The Effects of Health Information Exchange Access on Healthcare Quality and Efficiency: An Empirical Investigation

Abstract

Health Information Exchanges (HIEs) are designed to improve the efficiency and quality of healthcare through enhanced information sharing between disparate health entities. The objective of this study is to systematically examine the impact of HIE use in emergency departments (EDs) on quality and efficiency of medical care. We focus on two dimensions of healthcare quality, namely length of stay and 30-day readmission rate. From hospitals’ efficiency perspective, we examine if HIE access reduces the likelihood that more than one doctor would be consulted for a treatment. Drawing on complementarity theory, we adopt a contingency framework and examine the moderating role of patient-specific prior information (breadth of focal patient’s information and prior interaction between a focal patient and attending doctor) and doctor’s experience with the HIE on the effectiveness of HIE access on quality and efficiency of medical care. To accomplish our objectives, we leverage a unique panel data of actual HIE access by physicians who practice in a hospital system that participate in an HIE. The individual patient-level dataset comprises detailed medical provider information, patient-level medical information, and various other information related to procedures that were performed. Leveraging this unique and comprehensive data on physicians’ access of HIE system, we examine the effect of HIE use on the three outcome variables. After controlling for a battery of patient-specific, doctor-specific, and hospital-specific control variables, our results show that HIE access in EDs results in reduction in length of stay and 30-day readmission rate, and reduces the likelihood that more than one doctor would be consulted. We find that the benefits of HIE access are greater with greater breadth of patient information, greater experience of the attending physician with the HIE, and prior interaction between the focal patient and focal attending doctor. We account for endogeneity due to self-selection in HIE use and perform additional tests to ensure that our results are robust. Based on our results, we offer insights to practitioners and academicians alike on how adopting and sustaining HIE can yield better patient-level and provider-level outcomes.