Hospitals' adoption of intra-system information exchange is negatively associated with inter-system information exchange

Joshua R. Vest, Kosali Simon

Research output: Contribution to journalArticle

5 Scopus citations


Introduction: U.S. policy on interoperable HIT has focused on increasing inter-system (ie, between different organizations) health information exchange. However, interoperable HIT also supports the movement of information within the same organization (ie, intra-system exchange). Methods: We examined the relationship between hospitals' intra-and inter-system information exchange capabilities among health system hospitals included in the 2010-2014 American Hospital Association's Annual Health Information Technology Survey. We described the factors associated with hospitals that adopted more intra-system than inter-system exchange capability, and explored the extent of new capability adoption among hospitals that reported neither intra-or inter-system information capabilities at baseline. Results: The prevalence of exchange increased over time, but the adoption of inter-system information exchange was slower; when hospitals adopt information exchange, adoption of intra-system exchange was more common. On average during our study period, hospitals could share 4.6 types of information by intra-system exchange, but only 2.7 types of information by inter-system exchange. Controlling for other factors, hospitals exchanged more types of information in an intra-system manner than inter-system when the number of different inpatient EHR vendors in use in health system is larger. Conclusion: Consistent with the U.S. goals for more widely accessible patient information, hospitals' ability to share information has increased over time. However, hospitals are prioritizing within-organizational information exchange over exchange between different organizations. If increasing inter-system exchanges is a desired goal, current market incentives and government policies may be insufficient to overcome hospitals' motivations for pursuing an intra-system-information-exchange-first strategy.

Original languageEnglish (US)
Pages (from-to)1189-1196
Number of pages8
JournalJournal of the American Medical Informatics Association
Issue number9
StatePublished - 2018


  • health information exchange
  • hospitals
  • medical informatics
  • policy

ASJC Scopus subject areas

  • Health Informatics

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