Hospital's adoption of multiple methods of obtaining outside information and use of that information

Abstract

Objective: Hospitals have multiple methods available to engage in health information exchange (HIE); however, it is not well understood whether these methods are complements or substitutes. We sought to characterize patterns of adoption of HIE methods and examine the association between these methods and increased availability and use of patient information.

Materials and methods: Cross-sectional analysis of 3208 nonfederal acute care hospitals in the 2019 American Hospital Association Information Technology Supplement.

Results: The median hospital obtained outside information through 4 methods. Hospitals that obtained data through a regional HIE organization were 2.2 times more likely to also obtain data via Direct using a health information service provider (HISP) than hospitals that did not (P < .001). Hospitals in a single electronic health record (EHR) vendor network were no more or less likely to participate in a HISP or HIE. Six of 7 methods were associated with greater information availability. Only 4 of 7 methods (portals, interfaces, single vendor networks and multi-vendor networks but not access to outside EHR, regional exchange or Direct using a HISP) were associated with more frequent use of information, and single vendor networks were most strongly associated with more frequent use (odds ratio = 4.7, P < .001).

Discussion: Adoption of some methods was correlated, indicating complementary use. Few methods were negatively correlated, indicating limited competition. Although information availability was common, low correlation with use indicated that challenges related to integration may be slowing use of information.

Conclusion: Complementarities between methods, and the role of integration in supporting information use, indicate the potential value of efforts aimed at ensuring exchange methods work well together, such as the Trusted Exchange Framework and Common Agreement.

Keywords: health information exchange; hospitals; interoperability.

Figure 1.

Frequency of adoption and use of methods of obtaining outside information. N=3208 non-federal acute care hospitals in the US States and DC. Adoption defined as at least rarely using a method. Methods often used defined among hospitals that reported at least rarely used the method. Sample weights adjusted for response bias based on hospital size, system membership, and location.

Figure 2.

Association between adoption of each intermediary HIE method of obtaining information and adoption of other methods. Note: Relative risk ratio derived from Poisson regression model including the 6 other methods of exchange, hospital size, multi-hospital system status, urban/rural location, teaching status ownership, and presence of cardiac ICU and operating margin. Sample weights adjusted for response bias based on hospital size, system membership, and location. HIE: health information exchange.