Impact of Health Information Exchange Adoption on Referral Patterns

Eftekhari, Saeede; Yaraghi, Niam; Gopal, Ram D.; Ramesh, Ram

doi:10.1287/mnsc.2022.4435

Cited by 7 publications

(3 citation statements)

References 58 publications

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“…In comparison with that of specialty provider groups, PCP groups may have lower rates of HIE use because of “differences in the centrality of PCPs and specialists in provider referral networks” [ 14 ]. Specialty provider groups plausibly seek to maintain as many connections as possible to PCP groups via HIE because provider HIE adoption has been proven to increase the number of referrals received [ 29 ], and specialists often prominently rely on referrals from PCPs for new patient acquisition. In turn, this compels specialty provider groups to maintain high rates of HIE use for both sending health information and receiving health information, as it allows them to not only acquire new patients in a more effective and efficient manner but also better participate in these referral networks, should they need to refer a patient to a provider of another specialty or subspecialty, or close the referral loop by returning a given patient’s medical record back to the referring PCP.…”

Section: Discussionmentioning

confidence: 99%

Asymmetric Interoperability as a Strategy Among Provider Group Health Information Exchange: Directional Analysis

Shah¹,

Bailey²

2023

J Med Internet Res

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Background High levels of seamless, bidirectional health information exchange continue to be broadly limited among provider groups despite the vast array of benefits that interoperability entails for patient care and the many persistent efforts across the health care ecosystem directed at advancing interoperability. As provider groups seek to act in their strategic best interests, they are often interoperable and exchange information in certain directions but not others, leading to the formation of asymmetries. Objective We aimed to examine the correlation at the provider group level between the distinct directions of interoperability with regard to sending health information and receiving health information, to describe how this correlation varies across provider group types and provider group sizes, and to analyze the symmetries and asymmetries that arise in the exchange of patient health information across the health care ecosystem as a result. Methods We used data from the Centers for Medicare & Medicaid Services (CMS), which included interoperability performance information for 2033 provider groups within the Quality Payment Program Merit-based Incentive Payment System and maintained distinct performance measures for sending health information and receiving health information. In addition to compiling descriptive statistics, we also conducted a cluster analysis to identify differences among provider groups—particularly with respect to symmetric versus asymmetric interoperability. Results We found that the examined directions of interoperability—sending health information and receiving health information—have relatively low bivariate correlation (0.4147) with a significant number of observations exhibiting asymmetric interoperability (42.5%). Primary care providers are generally more likely to exchange information asymmetrically than specialty providers, being more inclined to receive health information than to send health information. Finally, we found that larger provider groups are significantly less likely to be bidirectionally interoperable than smaller groups, although both are asymmetrically interoperable at similar rates. Conclusions The adoption of interoperability by provider groups is more nuanced than traditionally considered and should not be seen as a binary determination (ie, to be interoperable or not). Asymmetric interoperability—and its pervasive presence among provider groups—reiterates how the manner in which provider groups exchange patient health information is a strategic choice and may pose similar implications and potential harms as the practice of information blocking has in the past. Differences in the operational paradigms among provider groups of varying types and sizes may explain their varying extents of health information exchange for sending and receiving health information. There continues to remain substantial room for improvement on the path to achieving a fully interoperable health care ecosystem, and future policy efforts directed at advancing interoperability should consider the practice of being asymmetrically interoperable among provider groups.

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Section: Discussionmentioning

confidence: 99%

Asymmetric Interoperability as a Strategy Among Provider Group Health Information Exchange: Directional Analysis

Shah¹,

Bailey²

2023

J Med Internet Res

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“…In response to this challenge, it can be alleviated through cooperation mechanisms between different cities, including sharing health resources, so as to promote better coverage of health services in different cities, thereby improving the overall level of public health services ( 48 ). At the same time, some medical networks can improve the efficiency of referral by quickly sharing the information of referred patients, so as to reduce the damage to equity caused by referral problems caused by hospital classification ( 49 ). On the other hand, starting from the population level, paying attention to the small cities that are often ignored is also an effective way to promote the fair allocation of medical resources ( 50 ).…”

