Health Information Exchange Adoption Research Articles

Impact of Perceived Barriers of Electronic Health Information Exchange on Physician’s Use of EHR: A Normalisation Process Theory Approach

AbstractDigitizing healthcare is a major aim of healthcare policy, with efforts aimed at increasing adoption of electronic health records (EHRs). We study the capability use for EHRs through the lens of normalisation process theory to assess whether these barriers to adoption also remain barriers to sustained use. We focus on health information exchange (HIE), which is one of the most challenging capabilities identified in the literature. We analyse the National Electronic Health Records Survey data, in which physicians were asked whether known HIE adoption barriers remain in place, and how frequently they use HIE capabilities. Though we expect that adoption barriers reported to be less problematic will be associated with greater capability use, we found that adoption barriers perceived to be more (less) problematic were not necessarily those that predicted less (greater) capability use. This study contributes through a critical examination of the process of normalization of EHR capabilities.

Data Consistency of Two National Registries in Iran: A Preliminary Assessment to Health Information Exchange.

The National Spinal Cord Injury Registry of Iran (NSCIR-IR) and the National Trauma Registry of Iran (NTRI) were established to meet the data needs for research and assessing trauma status in Iran. These registries have a group of patients shared by both registries, and it is expected that some identical data will be collected about them. A general question arises whether the spinal cord injury registry can receive part of the common data from the trauma registry and not collect them independently. We examined variables captured in both registries based on structure and concept, identified the overlapping period during which both systems recorded data in the same centers and extracted relevant data from both registries. Further, we evaluated the data for any discrepancies in amount or nature and pinpointed the underlying reasons for any inconsistencies. Out of all the variables in the NSCIR-IR database, 18.6% of variables were similar to the NTRI in terms of concept and structure. Although four hospitals participated in both registries, only two (Sina and Beheshti Hospitals) had common cases. Patient names, prehospital intubation, ambulance arrival time, ICU length of stay, and admission time were consistent across both registries with no differences. Other common data variables had significant discrepancies. This study highlights the potential for health information exchange (HIE) between NSCIR-IR and NTRI and serves as a starting point for stakeholders and policymakers to understand the differences between the two registries and work toward the successful adoption of HIE.

Barriers to Health Information Exchange Among Ambulatory Physicians: Results From a Nationally Representative Sample.

Health information exchange (HIE) improves healthcare quality, but is underutilized by providers. This study used a nationally representative survey of ambulatory physicians to examine barriers to HIE, and identify which barriers have the greatest impact on providers' use of HIE. A pooled sample of 1,292 physicians from the 2018-2019 National Electronic Health Record Survey was used. Univariate statistics described rates and patterns of eight common barriers to HIE. Multivariate logistic regression examined the relationship between each barrier and the use of HIE. Barriers to HIE were common and diverse. Negative attitudes toward HIE's ability to improve clinical quality significantly decreased HIE use (OR = .44, p < .01). To increase adoption of HIE, efforts should focus on addressing providers' negative attitudes toward HIE. These findings can guide targeted implementation strategies to improve HIE adoption.

Health Information Exchange: Understanding the Policy Landscape and Future of Data Interoperability.

To review recent literature on health information exchange (HIE), focusing on the policy approach of five case study nations: the United States of America, the United Kingdom, Germany, Israel, and Portugal, as well as synthesize lessons learned across countries and provide recommendations for future research. A narrative review of each nation's HIE policy frameworks, current state, and future HIE strategy. Key themes that emerged include the importance of both central decision-making as well as local innovation, the multiple and complex challenges of broad HIE adoption, and the varying role of HIE across different national health system structures. HIE is an increasingly important capability and policy priority as electronic health record (EHR) adoption becomes more common and care delivery is increasingly digitized. While all five case study nations have adopted some level of HIE, there are significant differences across their level of data sharing infrastructure and maturity, and each nation took a different policy approach. While identifying generalizable strategies across disparate international systems is challenging, there are several common themes across successful HIE policy frameworks, such as the importance of central government prioritization of data sharing. Finally, we make several recommendations for future research to expand the breadth and depth of the literature on HIE and guide future decision-making by policymakers and practitioners.

