Despite the passage five years ago of the HITECH Act, and the promise that it would help to improve patient care through the creation of a secure, interoperable nationwide health information network, a study in the journal Healthcare, the Journal of Delivery Science and Innovation shows that the vast majority of hospitals still don’t engage in health information exchanges (HIE).
Using the most recent data from the IT supplement to the annual American Hospital Association annual survey (administered at the end of 2012), authors Julia Adler-Milstein, assistant professor of health management and policy at the University of Michigan School of Public Health, and Ashish Jha, MD, professor of health policy and management at the Harvard University School of Public Health, found that only 30 percent of U.S. hospitals were engaged in HIE with unaffiliated providers at that time.
A study by Adler-Milstein in 2009 had determined that 10 percent of hospitals were engaged in HIE. And while the 20-point increase since that time may seem substantial, given the amount of attention paid to—and the amount of money spent on—health information exchange in the intervening time, Adler-Milstein observed that the 30 percent figure is “a little disappointing.”
The most recent study also found a substantial variation in hospital HIE participation across the states, ranging from a significant level of participation in states like Vermont (88 percent), Delaware (75 percent) and Rhode Island (71 percent), to minimal participation in states like Alaska, North Dakota, New Hampshire and Wyoming.
Adler-Milstein and Jha also determined that there were large differences in HIE participation based on hospital and market conditions. “For-profit hospitals are much less likely to participate, as are those with smaller market share and those in less competitive markets,” she said. “This points to the fact that it’s not clear that we have created conditions in which it is obvious to hospitals that they will benefit from engaging in health information exchange. And it continues to place increased pressure on policymakers to ensure that there are financial as well as other motivations that will make hospitals feel that it’s worth it to share data to make sure that information can follow patients as they move between health systems.”
Adler-Milstein said she believes that finances are a “key part” of the equation when looking at why so many hospitals are reluctant to engage in HIEs. “I think that resources are tight and priorities need to be put in place,” she said. “And I think that for many hospitals HIE is a priority, but it’s not enough of a priority that it’s going to receive funding relative to other areas where the cost-benefit tradeoff is clearer. They aren’t saying that [HIE] is necessarily a bad investment, but just not a good enough investment to make it a top priority.”
So what are the implications for policymakers? Adler-Milstein suggests that part of the problem has to do with technology, and specifically with the fact that “the interoperability of electronic health records is just terrible right now.”
Accordingly, progress could be made “by getting more robust on the interoperability piece,” she said, which could help encourage hospitals worried about both the financial implications and technological complexity involved in engaging in HIE.
"Another alternative—and it seems like we are heading in this direction— is to really ramp up incentives for cost and quality performance,” she said. “And then you can make the assumption that in order to do that well, you need HIE to happen. The best example of that is that if hospitals are on the hook for the total cost of care for their patient population, they are going to need to know what care their patients are getting in other care settings, and a logical way to do that is to figure how to get that electronic connectivity in place.”