than 20 healthcare professionals from 2013 to 2016 to explore their experience around adoption and use of HIT systems. Respondents included multiple classes of clinicians (such as private practitioners, hospital physicians, and nurse-practitioners), managers, and IT professionals. The interviews were transcribed and coded in NVivo software to identify common patterns and themes. 4

In general, we observed that in
New York State, 2014–2015, substan-
tial HIT investments led to the wide-
spread acquisition and use of EHR
systems, implementation of clinical
decision-support functionality, and
significant participation in HIEs.
Specifically, New York healthcare
providers implemented most EHR
functionalities classified as “basic”
(see Figure 1). On average, New York
hospitals implemented 5. 48 out of
six basic EHR functions (such as
electronic document viewing, results
viewing, CPOE, and decision sup-
port); and hospitals differ only by the
degree of implementation around
other advanced EHR functionalities
(such as barcode identification, tele-
health, mobile device connections).
Additionally, the number of new hos-
pitals joining local HIEs corresponds
to the surge in the state’s public
funding for HIT investment in 2008,
significantly augmented in 2015 and
2016 (see Figure 2).e As of 2018, over
80% of New York healthcare-provider
d Details of our research methodology is
provided in the online appendix “Re-
search Methodology”; dl.acm.org/citation.
cfm?doid=3183583&picked=formats
e These local HIEs received public grants from
New York State to increase information shar-
ing among hospitals; https://www.health.
ny.gov/technology/financial_investment.htm
dination among healthcare providers
across boundaries.c
To understand HIT effects among
New York healthcare providers, we
conducted a mixed-methods study us-
ing both quantitative and qualitative
approaches. Our quantitative analy-
ses used publicly available data from
New York HIEs, New York State web-
sites, and databases made available
by the not-for-profit American Hospi-
tal Association and the U.S. Centers
for Medicare and Medicaid Services.
The dataset covered the period 2014–
c https://www.healthit.gov/
in health information infrastructure.
In that time, a variety of initiatives
within the state have sought to fos-
ter information exchange, improve
quality and outcomes of care, reduce
healthcare costs, and engage con-
stituents in their care. 22 Specifically,
the state has focused on establishing
governance and policies that increase
participation in regional HIEs and
encourage EHR system adoption by
hospitals and individual providers.
These efforts align with federal HIT
meaningful-use initiatives aimed
at creating better management of
medical records and seamless coor-