Facilitators and barriers to use of the San Diego Community Information Exchange for cross-sector care coordination

Context: The health care sector is increasingly seeking to connect patients who experience socioeconomic needs to social services that can help address those needs. A number of technology tools are being developed to help support these cross-sector referrals. One of most well-developed examples of such a tool is the San Diego Community Information Exchange (CIE), a web-based tool developed by 2-1-1 San Diego in 2018 that enables San Diego providers from a range of sectors to share patient/client data and make referrals to each other.

Objective: To characterize use and value of the San Diego CIE and to identify facilitators and barriers to its use among health and human service organizations in San Diego in order to inform similar CIE efforts in other parts of the country.

Study Design and Analysis: Mixed methods study of CIE usage data and surveys and interviews of CIE users.

Setting or Dataset: San Diego, CA.

Population Studied: Leaders, managers, and front-line staff at health and social services organizations.

Intervention/Instrument: N/A

Outcome Measures: CIE usage metrics, reported impacts of CIE usage, reported value of the CIE, and reported facilitators and barriers to use.

Results: Use of the CIE has increased over time since its launch in 2018, with a pronounced spike in usage during the first few months of the COVID pandemic. Top users of the CIE include community health centers, housing organizations, child and family services organizations, and food aid organizations. CIE users report that the CIE enables them to spend less time understanding their clients’ needs and finding resources that meet clients’ needs and to avoid service duplication. Users reported using the CIE to understand patients’/clients’ histories of service use, to locate clients, to search for relevant services, and to make and receive electronic referrals. Facilitators of usage include having a clear use case and an organizational culture that is comfortable with sharing client data outside the organization. Barriers to use include perceptions that the resource directory is not always up-to-date and concerns about data privacy (particularly salient for substance use and mental health organizations).

Conclusions: Although use of the San Diego CIE by organizations across a range of sectors continues to grow, concerns about privacy and the accuracy of resource information as well as uncertain value propositions remain obstacles to broader and more sustained use.