Hospitals using the same EHR developer more likely to share patients

However, study contends that developer-influenced health information exchange may negatively affect patient outcomes.

The extent to which an electronic health record developer dominates a market is a significant driver in a hospital’s choice of EHR system and the sharing of patients among hospitals.

That’s the conclusion of new research published in the Journal of the American Medical Informatics Association, which examined the impact that EHR developers have on patient transfers and referrals at 3,076 U.S. non-federal acute care hospitals from 2011 to 2016.

The findings also have important implications for future policies regarding the interoperable exchange of health information. The EHR market is increasingly concentrated, and developer-based networks have become increasingly important as the number of state and community health information exchanges decreases.

The study found that a hospital’s decision to switch to a new EHR developer increased the ratio of patients shared with other hospitals using the same developer from 4.1 percent to 19.3 percent. The ratio was higher when a developer controlled a large share of the market.   

Contributing factors could include the growth of developer-based health information exchanges, customizable referral management systems, and provider preference for easy and reliable data exchange. Hospitals switching to Cerner, Epic and Meditech drove the increase in same developer patient sharing, the study concluded.

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The researchers noted that this shift could have a clinical impact. For instance, same-developer patient sharing could benefit patients by ensuring that providers have access to accurate and timely health information, resulting in fewer diagnosis errors. However, referrals and transfers influenced more by the EHR than the needs of the patient could result in poor patient-provider matches.

“The change in transfer and referral patterns occurs immediately after the focal hospital switches EHR developers, which suggests it could be due to technical attributes of the new EHR system, rather than a shift in provider’s preferences for hospitals based on their quality of care,” the study authors noted.

There are additional costs imposed by developers on providers seeking to exchange information outside of their own network, which indicates that providers may be strategic in which EHR developer to use, a choice that could affect the quality of care and patient volume.  

“In a perfectly interoperable environment, the referring physician’s EHR developer would not affect hospitals’ transfer or referral patterns. Our analysis cannot confirm whether technical problems associated with cross-developer exchange or efforts to block the transfer of information among hospitals and developers affect hospital patient sharing. However, we believe that both could contribute to our findings.” The study authors noted. 

The findings additionally indicate that compliance with the new data sharing requirements imposed by the 21st Century Cures Act may be a greater challenge for providers in more diverse markets.

The authors said more research is needed to formulate regulatory policies. However, even if developer-based EHRs don’t adversely influence patient sharing, there is still a need for open community-based health information exchange to improve data transfer.

The study, the first to examine the role of EHR developers on hospital patient sharing, points to the need for further scrutiny.

“Overall, it is a well-done, thoughtful study that provides additional evidence of a relationship between EHR vendor consolidation and care patterns,” said Julia Adler-Milstein, a professor of medicine and Director of the Center for Clinical Informatics and Improvement Research at the University of California San Francisco School of Medicine. “It is still hard to know what is cause and what is effect, and how much EHR vendor dynamics are tied up in broader organizational consolidation that is also happening.”

The study indicates that provider organizations may have to do a better job of ensuring that patients’ best interests are the top priority in treatment decisions.

“The best-case scenario is that patients still feel that they have free choice of provider, but that where organizations share a lot of patients, they are increasingly able to share information (in this case, by moving to be on the same vendor’s platform),” Adler-Milstein said. “A more concerning scenario is that providers feel that they have to move to a particular EHR to be able to participate in specific referral relationships, or that patients have to limit their care to providers on the same EHR. So these are factors that we need to carefully watch.”

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