Community Health Information Exchange Research Articles

Directly Integrating Health Information Exchange (HIE) Data with the Electronic Health Record Increases HIE Use by Emergency Department Clinicians

Abstract Objectives This article (1) develops a Fast Healthcare Interoperability Resources app, Health Dart, that integrates information from Indiana's community health information exchange (HIE), the Indiana Network for Patient Care (INPC), directly with Cerner, an electronic health record (EHR), and (2) evaluates the effect of Health Dart's implementation on HIE use. Methods Health Dart was implemented in 14 Indiana University Health emergency departments (EDs) using a stepped-wedge study design. We analyzed rates of INPC use in 286,175 ED encounters between October 1, 2019 and December 31, 2020. Logistic regression was used to model the probability of INPC use given the implementation context, such as user interface (UI) enhancements and the coronavirus disease 2019 pandemic. Results INPC use increased by 131% across all encounters (from 3.6 to 8.3%; p < 0.001) after Health Dart implementation. INPC use increased by 144% (from 3.6 to 8.8%; p < 0.001) more than 2 months postimplementation. After UI enhancements, postimplementation INPC use increased by 123% (from 3.5 to 7.8%) compared to 181% (from 3.6 to 10.1%; p < 0.001) in postimplementation encounters that occurred before UI enhancements. During the pandemic, postimplementation INPC use increased by 135% (from 3.4 to 8.0%; p < 0.001) compared to 178% (from 3.6 to 10%; p < 0.001) in postimplementation encounters that occurred before the pandemic. Statistical significance was determined using 95% confidence intervals (α = 0.05). Conclusion Direct integration of HIE information into an EHR substantially increased frequency of HIE use, but the effect was weakened by the UI enhancements and pandemic. HIE information integrated into EHRs in the form of problem-oriented dashboards can potentially make information retrieval more efficient and effective for clinicians.

The Impact of Community Health Information Exchange Usage on Time to Reutilization of Hospital Services.

Few studies have determined whether clinician usage of a community health information exchange (HIE) directly improves patient care transitions. We hypothesized that lookup in the HIE by primary care physicians of patients recently released from the hospital would increase the time until hospital reuse. We identified a retrospective cohort of 8,216 hospital inpatients aged over 18 years that were discharged from January 1, 2021 through November 30, 2021 using the Paso del Norte Health Information Exchange, in El Paso County, Texas. All patients had a primary care physician visit within 30 days after hospital discharge, and we identified patients that were looked up in the HIE close to that visit. Of the cohort, 2,627 were rehospitalized and 3,809 visited an emergency department (ED) during the follow-up window. The remaining 1,780 patients were controls. We conducted survival analysis, censoring at the second ED or inpatient visit or end of the study window (January 31, 2022). The model was adjusted by ethnicity, gender, insurance, and age. Lookup in the HIE was significantly associated with reducing the likelihood of visiting the ED by 53% and being rehospitalized by 61%. Lookup in the HIE was associated with an increased median time to use of the ED after inpatient discharge from 99 to 238 patient days. Ethnicity, insurance, gender, and age were also significant predictors of hospital reuse. Increased utilization of community HIEs by primary care physicians on behalf of their recently discharged patients may dramatically increase the time until inpatient or ED reuse.

Towards Estimating Childhood Obesity Prevalence Using Electronic Health Records

Towards Estimating Childhood Obesity Prevalence Using Electronic Health Records

The benefits of health information exchange: an updated systematic review.

Widespread health information exchange (HIE) is a national objective motivated by the promise of improved care and a reduction in costs. Previous reviews have found little rigorous evidence that HIE positively affects these anticipated benefits. However, early studies of HIE were methodologically limited. The purpose of the current study is to review the recent literature on the impact of HIE. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct our systematic review. PubMed and Scopus databases were used to identify empirical articles that evaluated HIE in the context of a health care outcome. Our search strategy identified 24 articles that included 63 individual analyses. The majority of the studies were from the United States representing 9 states; and about 40% of the included analyses occurred in a handful of HIEs from the state of New York. Seven of the 24 studies used designs suitable for causal inference and all reported some beneficial effect from HIE; none reported adverse effects. The current systematic review found that studies with more rigorous designs all reported benefits from HIE. Such benefits include fewer duplicated procedures, reduced imaging, lower costs, and improved patient safety. We also found that studies evaluating community HIEs were more likely to find benefits than studies that evaluated enterprise HIEs or vendor-mediated exchanges. Overall, these finding bode well for the HIEs ability to deliver on anticipated improvements in care delivery and reduction in costs.

The implications and impact of 3 approaches to health information exchange: community, enterprise, and vendor-mediated health information exchange.

