• Not enough known about health information exchanges

    Despite The Spread Of Health Information Exchange, There Is Little Evidence Of Its Impact On Cost, Use, And Quality Of Care,” by Saurabh Rahurkar, Joshua Vest, and Nir Menachemi, is a systematic review (N=27 articles) of the use and effects of health information exchange (HIE). It appears in Health Affairs. Some quotes:

    • “A total of fifty-four analyses (57.5 percent) found a beneficial effect of HIEs on the outcome they studied.”
    • But, “while cohort studies [N=20] were more likely than other study designs to report a beneficial effect from HIE (75 percent versus 26.5 percent), randomized controlled trials [N=5] (17.7 percent versus. 66.2 percent) and quasi-experimental studies [N=1] (16.7 percent versus 63.4 percent) were significantly less likely to find a beneficial effect
      from HIEs.”*
    • “[S]tudy design was the only characteristic that was found to be significantly associated with finding a beneficial effect of HIE.” Other explanatory variables included in the analysis were indicators of: US-based study, utilization was the outcome, ED setting, hospital setting, study years 2009-2014 (vs 1987-2008).
    • “A key conclusion of our systematic review is that there is a dearth of rigorous studies that link HIE adoption to clear benefits.”

    This should not be read as an indication that HIE is of little value. It should be read as a challenge to the research community to study it more rigorously.

    My own advice would also be to do so with as long a follow-up time as is feasible and to stratify analyses by measures of culture and management.** It’s reasonable to expect that, if it produces positive results at all, implementation of new information technology doesn’t produce them immediately. It’s also reasonable to expect that new technology won’t do very much in a cultural or management environment that isn’t capable of exploiting it.

    Another, recent systematic review of the use and effects of HIE appeared in the Annals of Internal Medicine.

    * I believe the percents in parentheses pertain to the number of analyses not the number of studies, which I’ve indicated in brackets.

    ** I confess not to know in great deal how to do this. Look here and here for links to papers with some measures of good management.


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