Adopting Health Information Exchanges (HIE) increased the exchange of clinical data relevant to patient care. This type of data exchange can reduce medical costs and increase efficiencies of care. However, most health care organizations and providers fail to reap the full intended benefits, as only 28% of health care organizations integrate external data into patients’ charts. Researchers, such as Hossein Ahmadi, Mark J. Dobrow, Nir Menachemi, and Farahnaz Sadoughi validate there is no shortage of literature available related to the adoption of HIE technology. However, no previous studies address adoption attributes for reconciling and integrating data into patients’ charts to address this gap, so this study uses a case study of a safety net hospital, Grady Hospital. This study draws on the Technology-Organization-Environment (TOE) framework, developed by Tornatzky and Fleischer in 1990, to determine adoption-related factors. As a result, this study offers a process model with detailed opportunities to increase reconciliation and integration of external clinical data. The detailed account demonstrates how the TOE framework remains relevant and applicable in the adoption of reconciling and integrating external clinical data.

Keywords: Continuity of Care Document (CCD), External Clinical Data, Health Information Exchange (HIE), Health care Information Technology (HIT), Interoperability, Merit-Based Incentive Payments System (MIPS), Promoting Interoperability (PI), Receiving and Incorporating Clinical Data, Technology-Organization-Environment (TOE) Framework