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Research on Health Information Exchange Limited, AHRQ Finds

“Despite these concerns, expansion of HIE seems likely, and research could better serve this effort by developing and pursuing a more deliberate research agenda..."

By Sara Heath

Research informing healthcare organizations and providers of the outcomes of adequate health information exchange (HIE) appears to be lacking, according to research from the Agency for Healthcare Research Quality (AHRQ).

health information exchange

The study investigated the literature surrounding HIE, and sought to determine this literature’s effectiveness in informing healthcare provider decisions about HIE adoption.

HIE is often touted as a game-changer for healthcare quality, efficiency, and effectiveness, and is a considerable investment for healthcare organizations. AHRQ sought to examine the literature regarding the effectiveness of HIE to understand the influencers and healthcare organizations’ adoption decisions.

“HIE also requires considerable investment by sponsors, which have included governments as well as health care organizations,” the report began. “This review aims to synthesize the currently available research addressing HIE effectiveness, use, usability, barriers and facilitators to actual use, implementation, and sustainability, and to present this information as a foundation on which future implementation, expansion, and research can be based.”

AHRQ reviewed countless HIE studies, and included a total of 136 in their final review. Thirty-four of these studies were about effectiveness, 26 were about intermediate clinical, economic, or patient outcomes, and eight were about clinical perceptions of HIE. The study also included 58 studies on HIE use, 22 on usability and facilitators of barriers on HIE use, 45 on facilitators or barriers on HIE implementation, and 17 on the sustainability of HIE.

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What the agency found was that much of this research was inconclusive, and didn’t clearly indicate many of the benefits of HIE. Between all of the studies included in AHRQ’s study, the researchers concluded that there is very little literature on the full effects of HIE.

“The full impact of HIE on clinical outcomes and potential harms is inadequately studied, although evidence provides some support for benefit in reducing use of some specific resources and achieving improvements in quality-of-care measures,” AHRQ reported.

However, HIE has numerous times been reported to be a vital part of healthcare reform. Several industry stakeholders believe data sharing to be a key in improving care coordination and patient engagement, thus improving the overall quality of a patient’s care. Because of this, HIE and interoperability have been brought to the forefront of healthcare reform.

For example, the Health IT Policy Committee recently reported to Congress four steps the industry can make in improving and speeding up HIE and interoperability. Overall, HIE stakeholders need to create HIE-specific measures for both users and vendors, speed up HIE incentive payments, and collaborate on establishing these provisions together.

Because of the importance of HIE, underscored by the several industry professionals advocating for it, AHRQ maintained that more research needs to be done to determine the effects of HIE.

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Specifically, AHRQ says that the information obtained in this research needs to be improved so that the results become more useful.

[T]his body of literature is limited in several ways. Most of the studies are not designed to sufficiently control for risk of bias, and they focus on relatively narrow outcomes when assessing the impact of a broad-based, complex, systemic intervention such as HIE. While the studies of use, usability, implementation, and sustainability provide information on context and allow some insight into trends, in general they do not permit any comparative assessment or ranking of the importance of different barriers or facilitators. Additionally these studies do not provide sufficient technical detail to compare HIE systems by function or architecture.

Furthermore, AHRQ explained that studies need to focus on the scope of HIE use, rather than simply the prevalence of it. Without looking into how HIE is used, the agency stated that it is hard to understand the end use of the infrastructure.

“Exactly what is needed for HIE to be effective is also difficult to discern from a body of literature that does not include many comparative studies and that does not seem to build on prior results to create a succession of increasingly relevant studies,” the researchers wrote. “We hope that this will improve as HIE implementations become more mature and more robust study designs are used.”

In light of the expansion of HIE use, AHRQ confirmed that more expansive studies regarding HIE will facilitate the adoption of HIE.

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“Despite these concerns, expansion of HIE seems likely, and research could better serve this effort by developing and pursuing a more deliberate research agenda designed to capture the full potential impact of HIE and identify the comparative role of specific factors related to use, usability, implementation, and ultimately, sustainability,” AHRQ concluded.

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