All ETDs from UAB

Advisory Committee Chair

S Robert Hernandez

Advisory Committee Members

Darrell E Burke

Sue S Feldman

Nataliya V Ivankova

Amy Y Landry

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) School of Health Professions


As the health care sector faces pressure to improve quality and contain costs, sharing information among the various care providers will become an essential practice among health care providers. Many countries are now adopting policies to foster Health Information Exchange (HIE), which is defined as the electronic transfer of data or information among health care organizations involved in the delivery of care. The literature about HIE reports contradictory evidence about the adoption and the use of HIE and more research is needed to understand this complex phenomenon. Specifically, HIE is a complex phenomenon that produces outcomes at different levels and to completely understand the complexity of the decision of exchanging information, a single-level perspective (international policies, national trends, or organizational strategies) is not sufficient. By using multilevel lenses in this type of management research, a more comprehensive understanding of this type of complex phenomena can be provided. To successfully perform multilevel research, researchers need to integrate quantitative and qualitative methodologies to fully explore the studied phenomenon. Therefore, this dissertation study aims at investigating at three different levels of analysis (international, national, organizational) what factors affect HIE. Starting from the higher level of analysis policy and the experiences surrounding the adoption of HIE in one country can be explained in a more comprehensive and integrated manner through a comparison of countries that have adopted similar policies. Therefore, the first phase of this study, after identifying a taxonomy of health systems, analyzes institutional and resource-based factors related to HIE adoption, and how they differ in three main types of health systems. Based on the findings of the first phase, the second phase quantitatively analyzes one of the elements identified, studying HIE in the context of bundled payment reimbursement in the United States. To better understand the results about the national trends, the third phase analyzes what factors influence HIE at the organizational level. The integrated conclusions of this study reveal different factors that affect HIE according to the perspective of analysis, confirming the necessity to perform multilevel research to obtain a comprehensive understanding of complex phenomena such as HIE.



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