The Impact of Health Information Exchanges on Emergency Department Length of Stay
Production and Operations Management, doi:10.1111/poms.12953
44 Pages Posted: 17 May 2017 Last revised: 9 Oct 2018
Date Written: September 9, 2018
Health information exchanges (HIEs) are expected to improve poor information coordination in Emergency departments (EDs); however, whether and when HIEs are associated with better operational outcomes remains poorly understood. In this work, we study HIE and length of stay (LOS) relationship using a large dataset from the Healthcare Cost and Utilization Project consisting of about 5.8 million treat-and-release visits made to 63 EDs in Massachusetts. Overall, we find that HIE adoption is associated with a 11.1% reduction in LOS and the percentage reduction increases to 16.5% when a patient has a previous visit to an HIE-carrying hospital. We further find that 1) teaching hospitals benefit more from HIE adoption compared with non-teaching hospitals, 2) HIE is less effective in reducing LOS when EDs are crowded, 3) patients with severe or multiple comorbid conditions spend less time in the ED under HIE presence, and 4) there exist variations in HIE and LOS relationship across primary diseases/conditions that the patient is visiting the ED for. Together, these results imply that 1) HIE adoption reduces overall ED LOS, 2) wider HIE adoption would scale up the benefits for individual hospitals, and 3) the size of the reduction depends on certain contextual moderating factors. Given that Massachusetts has been considered a mini-model for the implementation of the Affordable Care Act, we believe that our findings have important implications and may inform policymakers regarding the nationwide HIE adoption.
Keywords: Health Information Exchange, Emergency Department, Length of Stay, Healthcare
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