Health Information Exchange, System Size and Information Silos

Abstract

There are many technology platforms that bring benefits only when users share data. In healthcare, this is a key policy issue, because of the potential cost savings and quality improvements from 'big data' in the form of sharing electronic patient data across medical providers. Indeed, one criterion used for federal subsidies for healthcare information technology is whether the software has the capability to share data. We find empirically that larger hospital systems are more likely to exchange electronic patient information internally, but are less likely to exchange patient information externally with other hospitals. This pattern is driven by instances where there may be a commercial cost to sharing data with other hospitals. Our results suggest that the common strategy of using 'marquee' large users to kick-start a platform technology has an important drawback of potentially creating information silos. This suggests that federal subsidies for health data technologies based on 'meaningful use' criteria, that are based simply on the capability to share data rather than actual sharing of data, may be misplaced.

Hospital Electronic Health Information Exchange Grew Substantially In 2008–12

“…Prior research found that hospitals in large systems were less likely than others to exchange information with providers outside their organization, 18 and increased competition may inhibit hospitals' participation in HIOs. 16,19,23 Although our study did not find an association between market concentration and exchanges with outside providers, competition as well as limited cross-vendor interoperability may be barriers to exchanges between unaffiliated hospitals.…”

“…16,19,23 Although our study did not find an association between market concentration and exchanges with outside providers, competition as well as limited cross-vendor interoperability may be barriers to exchanges between unaffiliated hospitals. 18 Exchanges with unaffiliated providers and hospitals are currently limited. However, payment reform may encourage hospitals to exchange information outside their organization, including with unaffiliated hospitals.…”

“…Limited incentives and competition may further hinder exchanges between hospitals and outside organizations. 17,18 Beyond the recent expansion in approaches to health information exchange, little is known about the extent of exchange activity in hospitals. In particular, research to date has not focused on the roles of interoperable EHR systems and regional HIOs in facilitating exchange activity among hospitals, nor has it examined variations in the types of exchange among providers and hospitals.…”

“…16,19 In contrast, we assessed the extent of exchange activity based on the reported exchange of clinical information with other providers, including exchanges that occurred through an HIO. Building on another study that examined exchange activity by organizational affiliation, 18 our study focused on the association between hospitals' EHR adoption and HIO participation, on the one hand, and their exchange activity, on the other hand. In addition to affiliation, we assessed the variation in exchange activity by type of provider and type of clinical information.…”

Health IT and Ambulatory Care Quality

“…Miller and Tucker (2014a) report evidence from the AHA special survey of hospitals regarding health IT and information exchange. A key finding of that paper was that hospitals that are part of larger systems are more likely to exchange patient information electronically with other providers (hospitals and ambulatory care providers), but they are less likely to exchange information outside of their systems.…”