More Research Necessary To Determine Efficacy Of HIEs

By Christine Kern, contributing writer

A lack of quality research gauging the impact of health information exchanges remains.

An Agency for Healthcare Research and Quality (AHRQ) study has found the impact of health information exchanges (HIEs) has been inadequately studied to date. The report, conducted by the Pacific Northwest Evidence-based Practice Center, reviewed more than 130 research studies of HIE conducted in the past seven years and found that, while they revealed user confidence HIEs improved coordination of care and improves public health reporting, ambulatory quality of care, and disability claims processing, there was no real evidence regarding the impact of health information exchange on mortality and morbidity.

The report, Outcomes From Health Information Exchange: Systematic Review and Future Research Needs, further found some evidence exists HIEs improve care and help reduce duplication of testing, lower emergency room costs, and reduce hospital admissions. “No studies of HIE effectiveness reported impact on primary clinical outcomes (e.g., mortality and morbidity) or identified harms,” the report says. “Studies have identified numerous facilitators and barriers to implementation and sustainability, but the studies have not ranked or compared their impact.”

According to iHealth Beat, the report found only “low-quality evidence” that “somewhat supports the value of HIE” for:

• reducing duplicative laboratory and radiology test ordering
• improving disability claims processing
• improving public health reporting
• increasing ambulatory quality of care
• lowering emergency department costs
• reducing hospital admissions

“Although it may not be the purview of research to decide if HIE should be funded as infrastructure [as with a utility] or as a part of business operations, the notion that HIE should improve efficiency and quality of care, including clinical and economic benefits, is not overwhelmingly supported by the available evidence,” the report’s authors wrote, according to Fierce EMR. “Positive findings are encouraging, but both the level of the impact and some inconsistencies in results preclude any definitive conclusion.”

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The study identified 34 research projects regarding HIE outcomes and concluded “the full impact of HIE on clinical outcomes and potential harms are inadequately studied. Future studies must address comprehensive questions, use more rigorous designs, and employ a standard for describing types of HIE.

“HIE has been promoted as an important application of technology in medicine that can improve the efficiency, cost-effectiveness, quality, and safety of health care delivery. However, HIE also requires considerable investment by sponsors, which have included governments as well as health care organizations.”

According to the findings, the use of HIE has risen over time and is highest in hospitals and lowest in long-term care settings. Three-quarters of U.S. hospitals exchanged information in 2014, up 85 percent from 2008 figures. HIE was used in 38 percent of office-based physicians, but only 1 percent in long-term care providers in 2012.

 A similar review published by RAND Corporation last year found the lack of evaluation of the more than 100 HIEs 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.

And in March, another study published by Health Affairs found the benefits and cost savings attributed to the use of HIEs have not been clearly identified by the bulk of research on such exchanges, as Health IT Outcomes reported.