The Benefits of Health Information Exchange, or Lack Thereof

Yet another of the much-promoted health system cures is better information exchange capabilities among providers, which should avoid redundant services and improve quality by ensuring that providers have as much information on a patient’s health status and treatment history as possible, at least that is the theory.  Once again, our hopes are dashed, as a study in Health Affairs finds little evidence of benefit to date from expanded health information exchange.   (HA Article)   The federal meaningful use provisions encourage health information exchange and there are a number of organizations which provide this functionality.  By 2013, about two-thirds of hospitals and half of physician practices had some health information exchange relationship with outside organizations.  The authors conducted an extensive literature review to determine whether there was any effect on any outcomes from use of HIE.  They identified 27 articles which included 94 outcome analyses.  Most of the studies included in the review were focused on HIE use in the United States and used data from emergency rooms or hospitals.  Few were actual randomized trials and the aspects of the HIE studied were very heterogeneous.  The most common outcomes measured were use of health care services, health care costs, quality of care, and coordination of care, with utilization being far and away the most studied outcome.  Fifty-four of the analyses found some beneficial effect of health information exchange on the outcome examined.  Over 10% actually found an adverse effect.  Observational designs, which are less rigorous, were more likely to find a beneficial effect.  The relatively few studies that used more stringent experimental designs did not find much beneficial effect.  Only two of six showed positive results, one showing that access to prior test results lowered the number of tests ordered at one primary care practice affiliated with a hospital and one was conducted in Israel, finding some reduction of testing on medical wards in hospitals.  Several of the observational studies found reductions in utilization.  One clear conclusion, which is very common in evaluations of various health system improvement techniques, is that there is often very little reliable evidence on actual effects, and that is certainly true in regard to HIE.  It sounds like it should be helpful, and hopefully it is, but the evidence to document that is pretty limited so far.