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Just 3 years ago, the same authors found “little generalizable evidence” of HIE benefits.
Researchers at the Indiana University’s Richard Richard M. Fairbanks School of Public Health have released a new review that they say shows that health information exchanges (HIEs) “represent progress towards the national goals of better-quality care, improved population health, and lower costs.”
Three of the 4 authors on the new report—published in the Journal of the American Medical Informatics Association—actually authored an earlier study that said the opposite. In 2015, Nir Menachemi, PhD, Joshua R. Vest, PhD, and Saurabh Rahurkar, BDS, DrPH, concluded that there was “little generalizable evidence” that HIEs provided attributable benefits because the existing research was “methodologically limited.”
“It is incumbent upon future research to increase the use of study designs capable of reducing selection bias and confounding and to include settings, populations, and outcome measures for which little research currently exists,” they wrote, urging the use of stronger evaluation designs to enable better, more holistic assessments.
For the new report, the trio was joined by Christopher A. Harle, PhD, and this time they scoured PubMed and Scopus for articles that evaluated HIEs specifically as they related to healthcare outcomes. While the 2015 report focused on studies published between January 1980 and May 2014—where they found a “dearth of rigorous studies that link HIE adoption to clear benefits.” The new research picks up where the first left off, plucking 63 unique analyses from 24 articles published between May 2014 and June 2017.
About 68% of the analyses reported some sort of clear benefit resulting from an HIEs functions, whether it was a reduction in duplicate procedures or unnecessary imaging practices, a measure of financial savings, or an improvement in patient outcomes.
The study also found that studies assessing community HIEs were more likely to find benefits than those evaluating enterprise or vendor-mediated exchanges. Menachemi said that it “looks like community health information exchanges might be more likely to achieve improved outcomes.”
Around 8% of the studies did report “an unexpected adverse event,” though that number was down from 10.6% in the 2015 report. The remaining analyses produced neutral results.
There could be a number of reasons for the authors’ change in tune. For one, there’s been a rapid uptick in the adoption of the underlying technology that enables HIEs: electronic health records, which were barely invented when the previous study’s review window opened (1980). There’s also the chance that the HIEs themselves have matured between the 2 studied time periods, according to Menachemi.
"Up until this point, the promise of health information exchanges to improve care and reduce costs has been theoretical," he said. "We now have reasonably strong evidence that there are benefits to using health information exchanges."