Can State Policy Levers Catalyze Health Information Exchange Use?

As states increasingly prioritize improved healthcare quality, the promotion of health information exchange (HIE) has become a key focus. However, the key to increasing HIE use may ultimately rely on state policy, according to a recent study from the MIT Sloan School of Management.

Experts have acknowledged that health information sharing can greatly improve healthcare outcomes. While there is significant progress towards interoperability through HIE networks following the HITECH Act, research has shown that HIE use is still limited, highlighting the need for further efforts to encourage adoption.

“If states want to increase the use of health information sharing in an effort to improve quality of care, we need to understand how state laws most encourage and discourage the use of HIEs, and then weigh the benefits of information sharing with other goals like the strength of privacy protections,” study author Joseph Doyle, professor of management at MIT Sloan School of Management, said in a press release.

By creating a unique database of state laws that tracks 12 policy dimensions from 2000 through 2019, the researchers identified policies that may encourage HIE usage. These dimensions fall into four categories: clarifying HIE governance, strengthening financial stability, specifying the uses and users of an HIE, and protecting the underlying data.

The study showed that state policy levers associated with data protection had the most significant impact on health information sharing, increasing HIE usage by 18 percent in states where data protection was less costly. Within the category of data-protection measures, researchers found that enacting legislation that has patient participation stood out, leading to a 16 percent increase in HIE usage.

Additionally, adding a dimension for each of the other three categories led to a 4 percent increase in HIE usage. However, only the relationship with financial sustainability is measured precisely enough to be statistically significant.

“When comparing outcomes of policies that had patients ‘opting in’ or ‘opting out’ of using health information exchanges, we found that ‘opt in’ policies resulted in less participation and data sharing,” Doyle said.

Regarding financial sustainability, the researchers noticed that states with the ability to charge participant fees increased the HIE Usage Index by 10 percentage points. In addition, adding the ability to request state, federal, and private funding led to a 6-percentage point increase.

Overall, these findings offer insights into how policy decisions can drive HIE use, which may improve patient outcomes.

Studies have shown that HIE usage can positively impact the quality of care, with lower readmission rates for heart attack patients in hospitals participating in HIEs and physician offices with strong information-sharing capabilities achieving lower Medicare spending.

HIES can also offer significant cost savings. The Statewide Health Information Network for New York (SHIN-NY), the NYC HIE, saved The New York Health Collaborative (NYeC) nearly $195 million annually in healthcare spending.

These cost savings are mainly associated with duplicate testing, avoidable hospitalizations and readmissions, and preventable emergency department visits, allowing for an estimated $1 billion in savings if current participants used the NYeC’s full capabilities. 

HIE even has the potential to assist healthcare organizations in achieving the triple aim of value-based care, including improved population health management strategies, better individual care, and reduced healthcare costs. Despite the benefits, HIEs are not without their challenges, including financial viability, state regulations, and privacy concerns, which healthcare organizations must consider.