Health systems' use of enterprise health information exchange vs single electronic health record vendor environments and unplanned readmissions

Abstract

Objective: Enterprise health information exchange (HIE) and a single electronic health record (EHR) vendor solution are 2 information exchange approaches to improve performance and increase the quality of care. This study sought to determine the association between adoption of enterprise HIE vs a single vendor environment and changes in unplanned readmissions.

Materials and methods: The association between unplanned 30-day readmissions among adult patients and adoption of enterprise HIE or a single vendor environment was measured in a panel of 211 system-member hospitals from 2010 through 2014 using fixed-effects regression models. Sample hospitals were members of health systems in 7 states. Enterprise HIE was defined as self-reported ability to exchange information with other members of the same health system who used different EHR vendors. A single EHR vendor environment reported exchanging information with other health system members, but all using the same EHR vendor.

Results: Enterprise HIE adoption was more common among the study sample than EHR (75% vs 24%). However, adoption of a single EHR vendor environment was associated with a 0.8% reduction in the probability of a readmission within 30 days of discharge. The estimated impact of adopting an enterprise HIE strategy on readmissions was smaller and not statically significant.

Conclusion: Reductions in the probability of an unplanned readmission after a hospital adopts a single vendor environment suggests that HIE technologies can better support the aim of higher quality care. Additionally, health systems may benefit more from a single vendor environment approach than attempting to foster exchange across multiple EHR vendors.

Keywords: electronic health records; health information exchange; hospitals; patient readmission policy.

Figure 1.

Adoption of enterprise health information exchange and single electronic health record vendor environments among hospitals initiating health information exchange in Arkansas, California, Florida, Iowa, Maryland, New York, and Washington over the period 2010–2014.

Figure 2.

Marginal means of unplanned readmission rates by different approaches and structures to intraorganizational information exchange.¹¹Adjusted for the factors (other than type of health information exchange) reported in Table 1, but omitted for readability (see Supplementary Appendix for full results) Abbreviations: eHIE, enterprise health information exchange; her, electronic health record. * P < .05 compared to other categories within the same panel.