Sharing information electronically with other hospitals is associated with increased sharing of patients

Abstract

Objective: One potential benefit of greater electronic health information exchange is a reduction in the effort required for patients to switch between providers. We therefore assessed whether hospital participation in health information organizations (HIOs) led to increased patient sharing.

Data sources: Secondary data from 2010 to 2016.

Study design: Using hospital-pair and year fixed effects regression models, we assessed change in patient sharing volume following HIO participation by hospitals and compared the effect by the level of market competition and by hospital size.

Data extraction methods: We used national data on hospital participation in HIOs from the American Hospital Association Information Technology Supplement and data on the volume of Medicare patients shared between pairs of hospitals from 2010 to 2016.

Principal findings: The volume of patients shared between hospitals increased by 2.6 percent when both hospitals participated in a health information organization (P = .008, 95% CI: 0.7%-4.5%). This increase was greater in competitive markets (3.1 percent increase, P = .03 95% CI: 0.3%-5.9%) and between large hospitals (4.3 percent increase, P = .007 95% CI: 1.2%-7.3%). Participation by only one hospital in a pair had no effect on patient sharing.

Conclusions: Our results suggest that an important policy goal motivating the investment in health information exchange has been at least partially achieved. However, our results also support hospital concerns about the competitive implications of engaging in health information exchange. HIO participation appears to facilitate patient movement between hospitals, likely by lowering switching costs and resulting in greater competition.

Keywords: competition; health information exchange; health information technology; hospitals; interoperability.

Figure 1

Trend in volume of shared patients treated by two hospitals within 30 days, by hospital‐pair HIO participation status. Error bars represent 95% confidence intervals. Data from 2009‐2016 American Hospital Association Information Technology Supplement and 2010‐2013 medicare physician shared patient patterns files and 2014‐2016 HOP files [Color figure can be viewed at http://wileyonlinelibrary.com]

Figure 2

Association between hospitals joining a HIO and change in interhospital patient sharing. Error bars represent 95% confidence intervals. Data from 2009‐2016 American Hospital Association Information Technology Supplement and 2010‐2013 medicare physician shared patient patterns files and 2014‐2016 HOP files [Color figure can be viewed at http://wileyonlinelibrary.com]

Figure 3

Association between hospital size, hospitals joining a HIO, and change in interhospital patient flow. Error bars represent 95% confidence intervals. Data from 2009‐2016 American Hospital Association Information Technology supplement and 2010‐2013 medicare physician shared patient patterns files and 2014‐2016 HOP files [Color figure can be viewed at http://wileyonlinelibrary.com]