Health Information Exchange Adoption and Patient Satisfaction: The Mediating Role of Organizational Efficiency

Health Information Exchange Adoption and Patient Satisfaction: The Mediating Role of Organizational Efficiency

Associations Between Physician Practice Models and Health Information Exchange

The interaction between emerging physician practice models and the use of health information exchange (HIE) remains understudied. We examined associations between the use of emerging practice models and the use of HIE. We also examined barriers to HIE adoption among physicians who were not utilizing HIE. Survey data came from a 2019-2021 statewide census of all physicians in Arizona collected at the time of license renewal (n = 3312, or 17.9% of all practicing physicians). Primary outcomes were physician-reported HIE use for patient care summaries and for laboratory results. Secondary outcomes were 5 common HIE barriers among non-HIE users. The primary predictor was physician practice model: accountable care organization (ACO), clinically integrated network (CIN), or integrated delivery network (IDN) vs traditional care delivery model. Covariates included physician specialty, age, gender, and county of practice. Compared with physicians in traditional care delivery models, physicians in ACOs, CINs, or IDNs had significantly higher odds of using HIE to share both patient care summaries (P < .01) and laboratory results (P < .05 for ACOs), although associations varied across provider and practice characteristics. ACO providers not using HIE were more likely to cite a lack of connectivity and lack of information as HIE barriers. Providers in an emerging practice model are more likely to use HIE than those in a traditional care delivery model. However, nuances in these associations suggest a persistence of previously identified HIE gaps, and the barriers cited provide guidance for increasing HIE use among different practice types.

Identification of barriers affecting the use of health information exchange (HIE) in clinicians' practices: An empirical study in the United States

Health information exchange (HIE) programs as a policy subject in several developed countries can enable sharing of adequate and accurate information across providers and healthcare organizations to improve care coordination. However, besides the expected benefits of participating in HIE in enhancing coordination, reducing costs, and improving patient safety, previous studies report that clinicians' rate of using HIE mechanisms is still low. Insufficient participation of clinicians in data exchange networks can diminish the value of HIE. Based on utility theory, this study aims to identify and categorize barriers associated with the implementation of HIE projects in healthcare organizations and develop a comprehensive model to empirically examine the effects of HIE inhibitors on clinicians' intention to engage in HIE networks. Data was collected using an online survey from 318 clinicians working in different healthcare settings in the United States. Results show that internal inhibitors (including technological and organizational barriers) and external inhibitors (including partners, patients, vendors, and legal barriers) strongly influence clinicians' intention to engage in HIEs. Taking an integrated approach, this study can contribute to the existing literature by providing a more informed way of conceptualizing and explaining HIE adoption in healthcare organizations. The findings can help HIE decision-makers, healthcare organizations, and providers to identify key HIE inhibitors and take corrective actions to address them. Addressing both internal and external inhibitors would increase the likelihood of widespread implementation of HIEs in different healthcare settings and facilitate interoperability and connectivity in regional and community health information networks.

Rapid adoption of electronic health record and health information exchange among assisted living communities, 2010-2018.

Adoption of electronic health records (EHRs) and health information exchange (HIE) is a key tool to improving the quality of care in assisted living communities (ALC). We examined whether EHRs were being used in ALC to support HIE in 2010 and 2018. We found that adoption of EHR and HIE functions increased substantially over the study period. However, adoption of HIE functions lagged significantly behind EHR functions in both 2010 and 2018 and was accompanied by growing disparities in the adoption of EHR functions among smaller, nonchain, and for-profit communities. To improve the quality of care for this important and growing population, targeted policies are needed to support the adoption of both EHR and HIE functions in ALC.

Hospital SUD Programs, Psychiatric Hospitals Lag in Electronic Health Record Use

Hospital SUD Programs, Psychiatric Hospitals Lag in Electronic Health Record Use

Use of Electronic Health Information Technology in a National Sample of Hospitals That Provide Specialty Substance Use Care.

