How health info exchanges and data utilities are returning demonstrable benefits
Several initiatives have produced major returns on investment for facilitating the exchange of patient information, making the case for expansion of initiatives in all states.
After years of anticipation, the benefits of health information exchange are tantalizingly close. Serious progress on a national basis is in motion, as efforts are underway to implement the Trusted Exchange Framework and Common Agreement and achieve nationwide information exchange.
But initiatives in some states have been advancing for several years, and some of those results demonstrate the possibilities for a fully baked approach to information exchange. Some of the most beneficial impacts include reducing readmissions within 30 days at hospitals, decreasing ICU and emergency department encounters and eliminating unnecessary duplicative imaging procedures. Less imaging means less radiation, which means improved care.
Indeed, reviews of initiatives in several states provide significant evidence about how healthcare information exchange (HIE) and the use of health data utilities (HDU) can support care delivery, especially as healthcare aims to improve patient care and support population health management.
Also, there’s much to learn from the lost opportunities that have been reported in states that have lagged in adopting HIE and HDUs. Evidence suggests that there is substantial risk associated with slow adoption or lack of awareness of the federal mandates driving change.
In sum, there’s growing evidence that HIE and HDU are crucial to improving patient outcomes by facilitating the sharing of electronic health information between providers. In addition to preventing unnecessary admissions and procedures, information fluidity also can result in better medication reconciliation processes, enhanced therapeutic medical interventions and improve quality of care metrics.
Measuring the benefits
As one example of the benefits of information exchange, a study conducted by the American Medical Informatics Association found that hospitals participating in an HIE significantly reduced 30-day readmission rates, compared with those that don’t participate. Researchers attributed these results to better access to patient information across different healthcare organizations, enabling more informed decision-making that facilitates care coordination.
Other data indicates that hospitals utilizing HIEs had more timely access to critical patient data, resulting in decreased intensive care unit (ICU) admissions. It is demonstrated that patients admitted through emergency departments with available clinical data from other provider organizations via an HIE were significantly less likely to be admitted into ICUs than those without such data exchange capabilities.
Similarly, the Office of the National Coordinator for Health IT (ONC) reports that states with well-established HIE networks have seen reductions in emergency department visits, due in part to the fact that HIEs enable providers to access patients' information from other healthcare organizations, leading to better care coordination and decision-making, ultimately reducing the need for unnecessary emergency visits.
Research also demonstrates that HIEs can help reduce duplicate imaging procedures by providing physicians with easy access to previous test results. A study published in Med Care found that utilizing HIE is associated with a reduction in repeat CT, ultrasound and chest X-ray.
Other research indicates that effective health information exchange can improve population health management through better data sharing between public health agencies and healthcare providers. For example, the Indiana Health Information Exchange successfully used its network of electronic medical records during the H1N1 pandemic response, thus enabling real-time monitoring of disease progression across the state's population. Similarly, South Carolina successfully used it’s South Carolina Health Information Exchange (SCHIEx) and Carolina eHealth Alliance (CeHA) during the COVID-19 pandemic to accelerate test result availability to organizations and licensed providers statewide.
These studies and other research support the fact that states that have implemented HIE or HDU systems are reaping significant benefits in improved patient safety outcomes and lower costs associated with more efficient care delivery processes. As more states invest in their health information technology infrastructure, we can expect even more significant gains nationwide as we move towards genuinely interconnected healthcare ecosystems.
Many states’ efforts show savings
In addition, states – or regions within states – that have effective programs have demonstrated cost savings benefits linked to their information exchange/sharing initiatives.
For example, the use of health information exchange has been extensively studied in South Carolina by those health systems utilizing the Carolina eHealth Alliance (CeHA), all located in the greater Charleston region. Studies sought to determine the impact of HIE utilization on patient care while also identifying any cost benefit.
One study analyzed the impact of HIE on resource use and Medicare-allowable reimbursements at 11 emergency departments in a midsized city, finding that the use of information exchange was associated with a decrease in resource use and an increase in Medicare-allowable reimbursements. Another study looked at cost savings from HIE use in an academic ED, estimating the savings at $1.2 million over a 12-month period for the study population among regional participants. Another study looked at HIE-associated improvements in care coordination, lower costs, and improved quality and efficiency for patients in both academic medical centers and community hospital settings.
