Health Information Exchanges Show Little Evidence of Benefits

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Though health information exchanges are supposed to improve the speed, quality, safety and cost of patient care, there is little evidence of these benefits in existing HIE studies.

That is the conclusion of a research paper, published in this month’s issue of the journal Health Affairs, in which researchers reviewed 27 studies looking for evidence that HIEs increased efficiency, reduced healthcare costs or improved outcomes.

While researchers found that 57 percent of published analyses reported some benefit from HIE, they also reported that articles employing study designs having strong internal validity—such as randomized controlled trials or quasi-experiments—were significantly less likely than others to associate HIE with benefits.

Also See: HIE Cuts Redundant Imaging by 25 Percent

“Among six articles with strong internal validity, one study reported paradoxical negative effects, three studies found no effect, and two studies reported that HIE led to benefits,” state the researchers. “Furthermore, these two studies had narrower focuses than the others.”

Two of the six studies found beneficial effects largely as a result of a reduction in diagnostic and imaging tests, associated costs or both, and these studies were based in a single clinic affiliated with an Indiana hospital or in one healthcare system in Israel. Overall, the paper found that “little generalizable evidence currently exists regarding benefits attributable to HIE.”

To be clear, the paper doesn’t say there are no benefits from the use of HIEs. “It’s simply premature to say if we have or have not gotten our money’s worth out of HIE,” said Nir Menachemi, a professor and chair of the Department of Health Policy and Management in the Richard M. Fairbanks School of Public Health at Indiana University-Purdue University Indianapolis and one of the authors of the paper.

“There is no strong documented evidence in the studies that healthcare benefits are directly attributable to the use of HIE, rather than being correlated or incidentally related,” said Menachemi. “We still expect HIE benefits will accrue, but currently no one has been able to demonstrate in a general and convincing way that we can expect to see these benefits.”

According to the study, about two-thirds of U.S. hospitals and almost half of physician practices are now engaged in some type of HIE with outside organizations. However, another study released last year found that the majority of hospitals still do not engage in the electronic exchange of health information, despite strong federal policies designed to encourage these exchanges and a substantial investment in health information technology. That 2014 study also revealed that only 30 percent of hospitals engaged in HIE with unaffiliated providers.

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