PCP Use of Community HIE Cuts Likelihood of Hospital Reutilization

Increased primary care physician (PCP) use of community HIE may dramatically improve patient outcomes, according to a study published in Annals of Family Medicine.

Researchers used Paso del Norte Health Information Exchange (PHIX) to identify a retrospective cohort of 8,216 hospital inpatients discharged from January 1, 2021, through November 30, 2021.

Patients included in the study had a follow-up PCP visit within 30 days after hospital discharge.

Patients were 50 percent less likely to reutilize the hospital in the follow-up window when PCPs looked up patient information in the HIE.

If the patient did reutilize the hospital, the length of time to the subsequent hospital visit more than doubled if the PCP looked them up in the HIE.

However, the under-utilization of HIE by PCPs is a hurdle to improving outcomes through data exchange. PCPs only used PHIX to look up about three percent of patients who had a follow-up appointment 30 days after discharge.

“Low engagement with HIEs by US clinicians is a chronic problem despite widespread adoption of EHRs,” the study authors wrote. “Some physicians use the HIE as standard practice, which likely accounts for most lookups, while others never use it.”

There are several possible explanations for the under-utilization of PHIX and other HIEs, including a passive communication structure, the researchers noted.

“Patients may not disclose a recent hospital visit to their primary care physician when asked, or their primary care physician may fail to ask,” they wrote. “A solution PHIX is pursuing is more active communication by means of an alert system to notify primary care physicians when a patient is admitted to the hospital.”

“Increasing engagement with HIEs may also be aided through task-sharing with other clinical or administrative staff (eg, medical assistants, nurses, etc.),” the authors added.

The study also found that only 16 percent of individuals in El Paso discharged from hospital inpatient visits had a follow-up appointment with their PCP within 30 days.

“This is an undercount because not all primary care physicians in El Paso are part of the PHIX system,” the authors pointed out. “This is one of the weaknesses of the study and placed some limits on cohort size. We suspect, that despite incomplete data capture, there is a need for increased efforts to be sure patients visit their primary care physicians promptly for follow-ups.”