Challenges to Conducting Health Information Exchange Research and Evaluation: Reflections and Recommendations for Examining the Value of HIE

Abstract

Introduction: Health information exchange (HIE) promises cost and utilization reductions. To date, only a small number of HIE studies have demonstrated benefits to patients, providers, public health, or payers. This may be because evaluations of HIE are methodologically challenging. Indeed, the quality of HIE evaluations is often limited and authors frequently note unmet evaluation objectives. We provide a systematic identification of HIE research challenges that can be used to inform strategies for higher quality scientific evidence. Methods:We conducted qualitative interviews with 23 HIE researchers and leaders of HIE efforts representing experiences with more than 20 HIE efforts. We also conducted a six-person focus group to expand on and confirm individual interview findings. Qualitative analysis followed a grounded theory approach using multiple coders.Results: Participants experienced similar challenges across seven themes (i.e., HIE maturity, data quality, data availability, goal alignment, cooperation, methodology, and policy). Conclusion:Several options may exist to improve HIE research, including developing better conceptual models and methodological approaches to HIE research; formal partnerships between researchers and HIE entities; and establishing a nationwide database of HIE information. Our proposed approaches of promoting data availability, resource sharing, and new partnerships can help to overcome existing barriers and facilitate HIE research.

Health information exchange between hospital and skilled nursing facilities not associated with lower readmissions

“…SNFs face significant pressure to market themselves as willing collaborative partners in an environment where hospitals are increasingly looking to tighten their referral network and develop more integrated care practices. 16,19,20 While the evidence base demonstrating positive impact of HIE on cost and outcomes continues to grow, 21,22 there has been no empirical examination of whether HIE in the context of SNF transitions results in improved patient outcomes. This particular type of handoff merits special consideration, as information needs and organizational contexts differ substantially across these settings.…”

The associations between query‐based and directed health information exchange with potentially avoidable use of health care services

“…8 As such, comparisons of different studies are challenging, synthesizing the literature difficult, the generalizability of the current research is suspect, and we have limited insights into the effectiveness of different technological approaches to HIE to improve the quality of care. 28 This study sought to address the above shortcomings in the evidence base by focusing on the impact of HIE in ambulatory care settings with specific attention to the use of differing technological approaches. Specifically, the objectives were to quantify the impact of two different forms of HIE-query-based and directed HIE-on three types of potentially avoidable services: ambulatory care sensitive hospitalizations (ACSH), nonemergent emergency department (ED) utilization, and unplanned 30-day readmissions.…”