Health information exchange policies of 11 diverse health systems and the associated impact on volume of exchange

J Am Med Inform Assoc. 2017 Jan;24(1):113-122. doi: 10.1093/jamia/ocw063. Epub 2016 Jun 14.


Background: Provider organizations increasingly have the ability to exchange patient health information electronically. Organizational health information exchange (HIE) policy decisions can impact the extent to which external information is readily available to providers, but this relationship has not been well studied.

Objective: Our objective was to examine the relationship between electronic exchange of patient health information across organizations and organizational HIE policy decisions. We focused on 2 key decisions: whether to automatically search for information from other organizations and whether to require HIE-specific patient consent.

Methods: We conducted a retrospective time series analysis of the effect of automatic querying and the patient consent requirement on the monthly volume of clinical summaries exchanged. We could not assess degree of use or usefulness of summaries, organizational decision-making processes, or generalizability to other vendors.

Results: Between 2013 and 2015, clinical summary exchange volume increased by 1349% across 11 organizations. Nine of the 11 systems were set up to enable auto-querying, and auto-querying was associated with a significant increase in the monthly rate of exchange (P = .006 for change in trend). Seven of the 11 organizations did not require patient consent specifically for HIE, and these organizations experienced a greater increase in volume of exchange over time compared to organizations that required consent.

Conclusions: Automatic querying and limited consent requirements are organizational HIE policy decisions that impact the volume of exchange, and ultimately the information available to providers to support optimal care. Future efforts to ensure effective HIE may need to explicitly address these factors.

Keywords: EHR; HIE; electronic health record; high value care.

MeSH terms

  • California
  • Electronic Health Records
  • Health Facility Administration*
  • Health Information Exchange / statistics & numerical data*
  • Health Information Exchange / trends
  • Humans
  • Informed Consent
  • Organizational Policy*
  • Retrospective Studies