The Evidence Base for Health Information Exchange

Health information exchange (HIE) has been promoted to improve the efficiency, cost-effectiveness, quality, and safety of health care delivery. This chapter describes the evidence base to support that assertion, describing a systematic review of the effectiveness, use, usability, implementation, and sustainability of HIE. The review identified 136 studies: 34 on effectiveness, 58 on the use of HIE, 22 on usability and facilitators and barriers to use of HIE, 45 on facilitators or barriers to HIE implementation, and 17 on factors related to sustainability. No studies reported on clinical outcomes (eg, mortality and morbidity) or identified harms. Low-quality evidence generally finds that HIE reduces duplicative laboratory and radiology testing, emergency department costs, hospital admissions (less so for readmissions), and improves public health reporting, ambulatory quality of care, and disability claims processing. Most clinicians attributed positive changes in care coordination, communication, and knowledge about patients to HIE. The use of HIE has increased over time, but within organizations the number of users or HIE-accessed visits was generally low. Barriers to HIE use were lack of critical mass of data, inefficient workflow, and poorly designed interface as well as update features. Greater usability was associated with greater use but not with effectiveness. Facilitators of HIE implementation were characteristics of the organization (eg, leadership) or the HIE system, while barriers included competition or lack of a business case for HIE. Although the evidence supports a benefit of HIE in reducing the use of specific resources and may improve quality of care, the full impact of HIE on clinical outcomes and potential harms is inadequately studied. Future studies should address comprehensive questions, use more rigorous designs, and employ a standard for describing types of HIE.