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Evidence for Health Information Exchange Benefits

By December 18, 2015December 20th, 2015Commentary

So you would think that encouraging greater exchange of health information about a patient among providers would lead to better health outcomes and lower cost, right?  A review of the research on the subject by the Agency for Healthcare Research & Quality, however, finds little high-quality evidence that this is the case.   (AHRQ Report)   The report finds that the use of health information exchange capabilities has grown rapidly within hospitals, in 2014 76% say they have the capability to do electronic information exchange, up 85% since 2008.  On the other hand, only 38% of office-based physicians said they had such a capability in 2012 and less than 1% of long-term care facilities have a health information exchange capability, which is astoundingly low, given the high medical needs of many nursing home residents.  In general these numbers may be low as to all types of health information sharing, since almost every physician, for example, now has access to the SureScripts electronic prescribing network, which can share many types of data related to medication use and ordering.  Even within organizations with an extensive health information exchange capability, however, there is very low use of that capability.  Barriers to greater use include the usual suspects–interference with optimal workflows, poor user interface designs and lack of sufficient data to exchange to make the effort worthwhile.

136 research studies were reviewed by these researchers.  The found no studies which looked at an effect on actual primary clinical outcomes.  They found low quality evidence for some process of care or other effects, including a possible reduction of duplicative laboratory or radiologic test ordering, less emergency room use and increases in the quality of ambulatory care.  Some studies looked at provider attitudes toward health information exchange and these found that most providers believed that access to this capability improved coordination of care and communication across multiple clinicians for the patient.  As is often the case, it takes a lot of very hard and somewhat expensive research to gather credible evidence on whether a particular technology or capability actually makes a difference in health care, and so far that evidence appears to be lacking for health information exchange.

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