Abstract
Background: Despite the potential benefits of health information exchange ( HIE) and the two decades of efforts from the Canadian and the American governments to promote health exchange projects, failures far outnumber successes. Objective: To better understand the barriers influencing the adoption and implementation of inter-organization HIE systems in Canada and the USA. Method: A systematic literature review was conducted to examine English-language studies that identified barriers to HIE in Canada and the USA between 1995 and 2016. Electronic databases, backward searching and expert consultations were used. Results: 31 articles have been included. There is a dearth of publications reported on the HIE barriers in Canada. A total of 33 barriers have been identified. Conclusion: There are noticeable differences in the barriers reported in these countries. Privacy concerns and a lack of stakeholder buy-in are recurring barriers over time in the USA. Low adoption of electronic medical records is the main barrier in Canada.