IntroductionElectronic health information exchange (HIE) is considered essential to establishing a learning health system, reducing medical errors, and improving efficiency, but establishment of widespread, high functioning HIE has been challenging. Healthcare organizations now have considerable flexibility in selecting among several HIE strategies, most prominently community HIE, enterprise HIE (led by a healthcare organization), and electronic health record vendor‐mediated HIE. Each of these strategies is characterized by different conveners, capabilities, and motivations and may have different abilities to facilitate improved patient care.MethodsI reviewed the available scholarly literature to draw conceptual distinctions between these types of HIE, to assess the current evidence on each type of HIE, and to indicate important areas of future research.ResultsWhile community HIE seems to offer the most open approach to HIE allowing for high levels of connectivity, both enterprise HIE and vendor‐mediated HIE face lower barriers to formation and sustainability. Most existing evidence is focused on community HIE and points towards low overall use, challenges to usability, and ambiguous impact. To better guide organizational leaders and policymakers in the expansion of beneficial HIE and anticipate future trends, future research should work to better capture the prevalence of other forms of HIE, and to adopt common methods to allow comparisons of rate of use, usability, and impact on patient care across studies and types of HIE.ConclusionsHealthcare organizations' choice of HIE strategy influences the set of partners the organization is connected to and may influence the benefit that efforts supported by HIE can offer to patients. Current research is not fully capturing the diversity of approaches to HIE and their potentially varying impact on providers and patients.

Differing Strategies to Meet Information-Sharing Needs: Publicly Supported Community Health Information Exchanges Versus Health Systems' Enterprise Health Information Exchanges.

Community health information exchanges have the characteristics of a public good, and they support population health initiatives at the state and national levels. However, current policy equally incentivizes health systems to create their own information exchanges covering more narrowly defined populations. Noninteroperable electronic health records and vendors' expensive custom interfaces are hindering health information exchanges. Moreover, vendors are imposing the costs of interoperability on health systems and community health information exchanges. Health systems are creating networks of targeted physicians and facilities by funding connections to their own enterprise health information exchanges. These private networks may change referral patterns and foster more integration with outpatient providers. The United States has invested billions of dollars to encourage the adoption of and implement the information technologies necessary for health information exchange (HIE), enabling providers to efficiently and effectively share patient information with other providers. Health care providers now have multiple options for obtaining and sharing patient information. Community HIEs facilitate information sharing for a broad group of providers within a region. Enterprise HIEs are operated by health systems and share information among affiliated hospitals and providers. We sought to identify why hospitals and health systems choose either to participate in community HIEs or to establish enterprise HIEs. We conducted semistructured interviews with 40 policymakers, community and enterprise HIE leaders, and health care executives from 19 different organizations. Our qualitative analysis used a general inductive and comparative approach to identify factors influencing participation in, and the success of, each approach to HIE. Enterprise HIEs support health systems' strategic goals through the control of an information technology network consisting of desired trading partners. Community HIEs support obtaining patient information from the broadest set of providers, but with more dispersed benefits to all participants, the community, and patients. Although not an either/or decision, community and enterprise HIEs compete for finite organizational resources like time, skilled staff, and money. Both approaches face challenges due to vendor costs and less-than-interoperable technology. Both community and enterprise HIEs support aggregating clinical data and following patients across settings. Although they can be complementary, community and enterprise HIEs nonetheless compete for providers' attention and organizational resources. Health policymakers might try to encourage the type of widespread information exchange pursued by community HIEs, but the business case for enterprise HIEs clearly is stronger. The sustainability of a community HIE, potentially a public good, may necessitate ongoing public funding and supportive regulation.

Building an Integrated Patient Information System for a Healthcare Network

The recent healthcare reform act provides incentive payments to providers for their ‘meaningful use’ of electronic health records to achieve significant improvements in care. The HITECH Act 2009 provides incentives payments through Medicare and Medicaid to clinicians and hospitals when they achieve specified improvements in care delivery. Citrus Valley Health Partners’ (CVHP) goals are bigger than just to comply with the regulations or simply to qualify for incentives, but rather include transforming their business to the next level in care delivery. They are seeking cooperation from their affiliates to build a community health information exchange that will allow CVHP and the affiliates to share and integrate patient health related information between their medical centers and the private physicians in their community. The integrated system will help community healthcare providers to work as a single operating entity focused and aligned on improving patient care, operational efficiency and cost effectiveness.

Development and Assessment of a Public Health Alert Delivered through a Community Health Information Exchange

Timely communication of information to health care providers during a public health event can improve overall response to such events. However, current methods for sending information to providers are inefficient and costly. Local health departments have traditionally used labor-intensive, mail-based processes to send public health alerts to the provider community. This article describes a novel approach for delivering public health alerts to providers by leveraging an electronic clinical messaging system within the context of a health information exchange. Alerts included notifications related to the 2009 H1N1 flu epidemic, a syphilis outbreak, and local rabies exposure. We describe the process for sending electronic public health alerts and the estimated impact on efficiency and cost effectiveness.