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Are Health Information Exchanges Worth the Money?

Study finds few health care benefits

Health information exchanges (HIEs) are supposed to improve the speed, quality, safety, and cost of patient care, but there is little evidence of that in existing HIE benefit studies, according to an article published in Health Affairs.

Researchers assessed 27 HIE benefit studies, said co-author Dr. Nir Menachemi, chair of the Department of Health Policy and Management in the Richard M. Fairbanks School of Public Health at Indiana University–Purdue University Indianapolis. He was at the University of Alabama at Birmingham when the review of the HIE studies was conducted.

HIEs allow doctors, nurses, pharmacists, and other health care providers to share a patient’s computerized medical information electronically. For the new study, researchers analyzed data from previous HIE benefit studies, looking for evidence that HIEs boosted efficiency, reduced health care costs, or improved outcomes.

“There is no strong, documented evidence in the studies that health care benefits are directly attributable to the use of HIE, rather than being correlated or incidentally related,” Menachemi said.

To be clear, the paper isn’t saying that there are no benefits from the use of HIE, Menachemi said. “It's simply premature to say if we have or have not gotten our money’s worth out of HIE.”

In the paper, the authors write: “There is a dearth of rigorous studies that link HIE adoption to clear benefits. Moreover, the scant high-quality evidence that does exist was conducted in disparate settings and evaluated different outcomes.”

“We need to eliminate any confounding issues implicating the correlation between benefits and HIE,” Menachemi added. “For example, how do we know that the correlation between computerization and good outcomes isn’t really just being driven by the fact that early adopters of HIE are exemplary health care providers? We need to rule out those kinds of things.”

Prior studies that were designed to identify causal relationships were significantly less likely to find a benefit from HIEs for all outcomes except health care cost measures than were studies not using such designs.

Two of six such studies found beneficial effects of HIEs largely as a result of a reduction in diagnostic and imaging tests, associated costs, or both, and these studies were conducted in a single clinic affiliated with an Indiana hospital or in one health care system in Israel.

Menachemi said he would be hard pressed to say for sure that these benefits will happen in every health care setting that computerizes and uses HIEs. “We still expect HIE benefits will accrue, but currently no one has been able to demonstrate in a general and convincing way that we can expect to see these benefits,” he remarked.

There are several possibilities why that’s so, Menachemi said. One is that the use of HIEs in the U.S. is still in its infancy. Most studies focus on first-generation systems and exchanges in institutions where active usage is low. Widespread, meaningful use of HIEs may allow better evaluation of their adoption, he remarked.

Menachemi hopes to do just that, now that he is in Indianapolis, where an earlier HIE benefit study was conducted at a hospital clinic. Given that central Indiana is home to what is probably the most mature HIE system in the country, there is a “huge opportunity to generate evidence of HIE benefits using more rigorous studies than have been done in the past,” he said.

Source: Medical Xpress; March 25, 2014.

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