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Appl Clin Inform 2025; 16(02): 463-471
DOI: 10.1055/a-2516-1692
Research Article

Hospital Health Information Exchange Network Density and Predictors Across U.S. Hospital Referral Regions

Sunny C. Lin
1   Department of Medicine, Washington University School of Medicine in St. Louis, Saint Louis, Missouri, United States
2   Institute for Informatics, Data Science and Biostatistics (I2DB), Washington University School of Medicine in St. Louis, Saint Louis, Missouri, United States
,
Karen Joynt Maddox
1   Department of Medicine, Washington University School of Medicine in St. Louis, Saint Louis, Missouri, United States
,
Daphne Lew
2   Institute for Informatics, Data Science and Biostatistics (I2DB), Washington University School of Medicine in St. Louis, Saint Louis, Missouri, United States
,
Julia Adler-Milstein
3   Department of Medicine, University of California, San Francisco, California, United States
,
Thomas Kannampallil
2   Institute for Informatics, Data Science and Biostatistics (I2DB), Washington University School of Medicine in St. Louis, Saint Louis, Missouri, United States
4   Department of Anesthesiology, Washington University School of Medicine in St. Louis, Saint Louis, Missouri, United States
5   Department of Computer Science and Engineering, Washington University in St. Louis, Saint Louis, Missouri, United States
› Author Affiliations Funding None.
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Abstract

Objectives This study aimed to develop a measure of health information exchange (HIE) for characterizing the density of inter-hospital HIE connections and identify regional characteristics associated with HIE network density.

Methods HIE network density was measured as the proportion of hospital pairs within a region that are connected through HIE. The 2022 American Hospital Association's Information Technology Supplement survey was used to calculate HIE network density for US hospital referral regions (HRRs). Bivariate tests and multivariable regression were used to characterize hospital, electronic health record (EHR) vendor, and resident characteristics associated with HIE network density.

Results Data on 2,509 hospitals across 274 HRRs were included in the study, with 92% of hospitals participating in at least one HIE. On average, hospitals participated in two HIEs and there were seven HIEs present in each region. HIE network density ranged from 0.0 to 1.0, with a median of 0.78 and an interquartile range (IQR) of 0.51–1.00. Hospital and vendor characteristics associated with greater HIE network density include: more HIEs per hospital, a higher proportion of non-profit hospitals, greater Epic market share, and more concentrated hospital and EHR vendor markets. Resident characteristics associated with greater HIE network density include: higher home values, more educated residents, and higher median household incomes.

Conclusion We found that, on average, 7 out of 10 hospital pairs within a given HRR are connected via at least one HIE, with lower HIE network density in regions with lower socioeconomic status. This measure can be used to track the impact of the Trusted Exchange Framework and Common Agreement on area-level interoperability.

Keywords

health information exchange - health information interoperability - medical record systems - hospital referral regions

Protection of Human and Animal Subjects

This study was not considered human subjects research by federal definition and did not require IRB approval.


Supplementary Material



Publication History

Received: 30 September 2024

Accepted: 13 January 2025

Accepted Manuscript online:
15 January 2025

Article published online:
21 May 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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