Gaps in health information exchange between hospitals that treat many shared patients

Abstract

Objective: Hospitals that routinely share patients are those that most critically need to engage in electronic health information exchange (HIE) with each other to ensure clinical information is available to inform treatment decisions. We surveyed pairs of hospitals in a nationwide sample to describe whether and how hospitals within each hospital referral region (HRR) that have the highest shared patient (HSP) volume engaged in HIE with each other.

Methods: We used Medicare's Physician Shared Patient Patterns data to identify hospital pairs with the highest shared patient volume in each hospital referral region. We surveyed a purposeful sample of pairs and then calculated descriptive statistics to compare: (1) HIE with the HSP hospital vs HIE with other hospitals, and (2) HIE with the HSP hospital versus federal measures of HIE engagement that are not partner-specific.

Results: We received responses from 25.5% of contacted hospitals and 33.5% of contacted pairs, allowing us to examine information sharing among 68 hospitals in 63 pairs. 23% of respondents reported worse information sharing with their HSP hospital than with other hospitals while 17% indicated better sharing with their HSP hospital and 48% indicated no difference. Our HSP-specific measures of HIE differed from federal measures of HIE engagement: while 97% of respondents are classified as routinely sending information electronically in federal measures, in our data only 63% did so with their HSP hospital.

Conclusions: Despite increased HIE engagement, our descriptive results indicate that HIE is not developing in a way that facilitates information exchange where it might benefit the most patients. New policy efforts, particularly those emerging from the 21st Century Cures Act, need to explicitly pursue strategies that ensure that HSP providers engage in exchange with each other.

Figure 1.

Number of interoperability methods used for sending patient information to HSP hospital.

Figure 2.

Adoption rates, use rates, and value of information exchange methods. ^†We defined frequency by asking how often and assigning a 6 point scale by assigning 1 point for rarely, two for sometimes and three for ‘often’, then divided by the highest value, 6. ^‡For each exchange method, we asked providers if they disagreed or agreed with the following 2 statements using a 5-point scale: (1) information that you receive from hospital X includes all potentially relevant health information for care and (2) it is generally easy to find specific, relevant health information received from hospital X. We then summed responses to these questions and divided by the highest value possible (10). ^†‡We specifically asked hospital leaders about DIRECT messaging (through a standalone HISP or HISP provided by a third party). ^‡‡ This value is likely an underestimate the frequency of adoption of EHR vendor HIE based on construction of our sample.