Health information exchange (HIE) is the transfer of electronic information such as lab results, clinical summaries, and medication lists, and its proponents claim it can be used to boost efficiency, reduce health care costs, and improve outcomes for patients.
Because of its potential benefits, the federal government has boosted financial incentives for hospitals and physician practices to engage in some type of HIE with outside organizations, but HIE has yet to show strong evidence that it will live up the hype, according to a survey of research data analyzed in a study for Health Affairs.
Hospitals may eventually benefit from HIE, but for now, tradeoffs exist in data security and the doctor-patient bond, says study coauthor Saurabh Rahurkar of the University of Alabama-Birmingham.
The major benefits of HIE the study identified were a reduction in the use of imaging tests, labs, and diagnostic tests, and the associated costs of these tests.
Health information technology (HIT) may seem like a good idea because it makes sense for your doctor to have access to a patient’s medical history at his or her fingertips, but Devon Herrick, a senior fellow in health care policy at the National Center for Policy Analysis, says what looks good on paper doesn’t always work well in practice.
“It’s not that health IT isn’t a great idea, but in our current system the incentives are convoluted and perverse,” said Herrick. “Health care systems cannot be expected to implement a HIT system that is not in their self-interest to implement. Redundant medical testing that health economists call waste, hospitals count as revenue.”
Herrick says doctors don’t have an incentive to see if patients already had an MRI since the hospitals want to sell services to their patients. Doctors are not competing on price, so the fact that patients may be able to save a bundle on an MRI isn’t a concern for the physician. When doctors know an expensive test has been completed, however, they are less likely to put the patient through another one, the data suggest.
“I would expect to see HIEs result in improved clinical decision making by providing access to comprehensive patient information,” said Herrick. “Emergency departments are a setting that is most likely to benefit from this, and as such, I would expect to see benefits in health outcomes in ED settings, such as reduction in inpatient ED admissions, repeat ED visits, and costs associated with ED visits.”
Data aggregated by HIEs could also benefit research endeavors by making available rich datasets to individuals interested in improving care, says Herrick.
“Besides ED settings, we need to also focus on areas that have thus far not been studied,” said Herrick. “For example, populations with any chronic diseases, such as diabetes, asthma, cancer, etc. Lastly, to fully study the impact of HIEs, planned studies are needed to assess actual use of the system and not simply whether a system exists. This has, thus far, been absent for previous studies.”
Risk of Leaks
Information security concerns have been consistently reported as barriers to HIE adoption, but Rahurkar says there is risk involved in any means of storing records.
“I personally believe the tradeoff is worth it, but we have not seen this issue sufficiently publicly debated,” said Rahurkar.
Another barrier to adoption is the intrusion of computers and mobile devices into the doctor-patient relationship, Herrick says.
“One problem I’ve heard of from health care providers is how much productivity is lost when they continually have to use a pull-down menu and find the correct checkboxes while seeing a patient,” said Herrick. “Rather than looking the patient in the eye or looking for subtle signs of disease, the doctor struggles with software on an iPad or computer screen.”
Loren Heal ([email protected]) writes from Neoga, Illinois.
Saurabh Rahurkar, Joshua R. Vest, and Nir Menachemi, “Despite the Spread of Health Information Exchange, There is Little Evidence of Its Impact on Cost, Use and Quality of Care,” Health Affairs, March 2015: http://content.healthaffairs.org/content/34/3/477