Most U.S. acute care hospitals have adopted basic electronic health record (EHR) functionality and health information exchange (HIE) (84% and 88%, respectively, in 2017). This study examined whether rates of EHR and HIE adoption by hospital-based substance use disorder programs are lower than rates by acute care hospitals. Data from the 2017 National Survey on Substance Abuse Treatment Services were analyzed to examine adoption of basic EHR functionality (i.e., assessment, progress monitoring, discharge, labs, and prescription dispensing) and use of HIE by hospital-based programs. Analyses used weighted multivariable models of EHR and HIE outcomes, adjusted for nonresponse. Of 894 hospital-based substance use disorder programs with EHR information, two-thirds (N=606, 68%) reported use of basic EHR functionality. Psychiatric hospitals were less likely than acute care hospitals to have adopted EHR (odds ratio [OR]=0.49, 95% confidence interval [CI]=0.35-0.71). Compared with nonprofit hospitals, for-profit (OR=0.23, 95% CI=0.16-0.35) and government-owned (OR=0.52, 95% CI=0.33-0.83) hospitals were less likely to use basic EHR functionality. Hospital-based programs providing medications for alcohol or opioid use disorders were more likely than those not providing such medications to use basic EHR (OR=1.95, 95% CI=1.31-2.90). Of 839 hospitals with information on HIE use, 598 (71%) reported using electronic HIE. Adoption of basic EHR functionality was the strongest predictor of HIE use (OR=4.73, 95% CI=3.29-6.79). Hospital-based substance use disorder programs trail behind U.S. acute care hospitals in adoption of basic EHR and electronic HIE. Findings raise concerns about missed opportunities to improve hospital-based substance use disorder care quality and performance measurement.

Impacts of Patient Characteristics and Care Fragmentation on the Value of HIEs

We investigate the impact of health information exchange (HIE) use at the visit level on patient outcomes, such as future visit behavior and the number of procedures performed on the patient, and how the effects differ across patient and visit characteristics, for example, whether a patient has chronic conditions and whether a visit involves a hospital switch. Timely sharing of patient information is expected to decrease the fragmentation of care and improve decision‐making, diagnoses, and care plans, yet previous studies that examine the benefits of HIE use do not focus on these issues and are not unanimous in their findings in general about the benefits of HIEs. Further, prior studies generally focus on average effects with binary HIE measures, either using HIE adoption at the hospital level or whether HIE is accessed at the visit level. We argue that the benefits of HIE stem from the information contained within and are not equal across cases. We utilize a rich dataset of medical records from an HIE provider in New York. Our results show that the depth of information available for the patient in HIE use decreases the overall number of future visits, specifically, HIE use effectively reduces visits that are not preventative in nature while increases adherence to preventative care visits, aiding in the shift from treatment‐based care to preventative‐based care, that public health organizations have urged for. Further, HIE use lowers the number of procedures done at the focal visit. We have several other findings that have important implications for policymakers, healthcare providers, and patients.

Practice and market factors associated with provider volume of health information exchange.

To assess the practice- and market-level factors associated with the amount of provider health information exchange (HIE) use. Provider and practice-level data was drawn from the Meaningful Use Stage 2 Public Use Files from the Centers for Medicare and Medicaid Services, the Physician Compare National Downloadable File, and the Compendium of US Health Systems, among other sources. We analyzed the relationship between provider HIE use and practice and market factors using multivariable linear regression and compared primary care providers (PCPs) to non-PCPs. Provider volume of HIE use is measured as the percentage of referrals sent with electronic summaries of care (eSCR) reported by eligible providers attesting to the Meaningful Use electronic health record (EHR) incentive program in 2016. Providers used HIE in 49% of referrals; PCPs used HIE in fewer referrals (43%) than non-PCPs (57%). Provider use of products from EHR vendors was negatively related to HIE use, while use of Athenahealth and Greenway Health products were positively related to HIE use. Providers treating, on average, older patients and greater proportions of patients with diabetes used HIE for more referrals. Health system membership, market concentration, and state HIE consent policy were unrelated to provider HIE use. HIE use during referrals is low among office-based providers with the capability for exchange, especially PCPs. Practice-level factors were more commonly associated with greater levels of HIE use than market-level factors. This furthers the understanding that market forces, like competition, may be related to HIE adoption decisions but are less important for use once adoption has occurred.

