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

J Am Med Inform Assoc. 2019 Oct 1;26(10):989-998. doi: 10.1093/jamia/ocz116.


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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Commerce
  • Delivery of Health Care
  • Electronic Health Records*
  • Female
  • Health Information Exchange*
  • Hospital Administration*
  • Hospitals
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Organizational Policy*
  • Patient Readmission / statistics & numerical data*
  • United States