GAO: Small, Rural Hospital HIE Use Lags Larger Counterparts

While electronic health information exchange (HIE) has increased in recent years, use among small and rural hospitals is lower than that of other hospitals, according to a new GAO report.

The report is based on interviews with ONC, CMS, and state agency officials. GAO also analyzed hospital and physician survey data and interviewed physicians and organizations representing physicians, organizations representing hospitals, payers, HIE organizations, and other industry representatives.

The Health Information Technology for Economic and Clinical Health (HITECH) Act provided federal enhanced Medicaid matching funds to states through 2021 to support electronic data exchange. Nearly all states used these funds, and most have identified other sources to sustain those efforts.

States reported to CMS that they will pursue a variety of other approaches to sustain HIE efforts previously funded by HITECH funding, including provider or payer subscription fees, state funding, grants, or donations.

However, analysis of 2021 AHA survey data found that small hospitals were less likely to participate in HIE via EHR vendor networks, national HIE networks, and regional HIEs than medium/large hospitals.

Additionally, the report found that the percentage of rural hospitals that reported they “often” used fax or mail to exchange patient health information was higher than the percentage reported by non-rural hospitals.

Stakeholders GAO interviewed noted that small and rural providers were less likely to have the financial and technological resources to participate in or maintain electronic health data exchange.

The GAO report suggested that federal efforts, such as ONC’s Trusted Exchange Framework and Common Agreement (TEFCA), may address some obstacles to electronic HIE by mitigating costs through a simpler approach to healthcare interoperability.

However, interviewed stakeholders noted that participation in TEFCA is voluntary and does not address challenges to electronic data exchange among small and rural providers like health IT staffing shortages and gaps in broadband access.

Stakeholders also noted that it is not yet clear how ONC plans to sustain TEFCA and what fees providers and other network participants will need to pay to participate in the network of networks.