Vendor of choice and the effectiveness of policies to promote health information exchange

Abstract

BackgroundAs more hospitals adopt Electronic Health Records (EHR), focus has shifted to how these records can be used to improve patient care. One barrier to this improvement is limited information exchange between providers. In this work we examine the role of EHR vendors, hypothesizing that vendors strategically control the exchange of clinical care summaries. Their strategy may involve the creation of networks that easily exchange information between providers with the same vendor but frustrate exchange between providers with different vendors, even as both Federal and State policies attempt to incentivize exchange through a common format.MethodsUsing data from the 2013 American Hospital Association’s Information Technology Supplement, we examine the relationship between a hospital’s decision to share clinical care summaries outside of their network and EHR vendor market share, measured by the percentage of hospitals that have the same vendor in a Hospital Referral Region.ResultsOur findings show that the likelihood of a hospital exchanging clinical summaries with hospitals outside its health system increases as the percentage of hospitals with the same EHR vendor in the region increases. The estimated odds of a hospital sharing clinical care summaries outside their system is 5.4 (95% CI, 3.29–8.80) times greater if all hospitals in the Hospital Referral Region use the same EHR Vendor than the corresponding odds for a hospital in an area with no hospitals using the same EHR Vendor. When reviewing the relationship of vendor market concentration at the state level we find a positive significant relationship with the percentage of hospitals that share clinical care summaries within a state. We find no significant impact from state policies designed to incentivize information exchange through the State Health Information Exchange Cooperative Program.ConclusionThere are benefits to exchanging using proprietary methods that are strengthened when the vendors are more concentrated. In order to avoid closed networks that foreclose some hospitals, it is important that future regulation attempt to be more inclusive of hospitals that do not use large vendors and are therefore unable to use proprietary methods for exchange.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3230-7) contains supplementary material, which is available to authorized users.

Improving Oral–Systemic Healthcare through the Interoperability of Electronic Medical and Dental Records: An Exploratory Study

“…14,15 True interoperability, even among medical EHRs, remains rare, and is often reliant upon unrelated hospital systems purchasing the same EHR package. 16 Additionally, within both medicine and dentistry, consensus is still being reached on key components of clinical care and health information that should be universally recorded within a patient's EHR. 17 Another hurdle is the development of documentation standards for electronic dental records, which have not been satisfactorily nor frequently used.…”

Perceptions of chief clinical information officers on the state of electronic health records systems interoperability in NHS England: a qualitative interview study

“…Many of the suggested solutions mentioned by our participants have also been proposed in one form or another in the existing literature. Prioritising EHR interoperability from the outset, mandating data exchange standards, promoting user-centric design & systems usability, discouraging vendors from establishing proprietary data exchange networks, and the involvement of end-users in the design and implementation process, were all concepts previously identified [ 17 , 57 – 59 ]. At the organisational level, this can range from providing greater financial incentives for inter-organisational collaboration and reducing competing interests to cooperation, to simply improving communication and raising awareness of similar HIT initiatives nearby [ 17 , 60 ].…”

To follow the market or the parent system: Evidence from health IT adoption by hospital chains

“…Therefore, a market (chain) that is dominated by a particular vendor does not necessarily imply that market‐wise interoperability (chain‐wise uniformity) has been achieved. However, I view the efficiency gains in communication between hospitals choosing the same vendor as a potentially important source for network benefits, as studies have found that hospitals using a common vendor system face fewer technical barriers to establishing connections (Everson, 2017) and are more likely to engage in health information exchange activities (Castillo et al., 2018; Downing et al., 2017; Everson & Adler‐Milstein, 2016). 8…”

“…3 3 For instance, when the network definition accounts for vendor differences, both Desai (2016) and Lin (2021) find a positive correlation between the probability of choosing a vendor and its local market share. Moreover, empirical evidence suggests that hospitals are more likely to exchange patient records if they share a common EMR system (Castillo et al., 2018; Downing et al., 2017; Everson & Adler‐Milstein, 2016). One exception is the paper by Wang (2021), who finds the competition effect dominates when considering different levels of adoption, but her analysis does not account for vendor heterogeneity. …”