Little evidence found of HIE benefitting healthcare quality and costs

March 4, 2015

The ability to share patient health information among providers has been a key government goal since passage of the Health Information Technology for Clinical Health (HITECH) Act of 2009 and the Affordable Care Act the following year. Partly as a result of those pieces of legislation, by 2013 about two-thirds of U.S. hospitals and half of physician practices were using some form of health information exchange (HIE) with other organizations. So far, however, there is little conclusive evidence demonstrating that HIE benefits individual patients or the healthcare system generally.

The ability to share patient health information among providers has been a key government goal since passage of the Health Information Technology for Clinical Health (HITECH) Act of 2009 and the Affordable Care Act the following year. Partly as a result of those pieces of legislation, by 2013 about two-thirds of U.S. hospitals and half of physician practices were using some form of health information exchange (HIE) with other organizations. So far, however, there is little conclusive evidence demonstrating that HIE benefits individual patients or the healthcare system generally.

READ MORE: Health information exchange raises patient consent questions

That is the conclusion of a recent study of the literature examining the relationship between HIE and outcomes such as costs, quality, and use of services.  The study appears in the March 2015 issue of Health Affairs.

The authors looked at 27 articles containing 94 analyses of the impact of HIE on of outcomes, including:

  • healthcare utilization,

  • costs,

  • quality of care,

  • care coordination,

  • patient experience, and

  • disease surveillance

Overall, the study found that 57% of the analyses reported some form of benefit from HIE.

The authors add, however, that only six of the 27 articles used what they describe as “study designs having strong internal validity, such as randomized controlled trials or quasi-experiments.” Of those six, only two found a beneficial effect from HIE-in one case, the ordering of fewer tests in a primary care practice, and in the other, fewer diagnostic and imaging tests in medical (but not surgical) wards. “Thus, despite the abundance of observational studies finding a beneficial relationship between HIE an outcomes, there is currently no strong evidence to suggest that HIE is causally related to any widespread generalizable benefits,” the authors say.

The authors cite three possible reasons for the lack of evidence of HIE benefits: the fact that HIE in the United States is still relatively new, the costs and difficulties associated with designing real-world, randomized control trials, and the possibility that the benefits of HIE have been overestimated.