Health systems’ use of enterprise health information exchange vs single electronic health record vendor environments and unplanned readmissions

Abstract

Objective Enterprise health information exchange (HIE) and a single electronic health record (EHR) vendor solution are 2 information exchange approaches to improve performance and increase the quality of care. This study sought to determine the association between adoption of enterprise HIE vs a single vendor environment and changes in unplanned readmissions. Materials and Methods The association between unplanned 30-day readmissions among adult patients and adoption of enterprise HIE or a single vendor environment was measured in a panel of 211 system-member hospitals from 2010 through 2014 using fixed-effects regression models. Sample hospitals were members of health systems in 7 states. Enterprise HIE was defined as self-reported ability to exchange information with other members of the same health system who used different EHR vendors. A single EHR vendor environment reported exchanging information with other health system members, but all using the same EHR vendor. Results Enterprise HIE adoption was more common among the study sample than EHR (75% vs 24%). However, adoption of a single EHR vendor environment was associated with a 0.8% reduction in the probability of a readmission within 30 days of discharge. The estimated impact of adopting an enterprise HIE strategy on readmissions was smaller and not statically significant. Conclusion Reductions in the probability of an unplanned readmission after a hospital adopts a single vendor environment suggests that HIE technologies can better support the aim of higher quality care. Additionally, health systems may benefit more from a single vendor environment approach than attempting to foster exchange across multiple EHR vendors.

Single-Vendor Electronic Health Record Use Is Associated With Greater Opportunities for Organizational and Clinical Care Improvements

“…This single-vendor EHR strategy is likely to grow because of the potential efficiencies gained through standardization. 6 , 8 , 23 As a result, it is not surprising that hospitals using the same vendor EHR system in both their inpatient and outpatient services are more likely to use resultant data to inform their clinical care decisions and organizational management process. Further, the greater use of EHR data because of a single-vendor EHR system in a hospital has been identified to improve hospital performance.…”

“…Further, the greater use of EHR data because of a single-vendor EHR system in a hospital has been identified to improve hospital performance. 8 , 23 , 28 , 29 It seems clear that hospitals can and will continue to leverage the EHR data to improve organizational performance. Moreover, those adopting a single-vendor EHR strategy have better capabilities to leverage both clinical and organizational data to inform clinical care and operational performance, likely because of improved interoperablity.…”

“… 4 , 5 , 6 In either case, the solution chosen is focused on how the hospital can best leverage the chosen strategy to reduce costs and improve value-added care. 7 , 8 In many hospitals and health systems, the installation of a new EHR has prompted a shift to a single vendor. For example, over the past decade, health systems have spent considerable financial sums to convert to single-vendor EHR systems, including Mayo Clinic, which reports spending $1.5 billion, and the Kaiser Permanente, spending $4 billion to convert to Epic.…”

Transforming Health Data to Actionable Information: Recent Progress and Future Opportunities in Health Information Exchange

“…EHR adoption may be increased with country-specific incentives [66] or by linking with population-level payment models that are focused on care of individuals ("bundled payment") [48]. Similarly, effective HIE is built around a common set of standards, such that they can be enforced across care environments using common vendor systems [67]. Alternatively, contemporary technologies like blockchain can support performant HIE across healthcare systems when implementation considers the architecture of the data being exchanged [68].…”

“…By contrast, direct-access HIE enables the development of longitudinal histories for patients. Hospitals that engaged in HIE were shown to have reduced rates of re-admission [67], reduction in information loss during care transitions from outpatient [86] or specialty (e.g., psychiatric [87]) settings to acute care hospitals. Ultimately, these studies demonstrate how increased availability and use of HIE in hospital settings have had a markedly positive impact on improving healthcare delivery.…”