Health information exchange adoption: influences of public insurance programs

For many years, the US Government has pushed the adoption of health information exchange (HIE), which is a key to spur large-scale innovation in the healthcare delivery. As funding has diminished, ...

Health information exchange adoption: influences of public insurance programs

Health information exchange adoption: influences of public insurance programs

Hospital adoption of multiple health information exchange approaches and information accessibility

Hospital engagement in electronic health information exchange (HIE) has increased over recent years. We aimed to 1) determine the change in adoption of 3 types of information exchange: secure messaging, provider portals, and use of an HIE; and 2) to assess if growth in each approach corresponded to increased ability to access and integrate patient information from outside providers. Panel analysis of all nonfederal, acute care hospitals in the United States using hospital- and year-fixed effects. The sample consisted of 1917 hospitals that responded to the American Hospital Association Information Technology Supplement every year from 2014 to 2016. Adoption of each approach increased by 9-15 percentage points over the study period. The average number of HIE approaches used by each hospital increased from 1.0 to 1.4. Adoption of each approach was associated with increased likelihood that providers routinely had necessary outside information of 4.2-12.7 percentage points and 4.5-13.3 percentage points increase in information integration. Secure messaging was associated with the largest increase in both. Adoption of 1 approach increased the likelihood of having outside information by 10.3 percentage points, while adopting a second approach further increased the likelihood by 9.5 percentage points. Trends in number of approaches and integration were similar. No single HIE tool provided high levels of usable, integrated health information. Instead, hospitals benefited from adopting multiple tools. Policy initiatives that reduce the complexity of enabling high value HIE could result in broader adoption of HIE and use of information to inform care.

The Impacts of the Perceived Transparency of Privacy Policies and Trust in Providers for Building Trust in Health Information Exchange: Empirical Study.

BackgroundIn the context of exchange technologies, such as health information exchange (HIE), existing technology acceptance theories should be expanded to consider not only the cognitive beliefs resulting in adoption behavior but also the affect provoked by the sharing nature of the technology.ObjectiveWe aimed to study HIE adoption using a trust-centered model. Based on the Theory of Reasoned Action, the technology adoption literature, and the trust transfer mechanism, we theoretically explained and empirically tested the impacts of the perceived transparency of privacy policy and trust in health care providers on cognitive and emotional trust in an HIE. Moreover, we analyzed the effects of cognitive and emotional trust on the intention to opt in to the HIE and willingness to disclose health information.MethodsA Web-based survey was conducted using data from a sample of 493 individuals who were aware of the HIE through experiences with a (or multiple) provider(s) participating in an HIE network.ResultsStructural Equation Modeling analysis results provided empirical support for the proposed model. Our findings indicated that when patients trust in health care providers, and they are aware of HIE security measures, HIE sharing procedures, and privacy terms, they feel more in control, more assured, and less at risk. Moreover, trust in providers has a significant moderating effect on building trust in HIE efforts (P<.05). Results also showed that patient trust in HIE may take the forms of opt-in intentions to HIE and patients’ willingness to disclose health information that are exchanged through the HIE (P<.001).ConclusionsThe results of this research should be of interest to both academics and practitioners. The findings provide an in-depth dimension of the HIE privacy policy that should be addressed by the health care organizations to exchange personal health information in a secure and private manner. This study can contribute to trust transfer theory and enrich the literature on HIE efforts. Primary and secondary care providers can also identify how to leverage the benefit of patients’ trust and trust transfer process to promote HIE initiatives nationwide.

Health systems' use of enterprise health information exchange vs single electronic health record vendor environments and unplanned readmissions.

Enterprise health information exchange (HIE) and a single electronic health record (EHR) vendor solution are 2 information exchange approaches to improve performance and increase the quality of care. This study sought to determine the association between adoption of enterprise HIE vs a single vendor environment and changes in unplanned readmissions. The association between unplanned 30-day readmissions among adult patients and adoption of enterprise HIE or a single vendor environment was measured in a panel of 211 system-member hospitals from 2010 through 2014 using fixed-effects regression models. Sample hospitals were members of health systems in 7 states. Enterprise HIE was defined as self-reported ability to exchange information with other members of the same health system who used different EHR vendors. A single EHR vendor environment reported exchanging information with other health system members, but all using the same EHR vendor. Enterprise HIE adoption was more common among the study sample than EHR (75% vs 24%). However, adoption of a single EHR vendor environment was associated with a 0.8% reduction in the probability of a readmission within 30 days of discharge. The estimated impact of adopting an enterprise HIE strategy on readmissions was smaller and not statically significant. Reductions in the probability of an unplanned readmission after a hospital adopts a single vendor environment suggests that HIE technologies can better support the aim of higher quality care. Additionally, health systems may benefit more from a single vendor environment approach than attempting to foster exchange across multiple EHR vendors.

