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Report: HIEs Have Been Inadequately Studied

December 18, 2015
by Rajiv Leventhal
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The impact of health information exchange (HIE) is inadequately studied, although some benefits have been seen, according to a report recently released by the Agency for Healthcare Research and Quality (AHRQ).

The Pacific Northwest Evidence-based Practice Center conducted the report for AHRQ and reviewed more than 130 research studies of HIE most done since 2006.  While various studies did not provide information on the impact of health information exchange on mortality and morbidity, most of the studies showed that users felt HIE improved coordination of care. There is some evidence that it improves care and reduces duplicative laboratory and imaging tests, emergency room costs and hospital admissions, according to the report.

The report notes that the use of HIE has risen over time and is highest in hospitals and lowest in long-term care settings.  According to the report 76 percent of U.S. hospitals exchanged information in 2014, an 85 percent increase from 2008.  HIE was used in 38 percent of office-based physicians, but only 1 percent in long-term care providers in 2012. According to the report, “While surveys suggest that use of HIE is spreading, the scope of use within organizations is still limited, implementation is slow, and sustainability seems less than assured.”

The study attributed reports of low HIE use to the lack of critical mass of those electronically exchanging data, inefficient workflows, and poorly designed interfaces. The report also found that most of the studies of HIE were not designed to sufficiently control for risk of bias and were overly focused on narrow outcomes considering the potential impact of a broad-based complex, systemic intervention.

Similarly, late last year, a review from research organization RAND Corporation found that 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. 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 Annals of Internal Medicine.

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