- A new study in Health Affairs lends weight to the value of health information exchanges (HIE) in improving patient outcomes.
- Using state-level data for 2011-2014, the authors measured the effect of hospital participation in HIEs on quality and health outcomes in patients with acute myocardial infarction, or heart attack. Those that participated had a 1.3% greater decline in the likelihood of unplanned, 30-day readmissions for AMI, compared with non-HIE participating hospitals.
- The findings suggest HIEs can be deployed to enhance quality measures targeted by the Hospital Readmissions Reduction Program and possibly broader policy goals, the study authors say.
While HIEs are frequently touted for improving interoperability, most studies have focused on resource use in emergency room and ambulatory care settings. Results from the few studies on impact on care in inpatient studies have been mixed, the authors note.
The researchers, from Florida International University, focused on AMI for several reasons: Close to 20% of hospital stays for AMI lead to readmission within 30 days, hospital admission for AMI is reliable index event and timely information is critical for emergency diagnosis and treatment.
To understand how HIEs impacts readmissions, researchers looked at lab results, medication history, radiology reports and clinical care records. In each case, sharing information with other hospitals increased more and had a greater effect on readmissions in the HIE group than controls. Sharing radiology reports had the biggest impact, followed by medication histories, according to the study.
The researchers also examined the effect of HIE participation on intensity of inpatient care. After hospitals started participating in an HIE, heart attack patients' initial length of stay increased 0.248 days, they had 0.241 more procedures and registered $4,569 more in charges — though transfer rates, discharge destinations and in-hospital deaths remained largely unchanged.
That finding could help reduce untimely discharges that lead to more readmissions.
"Early discharge decisions may seem to save money in the short run. However, they may increase overall spending if patients are discharged prematurely and subsequently require more intense health care use," the authors write. "Our results suggest that HIE may have played an important role in determining the optimal cost trade-off between inpatient care and readmissions."
The study had several limitations. The data focused on a single state and condition, making it hard to generalize the findings to other patient populations and disorders. In addition, the authors used self-reported survey data to build their HIE measures, and the quasi-experimental design made it hard to establish causality.
Still, the findings have policy implications. "A greater policy focus on integrating HIE into quality improvement initiatives may help shift hospitals' focus to making better use of electronic patient information from outside providers in clinical decisions," the authors say.
The findings also bolster the argument for continuing policies that incentivize electronic data sharing by hospital and underscore the value of having standards and protocols to measure interoperability performance of EHRs and expose barriers to data exchange, they add.