Impacts of Patient Characteristics and Care Fragmentation on the Value of HIEs

Abstract

We investigate the impact of HIE use at the visit-level on patient outcomes, such as future visit behavior and the number of procedures performed on the patient, and how the effects differ across patient and visit characteristics, e.g., whether a patient has chronic conditions and whether a visit involves a hospital switch. Timely sharing of patient information is expected to decrease the fragmentation of care and improve decision-making, diagnoses, and care plans, yet previous studies that examine the benefits of HIE use do not focus on these issues and are not unanimous in their findings in general about the benefits of HIEs. Further, prior studies generally focus on average effects with binary HIE measures, either using HIE adoption at the hospital-level or whether HIE is accessed at the visit-level. We argue that the benefits of HIE stem from the information contained within and are not equal across cases. 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 the overall number of future visits, specifically, HIE use effectively reduces visits that are not preventative in nature while increases adherence to preventative care visits, aiding in the shift from treatment-based care to preventative-based care, that public health organizations have urged for. Further, HIE use lowers the number of procedures done at the focal visit. We have several other findings that have important implications for policymakers, healthcare providers, and patients.

Keywords: Health IT, health information exchange, care coordination, chronic disease management, care fragmentation