The literature review for this study specifically examined the evidence around the impact of electronic HIE. A summary of the literature review is provided in Appendix F. No studies of the impact of HIE in LTPAC/LTSS settings were identified. Further, the evidence of HIE impact remains sparse. Among the measures used to evaluate HIE, health care utilization is the most widely used (e.g., hospital admissions, rates of laboratory tests).116 Only one of the three randomized controlled studies included in this review identified positive HIE outcomes, which was significant cost savings in ED charges per visit at one of the two hospitals involved.117 Moreover, in three studies, HIE use was associated with greater health care services utilization.46, 118, 119
The lack of results supporting HIE to improve cost and clinical outcomes such as quality of care and safety is not surprising due to the nascency of HIE, methodological challenges in assessing outcomes (e.g., sufficient volume of use, complex study designs, short study intervention periods, need for control groups). The studies aggregated costs and other utilization measures, and results may be confounded by factors such as differences in illness severity in the study groups.
Kern et al. developed a framework and with advice of a national expert panel, searched the literature to identify functionalities enabled by EHRs and HIE across three health care settings (ambulatory, inpatient, and ED). Each of 233 functionality-setting combinations were rated on their likelihood of having a positive financial effect; top-scoring functionalities were validated with the expert panel. The most highly rated HIE functionalities driving financial value included sending and receiving imaging and laboratory reports and allergy history, authorizations for procedures; receiving discharge medication lists from ED and inpatient settings; and enabling structured medication reconciliation.120
46. Frisse ME, Johnson KB, Nian H, et al. The financial impact of health information exchange on emergency department care. J Am Med Inform Assoc; 2012; 19(3): 328-333.
Hincapie AL, Warholak TL, Murcko AC, et al. Physicians' opinions of a health information exchange. J Am Med Inform Assoc; 2011; 18(1): 60-65.
Overhage JM, Dexter PR, Perkins SM, et al. A randomized, controlled trial of clinical information shared from another institution. Ann Emerg Med; 2002; 39(1): 14-23.
Vest JR. Health information exchange and healthcare utilization. J Med Syst; 2009; 33(3): 223-231.
Vest JR, Jasperson J. What should we measure? Conceptualizing usage in health information exchange. J Am Med Inform Assoc; 2010; 17(3): 302-307.
Kern LM, Wilcox A, Shapiro J, et al. Which components of health information technology will drive financial value? Am J Manag Care; 2012; 18(8): 438-445.
"HIEengage.pdf" (pdf, 976.86Kb)
"HIEengageA.pdf" (pdf, 122.65Kb)
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"HIEengageL.pdf" (pdf, 141.17Kb)