Market Leader EHR Implementation Increases Patient Data Exchange

Patient sharing increases when hospitals switch to a dominant EHR developer in a market area, suggesting that market dominance leads to an increase in patient data exchange and shared patients, according to a study published in JAMIA.

The researchers used data from the 2011 to 2016 CMS Physician Shared Patient Patterns database for 3,076 nonfederal acute care hospitals to calculate the ratio of patients shared with hospitals outside of the focal hospital’s network that use the same EHR vendor as the focal hospital.

Then, the investigators compared same-vendor patient sharing among hospitals that switched vendors with those that did not leverage a new vendor.

Switching to a new EHR vendor increased the ratio of patients shared with other hospitals having the same EHR vendor by 4 to 19 percent, depending on model specification.

While consolidation in the health IT vendor industry has contributed to this trend, local market conditions play an important role as well, the study authors noted.

The need to coordinate with other hospitals in competitive markets reinforces the desire to lower the costs of patient data sharing by transferring patients to hospitals using the same vendor, the research team explained. Additionally, technical data exchange barriers are lessened when exchange partners use the same EHR vendor, the authors added.

These results have important implications for future policies regarding healthcare interoperability, the researchers said.

Same-vendor patient sharing could benefit patients by ensuring that providers have access to accurate and timely health information. However, transfers and referrals influenced more by the hospital’s EHR provider than the specific care needs of the patient could result in lower quality care delivery, the study authors suggested.

“There are also concerns that concentrations in patient sharing could further reduce competition in healthcare markets,” they added. “In a perfectly interoperable environment, the referring physician’s EHR developer would not affect hospitals’ transfer or referral patterns.”

The researchers hypothesized that technical issues associated with cross-vendor exchange and/or efforts to block the transfer of information among hospitals and vendors affect hospital patient sharing.

“Our results raise the question of whether higher patient sharing among hospitals with the same EHR developer is due, in part, to information blocking,” they wrote. “However, further research needs to address the mechanisms underlying the concentration in patient sharing identified in this study in order to formulate regulatory policies.”

The study has several limitations according to the researchers. First, they noted that they cannot distinguish between different types of patient sharing across hospitals.

“Because we consider patients shared within a 1-month period, we expect that patient sharing largely reflects intra-hospital transfers,” the study authors explained. “However, it is possible that the patient may have decided to visit a different hospital in another healthcare network without a referral from any provider.”

Additionally, provider preferences may interact with EHR design to influence patient sharing. For instance, physicians may develop a preference for transferring patients to hospitals with the same EHR vendor because they believe that the transmission of data is more reliable. Technical features of the vendor-based network may reinforce this preference, they added.

“Our inability to observe these and other potential mechanisms behind the change in patient sharing means that we cannot make welfare statements based on our findings,” the researchers said. “Future research is needed to determine whether increased patient sharing among hospitals with the same EHR developer adversely affects patient outcomes.”