Despite Large Investments, HIE Research Shows Few Positive Outcomes

Health information exchange (HIE) use is increasing in the US, but other than reducing emergency department usage and costs, little else is known about the effect of HIEs on other outcomes, according to a new study from RAND published in the Annals of Internal Medicine.

“It is pretty well established that the US healthcare system is highly fragmented,” Robert Rudin, lead author of the study and an associate policy researcher at RAND, said in a statement. “Lots of studies over the years, including some recent studies, have shown that a typical patient visits doctors in many different practices. Frequently the doctors don't have the patient's previous medical information.”

He added that instead of getting better, the situation may worsen if medicine continues on the path of becoming more specialized.

HIEs have been viewed as a promising solution to the increasingly fragmented healthcare delivery in the US, and usage of HIEs is incentivized by government policies. The federal government has provided nearly $600 million to support statewide HIE organizations with some states providing additional funding.

The industry is looking to HIEs as an attempt to improve communication among providers, to improve care and patient satisfaction, and reducing costs, according to RAND. However, the relatively few exchanges that have been studied don’t show much improvement.

“There are likely other health information exchange organizations in the country that are being used, and some may be having an impact,” Rudin said. “But, if they exist, they haven't been evaluated. And without an evaluation, it is difficult to draw conclusions.”

Although findings from 38 of the studies analyzed found providers, patients, and other stakeholders consider HIEs to be valuable, technical and workflow issues, costs, and privacy concerns continue to be barriers.

“We really don't know what works and what doesn't when it comes to implementing health information exchanges,” Rudin said. “The evidence base is small relative to the size of federal and state investments, and relative to expectations that it will help address issues related to fragmentation of care.”