The associations between query-based and directed health information exchange with potentially avoidable use of health care services.

To quantify the impact of two approaches (directed and query-based) to health information exchange (HIE) on potentially avoidable use of health care services. Data on ambulatory care providers' adoption of HIE were merged with Medicare fee-for-service claims from 2008 to 2014. Providers were from 13 counties in New York served by the Rochester Regional Health Information Organization (RHIO). Linear regression models with provider and year fixed effects were used to estimate changes in the probability of utilization outcomes for Medicare beneficiaries attributed to providers adopting directed and/or query-based HIE compared with beneficiaries attributed to providers who had not adopted HIE. Providers' HIE adoption status was determined through Rochester RHIO registration records. RHIO and claims data were linked via National Provider Identifiers. Query-based HIE adoption was associated with a 0.2 percentage point reduction in the probability of an ambulatory care sensitive hospitalization and a 1.1 percentage point decrease in the likelihood of an unplanned readmission. Directed HIE adoption was not associated with any outcome. The Centers for Medicare & Medicaid Services' (CMS) EHR certification criteria includes requirements for directed HIE, but not query-based HIE. Pending further research, certification criteria should place equal weight on facilitating query-based and directed exchange.

Local health department adoption of electronic health records and health information exchanges and its impact on population health

ObjectiveTo determine the impact in the adoption of electronic health records and health information exchanges by local health departments on population health. MethodsThe study analyzed 433 local health departments population-based data across 433 counties in the United States. Controlling for high school graduation rate, percentage of adults with some post- secondary education, race, median household income, percentage rural, population size served, governance structure of local health departments and revenue, the study used multiple linear regression to analyze the impact in the adoption of health information technology by local health departments on the population health of a county. ResultsElectronic health records adoption was statistically significant at improving population health at the county level. Health information exchange adoption was not statistically significant. ConclusionWhen local health departments adopt electronic health records, it improves health- related quality of life and reduces years of potential life lost. Policy implicationsThe value derived from the adoption of electronic health records by local health departments deserves attention because of its abilities to enhance the services provided at local health departments. It is important for local health departments to use health information technology to electronically capture patient information to improve upon the services received at community health centers.

The Value of Health Information Exchange Use for Chronic Disease Management

In this paper, we investigate the impact of health information exchange (HIE) use at the visit-level on patient outcomes, such as readmissions, length of stay, and the number of procedures. Built upon the theories of inter-organizational information sharing and transaction cost economics, we argue that the timely sharing of patient information can decrease fragmentation of care and improve decision-making, diagnoses, and care plans. The studies that examine the benefits of HIE use are not unanimous in their findings and generally limited to average effects with binary HIE measures, either using HIE adoption at the hospital-level or HIE access at the visit- level. The goal of this research is to get a deeper understanding by using a continuous measure that captures information depth of HIE in each use and investigate the benefits of HIE by patient characteristics (such as having a chronic condition) and patient movements between hospitals. We utilize a rich dataset of medical records from an HIE provider in New York. Our results show that the depth of information available for the patient in HIE use decreases future readmissions and the number of future visits, and these effects are significantly stronger for chronic patients compared to non-chronic patients. Further, HIE use lowers the length of stay and number of procedures done at the focal visit. The benefits for chronic patients generally accrue to both their chronic and non-chronic visits. Additionally, while hospital switches are associated with care fragmentation such as longer length of stay and more procedures being performed, we show that HIE use could effectively address these inefficiencies and reverse their effects, leading to overall net benefits. Results from this study have important implications for policymakers, healthcare providers, and patients.