The associations between query-based and directed health information exchange with potentially avoidable use of health care services

Joshua R. Vest, Mark Aaron Unruh, Jason S. Shapiro, Lawrence P. Casalino

Research output: Contribution to journalArticle

Abstract

Objective: To quantify the impact of two approaches (directed and query-based) to health information exchange (HIE) on potentially avoidable use of health care services. Data Sources/Study Setting: Data on ambulatory care providers’ adoption of HIE were merged with Medicare fee-for-service claims from 2008 to 2014. Providers were from 13 counties in New York served by the Rochester Regional Health Information Organization (RHIO). Study Design: Linear regression models with provider and year fixed effects were used to estimate changes in the probability of utilization outcomes for Medicare beneficiaries attributed to providers adopting directed and/or query-based HIE compared with beneficiaries attributed to providers who had not adopted HIE. Data Collection: Providers’ HIE adoption status was determined through Rochester RHIO registration records. RHIO and claims data were linked via National Provider Identifiers. Principal Findings: Query-based HIE adoption was associated with a 0.2 percentage point reduction in the probability of an ambulatory care sensitive hospitalization and a 1.1 percentage point decrease in the likelihood of an unplanned readmission. Directed HIE adoption was not associated with any outcome. Conclusions: The Centers for Medicare & Medicaid Services’ (CMS) EHR certification criteria includes requirements for directed HIE, but not query-based HIE. Pending further research, certification criteria should place equal weight on facilitating query-based and directed exchange.

Original languageEnglish (US)
Pages (from-to)981-993
Number of pages13
JournalHealth services research
Volume54
Issue number5
DOIs
StatePublished - Oct 1 2019

Keywords

  • ambulatory care
  • health information exchange
  • medical informatics
  • medicare

ASJC Scopus subject areas

  • Health Policy

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