Half of Providers Don’t Utilize Health Information Exchange

Health information exchange (HIE) is utilized in less than half of referrals, according to a study published in the Journal of the American Medical Informatics Association (JAMIA), and factors like EHR vendor and patient characteristics were highly related to HIE use.

Accurate patient data and health information exchange is vital to effective care coordination and provider cost savings. However, health information exchange relies on robust health IT infrastructure to connect providers and hospitals.

The Promoting Interoperability program helps providers establish HIE connection. However, interoperability remains an issue for providers.

Researchers aimed to evaluate practice and market-level HIE use factors. The research team analyzed provider data from over 40,000 providers in Stage Two Meaningful Use and combined it with provider, practice, and market characteristics to associate HIE provider volume with those factors. Provider HIE use volume was measured by the percentage of referrals sent with electronic summaries of care (eSCR), the researchers explained.

“Our findings directly inform ongoing efforts to increase the level of HIE in the US health care system toward the ends of reducing care fragmentation and improving the information available to providers at the point of care,” wrote the study authors.

“Policy-makers, health systems, and provider practices can use these findings to understand the factors that may increase HIE nationwide or within specific markets. Finally, we expand upon previous work examining HIE use level among hospitals to explore the extent to which these relationships hold in the outpatient setting,” the study authors continued.

In total, researchers found HIE use in 49 percent of referrals. Although primary care providers sent 2.1 million more referrals during the 90-day research period, PCPs had a 42.7 percent HIE use level compared to 57 percent among non-PCPs. Overall, clinicians sent 8,472,759 referrals during this time period and 4,096,299 utilized an eSCR to transmit the referral.

“We suspect this may be rooted in differences in the centrality of PCPs and specialists in provider referral networks,” explained the study authors. “Primary care providers can be positioned centrally in provider networks and thus must maintain a large pool of specialists to whom they refer patients. Furthermore, patients may have preferences for specialists, who may or may not have existing HIE connections with a given PCP.”

EHR vendors were the most significant factor of provider HIE use. Cerner, eClinicalWorks, Epic Systems, GE Healthcare, and NextGen Healthcare were negatively associated with HIE use levels. On the contrary, athenahealth and Greenway Health had positive HIE use level association.

“Given that integrated health systems include large numbers of ambulatory providers and specialists, lower use among providers with these vendors is especially problematic,” wrote the study authors. “Furthermore, 1 of the key value propositions of integrated health systems is better coordinated care through easier provider information exchange, and the MU Stage 2 measure allows inclusion of referrals that occur between 2 providers that share an EHR, presumably making electronic exchange near-seamless for these providers.”

Larger health systems reported greater HIE use rates than smaller health systems between two and five providers. Health systems with more than 50 providers also had a 3.8 percent higher HIE use level than smaller health systems.

Providers with an older patient population and the proportion of patients with diabetes had slightly more significant HIE use than other practice factors.

“This likely reflects the value of interoperability for these patient populations, as prior work has shown that providers seek out outside information at higher rates for older patients with chronic diseases,” study authors explained.

Meanwhile, health system membership, market concentration, and state HIE consent policy were unrelated to HIE use.

“To foster more use of HIE across the health care system, policy makers should consider the relative impact that market factors may have on adoption, compared to practice-level factors that are related to the use of HIE more directly,” wrote the researchers.

The study authors said providers could utilize these findings to examine the best EHR vendor practices and to engage in high-yield HIE approaches.

“Future research may explore in more detail the nature of the relationship between provider EHR vendor and HIE use levels, as well as the varying health IT needs of providers who may primarily send or primarily receive health data,” concluded the research team.