The Value of Health Information Exchange Use: The Impact of Patient and Locations Characteristics

In this paper, we investigate the impact of health information exchange (HIE) use at the visit-level on patient outcomes, such as readmissions, length of stay, and the number of procedures. Built upon the theories of inter-organizational information sharing and transaction cost economics, we argue that the timely sharing of patient information can decrease fragmentation of care and improve decision-making, diagnoses, and care plans. The studies that examine the benefits of HIE use are not unanimous in their findings and generally limited to average effects with binary HIE measures, either using HIE adoption at the hospital-level or HIE access at the visit- level. The goal of this research is to get a deeper understanding by using a continuous measure that captures information depth of HIE in each use and investigate the benefits of HIE by patient characteristics (such as having a chronic condition) and patient movements between hospitals. We utilize a rich dataset of medical records from an HIE provider in New York. Our results show that the depth of information available for the patient in HIE use decreases future readmissions and the number of future visits, and these effects are significantly stronger for chronic patients compared to non-chronic patients. Further, HIE use lowers the length of stay and number of procedures done at the focal visit. The benefits for chronic patients generally accrue to both their chronic and non-chronic visits. Additionally, while hospital switches are associated with care fragmentation such as longer length of stay and more procedures being performed, we show that HIE use could effectively address these inefficiencies and reverse their effects, leading to overall net benefits. Results from this study have important implications for policymakers, healthcare providers, and patients.