The Effects of Health Information Exchange Access on Healthcare Quality and Efficiency: An Empirical Investigation

Health information exchanges (HIEs) are designed to improve the quality and efficiency of healthcare by facilitating improved information sharing between health entities. This study systematically examines the impact of HIE use in emergency departments (EDs) on the quality and efficiency of medical care. We focus on the length of stay (LOS) and the 30-day readmission rate to capture healthcare efficiency and quality, respectively. We also examine whether the breadth of patient health information and physicians' experience with the HIE moderates these effects. We leverage a unique panel data that tracks actual HIE access by physicians who practice in a set of hospitals that participate in the focal HIE. The patient-level encounter data set-which involves more than 80,000 ED encounters attended by more than 300 physicians over a 19-month period-comprises detailed medical provider information, patient-level medical information, and various other information related to procedures that were performed. After controlling for a battery of patient-specific, physician specific, disease-specific, and ED visit-specific variables, our results show that HIE access in information-intensive environments (such as EDs) reduces LOS and 30-day readmission rate. We find that breadth of patient health information and physicians' HIE experience amplify these benefits. We account for endogeneity issues and perform additional falsification tests and robustness checks. We document that benefits of HIE access are amplified for noninjury, chronic condition, and uncommon diagnoses related patient visits. Based on our results, we offer insights to practitioners and academicians alike on how HIEs can yield better patient-level and provider-level outcomes.