Cover: Usage and Effect of Health Information Exchange

Usage and Effect of Health Information Exchange

A Systematic Review

Published In: Annals of Internal Medicine, v. 161, no. 11, Dec. 2014, p. 803-812

Posted on Dec 3, 2014

by Robert S. Rudin, Aneesa Motala, Caroline Lubick-Goldzweig, Paul G. Shekelle

Research Questions

  1. Do statewide health information exchanges—organizations that allow doctors to share medical information electronically—improve health outcomes?
  2. Are health information exchanges a viable solution to fragmented health care delivery in the U.S.?
  3. What are the barriers to adoption of health information exchanges?

BACKGROUND: Health information exchange (HIE) is increasing in the United States, and it is incentivized by government policies. PURPOSE: To systematically review and evaluate evidence of the use and effect of HIE on clinical care. DATA SOURCES: Selected databases from 1 January 2003 to 31 May 2014. STUDY SELECTION: English-language hypothesis-testing or quantitative studies of several types of data exchange among unaffiliated organizations for use in clinical care that addressed health outcomes, efficiency, utilization, costs, satisfaction, HIE usage, sustainability, and attitudes or barriers. DATA EXTRACTION: Data extraction was done in duplicate. DATA SYNTHESIS: Low-quality evidence from 12 hypothesis-testing studies supports an effect of HIE use on reduced use or costs in the emergency department. Direct evidence that HIEs were used by providers was reported in 21 studies involving 13 distinct HIE organizations, 6 of which were located in New York, and generally showed usage in less than 10% of patient encounters. Findings from 17 studies of sustainability suggest that approximately one quarter of existing HIE organizations consider themselves financially stable. Findings from 38 studies about attitudes and barriers showed that providers, patients, and other stakeholders consider HIE to be valuable, but barriers include technical and workflow issues, costs, and privacy concerns. LIMITATION: Publication bias, possible selective reporting of outcomes, and a dearth of reporting on context and implementation processes. CONCLUSION: Health information exchange use probably reduces emergency department usage and costs in some cases. Effects on other outcomes are unknown. All stakeholders claim to value HIE, but many barriers to acceptance and sustainability exist. A small portion of operational HIEs have been evaluated, and more research is needed to identify and understand success factors.

Key Findings

  • Despite significant federal and state funding of health information exchanges, there is very little research about the effects of these exchanges on the quality and efficiency of health care delivery in the U.S.
  • The few evaluations that do exist suggest that the use of health information exchanges has some beneficial effects on emergency department costs and utilization of services such as diagnostic imaging studies.
  • Barriers to widespread use of health information exchanges include interface, workflow, and cost issues, as well as patients' concerns about privacy.
  • There have not been enough studies to determine whether health information exchanges can solve the problem of fragmented health care in the U.S.


More research is needed to understand what does and doesn't work about health information exchanges, and how resources can most effectively be allocated to improve electronic sharing of medical information.

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