The Value of Health Information Technology Interoperability: Evidence from Interhospital Transfer of Heart Attack Patients

Abstract

Problem definition: Health information technology (HIT) interoperability refers to the ability of different electronic health record systems and software applications to communicate, exchange data, and use the information that has been exchanged. The U.S. Government has invested heavily to promote HIT interoperability in recent years in an attempt to improve patient outcomes and control healthcare expenditure. This study empirically assesses the value of HIT interoperability in the interhospital transfer process of heart attack patients. Academic/practical relevance: HIT interoperability is supposed to enable health information exchange between disparate providers. However, there exists little evidence about how it affects care delivery processes across providers. Methodology: Using transfer records of heart attack patients and HIT interoperability adoption records of hospitals in New York State between 2013 and 2015, we estimate the effect of HIT interoperability on care delivery process measures and patient outcome measures. We demonstrate the robustness of the results with alternative samples and model specifications, including the instrumental variable method, the propensity score matching method, the difference-in-differences method, and a falsification test. Results: We show that HIT interoperability shortens the throughput time of interhospital transfer by 45.6 minutes on average or 12.0%. Surprisingly, we find that HIT interoperability has little effect in reducing duplicate electrocardiogram (EKG) testing for transferred patients at receiving hospitals. When HIT interoperability is enabled through a common software vendor, it yields 15.6% more reduction in the throughput time than when it is enabled through different vendors, but it still has no significant effect on duplicate EKG testing. Furthermore, we find that HIT interoperability leads to a 3.0-percentage point decrease in the 30-day readmission rate of transferred patients, which can be explained by the reduction in the throughput time. Managerial implications: Our findings demonstrate the value of incentivizing HIT adoption and promoting widespread exchange of health information because HIT interoperability indeed improves the efficiency of healthcare delivery across providers, which ultimately translates to improved patient outcomes. Given the lack of reduction in duplicate testing in our study, we call for more provider effort toward realizing the full potential of HIT interoperability by minimizing the gap between technology adoption and utilization.