Health information exchange policies of 11 diverse health systems and the associated impact on volume of exchange

Abstract

Background: Provider organizations increasingly have the ability to exchange patient health information electronically. Organizational health information exchange (HIE) policy decisions can impact the extent to which external information is readily available to providers, but this relationship has not been well studied.

Objective: Our objective was to examine the relationship between electronic exchange of patient health information across organizations and organizational HIE policy decisions. We focused on 2 key decisions: whether to automatically search for information from other organizations and whether to require HIE-specific patient consent.

Methods: We conducted a retrospective time series analysis of the effect of automatic querying and the patient consent requirement on the monthly volume of clinical summaries exchanged. We could not assess degree of use or usefulness of summaries, organizational decision-making processes, or generalizability to other vendors.

Results: Between 2013 and 2015, clinical summary exchange volume increased by 1349% across 11 organizations. Nine of the 11 systems were set up to enable auto-querying, and auto-querying was associated with a significant increase in the monthly rate of exchange (P = .006 for change in trend). Seven of the 11 organizations did not require patient consent specifically for HIE, and these organizations experienced a greater increase in volume of exchange over time compared to organizations that required consent.

Conclusions: Automatic querying and limited consent requirements are organizational HIE policy decisions that impact the volume of exchange, and ultimately the information available to providers to support optimal care. Future efforts to ensure effective HIE may need to explicitly address these factors.

Keywords: EHR; HIE; electronic health record; high value care.

Figure 1

Overall trends in clinical summaries exchange volume: 2013–2015 Note: Volume of clinical summaries retrieved by each organization

Figure 2

Clinical summaries sent and received between organizations. Link thickness represents ratio of information sent and retrieved between 2 institutions normalized across the institutions (circos.ca).

Figure 3

Impact of auto-query on volume of clinical summaries received Note: This exhibit reports results from an interrupted time series analysis on volume of clinical summaries received from other collaborative organizations; data come from the 6 organizations with at least 4 months of data post auto-query go-live.

Figure 4

Total patient-match linkages by auto-query vs manual query

Figure 5

Impact of patient consent requirements on volume of clinical summaries sent Note: This exhibit reports results from a longitudinal model that assessed the volume of clinical summaries sent to other collaborative organizations based on whether or not the organization sending the clinical summaries required patient consent prior to the clinical summary being sent. All 11 organizations are included in this model.