Whether health information exchanges are contributing to healthcare cost savings and quality improvements still needs to be independently confirmed, a team of researchers from the RAND Corp. has concluded after a review of published studies. A few notable exceptions do stand out, the study also found.
Some studies that looked at cost savings stemming from health information exchange use in hospital emergency departments, for example, indicated HIEs contributed to reduced utilization or costs, the report authors said.
But their search of more than 1,300 published studies and other documents found the effects of health information exchanges on other healthcare outcomes were “insufficiently evaluated to draw conclusions.”
Only 14 HIEs, out of about 100 in operation, have had independent research done to validate whether the HIEs were even being used by providers, said Robert Rudin, an associate policy researcher at RAND and an instructor at Harvard Medical School.
“If HIE was a proven technology and provider process, maybe 14 would be enough, but after so many years, we still don't have a good idea what a successful HIE would look like and how to get there,” said Rudin, the lead author of “Usage and effect of health information exchange: A systemic review,” published online in the Annals of Internal Medicine.
Closing the research gap for HIEs “would be a challenge,” Rudin said. “All these operational HIEs, all of them, should be studied. Some of them may be doing a really great job, but we really don't know.”
The RAND researchers found that many of the studies done were on HIEs based in New York, where state government preceded the feds in funding HIE development.
Typical rates of HIE access and utilization ranged from 2% to 10% of visits, although one New York HIE studied had 60% of patients at one site having their data accessed through an HIE, the RAND report noted.
Those providers who use HIEs say they value them, but “many barriers to acceptance and sustainability exist,” the authors said. Those include workflow and interface problems, privacy and security issues and “the lack of a compelling business case for sustainability.”
“There is not a lot of material” on HIE efficacy research, said Will Ross, founding project manager of Redwood MedNet, a regional health information exchange in Ukiah, Calif. For some existing exchanges, tight budgets leave little money to fund efficacy studies, Ross said.
One of the studies reviewed by RAND found a correlation between state health disclosure laws and the number of operational HIEs, noting that “states that had laws requiring authorization from patients before the disclosure of health information were more likely to have operational HIEs.”
New York state government required a portion of its HIE grants to be spent on research for HIE efficacy, said David Whitlinger, executive director of the New York eHealth Collaborative, which runs the Statewide Health Information Network of New York.
For example, Whitlinger pointed to a study by researchers at Weill Cornell Medical College. Those researchers found that emergency department physicians at hospitals that were members of the Rochester Regional Health Information Organization were less likely to admit patients to the hospital when they had access to their patients' medical records, facilitated by the local HIE.
But outcomes research on health information exchanges in some other care settings will be much harder to conduct, he said.
“I think when it comes to efficacy because of team-based care, the HIE is going to be a necessary tool, but the quality improvement, is not going to be based just on HIE,” said Whitlinger. “It would be difficult to peel out the HIE requirement out of it.”
The RAND study was funded by the Veterans Affairs Department. It sought evidence of the effect of HIEs on health outcomes, healthcare utilization and efficiency, usage levels of HIEs by clinicians, and the financial stability of exchanges. The researchers also looked at reports on patient and provider attitudes toward health information exchange and external barriers and facilitators of data exchange.
The federal government has funneled more than $560 million to the states to promote the development of local, regional and statewide health information exchanges since passage of the American Recovery and Reinvestment Act in 2009.
The massive cash flow has had some effect, according to a recent report by Erica Galvez, the interoperability guru at the Office of the National Coordinator for Health Information Technology at HHS. It found that more than 226 million “directed” electronic transactions flowed through HIEs between the second quarter of 2012 and the fourth quarter of 2013.
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