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RAND Study: HIEs Have Not Been Evaluated Enough to Determine Benefits

December 2, 2014
by Rajiv Leventhal
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Study's lead author says that there is no sign of fragmented healthcare system getting better

A lack of evaluation of the more than 100 health information exchanges across the U.S. has made it difficult to determine the benefits of HIE, according to a recent review from research organization RAND Corporation.

The relatively few exchanges that have been examined show some evidence of reducing emergency department costs and usage, but other outcomes are unknown, according to the study, which was funded by the U.S. Department of Veterans Affairs and published in the Dec. 2 edition of the Annals of Internal Medicine.

The federal government has spurred the move to electronic data exchange by providing nearly $600 million to support statewide HIE organizations. Some states have added additional funding.

Findings from 38 studies about attitudes and barriers showed that providers, patients, and other stakeholders consider HIE to be valuable, but barriers include technical and workflow issues, costs, and privacy concerns.

While there are more than 100 HIE initiatives that are considered operational, researchers found that only 13 initiatives had been evaluated by examining usage information. Six of those exchanges were in New York State, which is probably the nation's biggest investor in the approach. “There are likely other health information exchange organizations in the country that are being used, and some may be having an impact. But, if they exist, they haven't been evaluated,” Robert Rudin, lead author of the study and an associate policy researcher at RAND, said in a news release statement. “And without an evaluation, it is difficult to draw conclusions.”

The researchers found no evidence showing whether or not health information exchanges are on track as a potential solution to the problem of fragmented healthcare.

“It is pretty well established that the U.S. healthcare system is highly fragmented,”  Rubin said. “Lots of studies over the years, including some recent studies, have shown that a typical patient visits doctors in many different practices. Frequently the doctors don't have the patient's previous medical information. There is no sign of that problem getting better, and in fact it may get worse if medicine continues to become more specialized.”

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