The ability to share information across various EHRs “is essential to achieving better coordination of patient care because of our highly fragmented U.S. healthcare system,” notes Elizabeth Regan, PhD, department chair of Integrated Information Technology, and associate professor of health information technology in the College of Engineering and Computing at the University of South Carolina.
“South Carolina’s current initiative for expanded statewide health information exchange is a critical step for improving patient care coordination, increasing access and reducing costs,” Regan says. “As the U.S. moves forward in building the national qualified health information network (QHIN Network) authorized under the 21stCentury Cures Act, advancing South Carolina’s health information exchange capacity will help position us to capitalize on the benefits.”
In Indiana, the Regenstrief Institute's statewide HIE – the Indiana Health Information Exchange (IHIE) – has been credited with reducing hospital admissions by 26 percent over a five-year period while also lowering overall healthcare costs. The system connects more than 100 hospitals across the state, enabling providers to access patient information quickly and securely.
Also in Indiana, the IHIE has enabled clinicians to access comprehensive patient data, helping them accurately review patients' medications during transitions in care settings, leading to safer treatment plans and fewer adverse drug events. In addition, because medical records are readily available to clinicians, physicians can avoid ordering redundant tests or imaging studies for their patients, saving both time and resources.
Similarly, an HIE implemented in New York state has provided estimated annual cost savings of $12 million. The Statewide Health Information Network in New York (SHIN-NY) facilitates secure access to patient data for more than 62,000 healthcare professionals – it pulls information from various sources such as EHRs, public health registries and insurance claims databases.
According to research, SHIN-NY helped reduce instances of duplicate testing by providing a comprehensive view of patients' medical histories, resulting in substantial financial savings for both providers and patients. Also, because SHIN-NY provides instant access to prior imaging studies, physicians can make informed decisions about whether additional imaging studies are necessary, thus avoiding unnecessary radiation exposure and lowering costs. Finally, real-time data exchange enables healthcare teams to collaborate more effectively on patient care plans, leading to improved population health outcomes overall.
Forces line up to aid HIE
As more states stand up HIEs and improve their capabilities to foster seamless information exchange among providers, lower healthcare costs and enhanced quality care will be available more broadly. Nevertheless, states that haven't adopted HIE/HDU statewide yet may be missing out on potential cost savings and interoperability; thus, it is vital to understand the role of stakeholders in effective executions.
Lagging states are expected to face increased pressure from federal mandates requiring greater interoperability between EHRs. All stakeholders, from healthcare professionals and clinicians to executives and policymakers, must recognize the importance of investing in infrastructure to achieve the efficient exchange of information across the care continuum to achieve benefits.
The American Medical Informatics Association has emphasized that HIEs play a critical role in achieving national goals related to improving population health, enhancing patient safety and reducing costs associated with care delivery inefficiencies. As a result, there is increasing pressure from federal agencies like ONC promoting nationwide adoption and use of HIE services through various initiatives and programs such as the 21st Century Cures Act's Trusted Exchange Framework and Common Agreement (TEFCA), among others.
In response to these directives, non-federal acute care hospitals have significantly increased participation in information exchange initiatives over the past decade; however, still only about three-quarters are actively engaged in sharing data via an HIE, according to a data brief reported by ONC in January 2023. This underscores the need for continued efforts to foster widespread implementation, particularly within those regions currently underperforming relative to national averages.
The importance of stakeholder involvement
To ensure successful HIE/HDU adoption, it is crucial for all stakeholders to be actively involved in the process. This includes healthcare professionals who can champion benefits such as improved care coordination, better access to patient information during emergency department visits and lower costs associated with redundant testing. Clinicians can play a key role by adopting health information technology tools that facilitate seamless data exchange between provider organizations while also advocating for necessary changes within their institutions.
Healthcare executives must recognize the potential return on investment offered through participating in effective HIE initiatives. Finally, policymakers should prioritize funding and support initiatives aimed at promoting interoperability across public and private sectors alike to maximize the overall impact of positive outcomes.
To facilitate efforts to accelerate HIE initiatives, the following action steps are crucial for effective rollouts:
- • Access the current state of HIE/HDU infrastructure: Identify gaps in existing systems and develop targeted strategies to address these shortcomings.
- • Promote stakeholder engagement: Foster collaboration among healthcare providers, payers, government agencies and patients to drive widespread adoption of information exchange technologies.
- • Increase funding support: Allocate resources to improve the technical infrastructure needed for efficient data sharing capabilities among provider networks.
