Study Suggests Use of Electronic Health Information Exchange may Reduce Emergency Department Utilization

BACKGROUND:
Healthcare providers are increasingly sharing clinical data with other providers who care for the same patients by using electronic health information exchange (HIE). In the United States, more than 100 organizations facilitate HIEs among provider organizations, as well as 30% of hospitals and 10% of ambulatory clinics. The use of HIE also is encouraged by financial incentives created by the Health Information Technology for Economic and Clinical Health Act of 2009, with nearly $600 million in federal funding designated to support statewide HIE organizations. Investigators in this study conducted a systematic review of the HIE literature, specifically examining the evidence of effect on health outcomes, healthcare use and efficiency, evidence of clinicians' use of HIE, and the financial sustainability of HIE organizations. Investigators also evaluated evidence about patient and provider attitudes toward HIE, as well as barriers and facilitators to its use. Selected databases were searched for relevant studies published between 1/03 and 5/14: 85 papers were identified that addressed study questions, including 12 hypothesis-testing studies that assessed the effect of an HIE organization.

FINDINGS:

• Using electronic health information exchange may reduce emergency department (ED) usage and costs. Of the HIEs that have been evaluated, low-quality evidence from 12 hypothesis-testing studies supports an effect of HIE use on reduced use or costs in the ED. The effects of HIE on other healthcare outcomes are uncertain.
• The use of HIE is low relative to the estimated potential need, with most studies reporting use in 2% to 10% of healthcare encounters. However, some sites reported much greater HIE use, and specifics of the context and implementation may be responsible for these differences.
• All stakeholders claim to value HIE, but many barriers to acceptance and sustainability exist, including workflow and interface issues, privacy and security of patient health information, and the lack of a compelling business case for sustainability.

LIMITATIONS:

• This review was limited to evaluations that have appeared in published or gray literature.
• Most of the published studies in this review had methodological issues in terms of their study design, response rates, and generalizability of the enrolled sample.
• This review is limited to what was reported in the published studies, which also were limited to those conducted within the United States.

IMPLICATIONS:
Investigators suggest identifying 2-4 VA sites where there is local interest in developing an HIE with other local providers, provide start-up money to try and test, and conduct side-by-side evaluations of the barriers and challenges and how they were overcome.

AUTHOR/FUNDING INFORMATION:
Drs. Goldzweig and Shekelle are part of HSR&D's Center for the Study of Healthcare Innovation, Implementation and the VA Greater Los Angeles Healthcare System.

Rudin R, Motala A, Goldzweig C, and Shekelle P. Usage and Effect of Health Information Exchange. Annals of Internal Medicine. December 2, 2014;161(11):803-811.