Section: Literature Reviewmentioning

confidence: 99%

Will urban scale affect health services inequity? The empirical evidence from cities in China

Wang,

Xu,

Fang

et al. 2024

Front. Public Health

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BackgroundThe equity of public resources triggered by city shrinkage is a global challenge. Significantly, the impact of city shrinkage on the allocation of health service resources needs to be better understood. This study explores the impact of population change on government investment and health service delivery in shrinking cities.Data and methodUsing data from China’s Urban Statistical Yearbook (2010–2020), we employ regression discontinuity (RD) and fixed-effect models to examine the causal relationship between city shrinkage and health service provision.ResultShrinking cities show significant disparities in health resources, particularly in bed numbers (−1,167.58, p < 0.05) and doctor availability (−538.54, p < 0.05). Economic development (p < 0.01) and financial autonomy (p < 0.01) influence hospital bed distribution. Investments in public services (primary schools and teachers, p < 0.01) affect health resource delivery. Robustness tests support our results.ConclusionThis study reveals how city shrinkage disrupts health service provision and equity, establishing a causal relationship between city shrinkage/expansion and health resource allocation, emphasizing the imbalance caused by urban population changes. City expansion intensifies competition for health resources, while shrinking cities struggle to provide adequate resources due to government reluctance. Policymakers should adapt health resource allocation strategies to meet patient demands in changing urban landscapes.

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“…Simply as a matter of practicality, once connected to an HIE, it may be easier and cheaper for providers to refer patients to other connected providers participating in their exchange network (Ramaiah et al, 2012). In fact, prior research suggests that primary care providers may be more likely to refer patients to specialists that are members of the same HIE network than specialists that are nonadopters of HIE (Eftekhari et al, 2016). If the connected primary care providers care for patient populations with desirable reimbursement rates, this influence on referral patterns could also result in cascading changes to the hospital's overall payer mix (Vest & Kash, 2016).…”

Section: Theoretical Frameworkmentioning

confidence: 99%

Strategic use of health information exchange and market share, payer mix, and operating margins

Vest

Freedman

Unruh

et al. 2020

Health Care Manage Rev

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Background: Health information exchange (HIE) capabilities are tied to health care organizations' strategic and business goals. As a technology that connects information from different organizations, HIE may be a source of competitive advantage and a path to improvements in performance. Purpose: The aim of the study was to identify the impact of hospitals' use of HIE capabilities on outcomes that may be sensitive to changes in various contracting arrangements and referral patterns arising from improved connectivity. Methodology: Using a panel of community hospitals in nine states, we examined the association between the number of different data types the hospital could exchange via HIE and changes in market share, payer mix, and operating margin (2010)(2011)(2012)(2013)(2014). Regression models that controlled for the number of different data types shared intraorganizationally and other time-varying factors and included both hospital and time fixed effects were used for adjusted estimates of the relationships between changes in HIE capabilities and outcomes. Results: Increasing HIE capability was associated with a 13 percentage point increase in a hospital's discharges that were covered by commercial insurers or Medicare (i.e., payer mix). Conversely, increasing intraorganizational information sharing was associated with a 9.6 percentage point decrease in the percentage of discharges covered by commercial insurers or Medicare. Increasing HIE capability or intraorganizational information sharing was not associated with increased market share nor with operating margin. Conclusions: Improving information sharing with external organizations may be an approach to support strategic business goals. Practice Implications: Organizations may be served by identifying ways to leverage HIE instead of focusing on intraorganizational exchange capabilities.

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Impact of Health Information Exchange Adoption on Referral Patterns

Cited by 7 publications

References 58 publications

Asymmetric Interoperability as a Strategy Among Provider Group Health Information Exchange: Directional Analysis

Asymmetric Interoperability as a Strategy Among Provider Group Health Information Exchange: Directional Analysis

Will urban scale affect health services inequity? The empirical evidence from cities in China

Strategic use of health information exchange and market share, payer mix, and operating margins

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