- • Leverage federal programs and initiatives: Utilize available assistance through ONC, the Centers for Medicare & Medicaid Services and other agencies to help accelerate progress towards achieving nationwide interoperability goals.
State involvement and funding
State investment and support are integral to the success of HIEs and HDUs. The degree to which states invest in these systems can significantly impact their effectiveness.
For example, the Massachusetts eHealth Institute (MeHI), established as part of a statewide initiative to promote health information technology adoption, has been instrumental in fostering HIE implementation throughout the state. With substantial financial backing from both federal grants as well as state funds, MeHI has facilitated widespread adoption of EHRs among providers while also supporting interoperability efforts through its statewide HIE program.
In neighboring Rhode Island, Rhode Island Quality Institute (RIQI) serves as an independent nonprofit organization operating CurrentCare, an HIE system that enables authorized clinicians to have secure access to comprehensive patient information across participating organizations. Through robust funding support provided by various sources, including federal grants, state funds and private contributions, RIQI has successfully achieved statewide adoption of CurrentCare.
However, some states have struggled with similar initiatives, for a variety of reasons. For example, Florida has struggled because of a lack of similar resources or commitment. The Florida Health Information Exchange (FL-HIE) was established with initial federal funding, but it has struggled to maintain momentum as state support waned over time. This resulted in limited participation rates among provider organizations and diminished impact on patient outcomes, compared with states with successful statewide initiatives.
In Texas, the Texas Health Services Authority (THSA), a public-private partnership responsible for coordinating health information exchange efforts, has faced challenges related to securing adequate funding for its programs. While THSA has made progress through partnerships with regional HIEs and other stakeholders, it continues to grapple with barriers such as insufficient financial support from both government sources as well as private entities that could help drive broader implementation across care settings.
To overcome these challenges and reap the benefits associated with robust HIE/HDU systems - including improved population health management capabilities - states must prioritize investment in necessary infrastructure while also engaging key stakeholders across healthcare sectors. By learning from success stories like Massachusetts and Rhode Island while addressing unique local challenges faced by regions like Florida or Texas, all 50 states can work towards achieving better patient outcomes through enhanced care coordination enabled by efficient health information exchange processes.
Overcoming barriers to adoption
Even with state involvement and funding support, there are still barriers to widespread adoption of health information exchange and data utilities. To overcome these obstacles, technical infrastructure challenges as well as broader systemic issues affecting interoperability need to be considered.
One major barrier in implementing HIEs and HDUs effectively is the challenge posed by technical infrastructure requirements. Healthcare providers need robust, secure and scalable IT systems that can handle large volumes of sensitive health information while ensuring seamless data exchange between various stakeholders. In addition, integrating disparate EHR systems within an organization or across multiple provider networks often proves difficult because of differences in data formats, standards and terminologies used.
To address these concerns, healthcare professionals should consider adopting interoperable EHR systems, which are designed with standardized interfaces for easier integration with other software applications. Additionally, organizations can benefit from collaborating with experienced health informatics experts, who can provide guidance on best practices for building efficient HIE/HDU infrastructures.
Beyond technical challenges lie several systemic issues that hinder effective health information exchange at a national level. These include:
- • Lack of financial incentives: Many healthcare providers may not see immediate financial benefits from investing in HIE/HDU initiatives. As a result, they might be reluctant to allocate resources towards such projects. These providers must look to eventual long-term improved patient outcomes and cost savings that can be achieved through better care coordination and reduced duplication of services.
- • Privacy concerns: Sharing sensitive patient information across multiple organizations raises legitimate privacy concerns. Ensuring compliance with the Health Insurance Portability and Accountability Act (HIPAA) is crucial to maintain trust among patients and providers while safeguarding personal health data.
- • Varying state-level regulations: Different states have varying policies regarding HIEs, which may affect their adoption rates. Harmonizing these regulations could facilitate more seamless exchange of health information across state lines.
To overcome these barriers, clinicians, executives and policymakers need to recognize the value in investing in infrastructure needed to support effective and efficient exchange of information across the care continuum. Promoting support from federal funding programs such as the ONC grants and public-private partnerships to drive innovation in this space should be advocated for.
In addition to addressing technical challenges and systemic issues affecting interoperability nationwide, fostering a culture of collaboration among stakeholders will play a key role in realizing the full potential benefits offered by HIEs and HDUs - ultimately leading to improved population health outcomes at lower costs for all Americans.