The association between health information exchange and measures of patient satisfaction
22 June 2011
accepted: 28 September 2011
16 December 2017 (online)
Objective: Health information exchange (HIE) is the interorganizational sharing of patient information and is one of many health information technology initiatives expected to transform the U.S. healthcare system. Two outcomes expected to be improved by HIE are patient-provider communication and patient satisfaction . This analysis examined the relationship between the level of HIE engagement and these two factors in a sample of U.S. hospitals.
Methods: Independent variables came from existing secondary sources and the dependent measures were from the Hospital Consumer Assessment of Healthcare Providers and Systems. The analysis included 3,278 hospitals. Using ordinary least squares regression, implemented HIE was positively associated with the percentage of patients reporting nurses communicated well and higher satisfaction. Due to the potential for selection bias, results were further explored using a propensity score analysis.
Results: Hospitals that had adopted HIE, but not yet implemented saw no benefits. Hospitals’ level of HIE was not associated with the percentage of patients reporting doctors communicated well. According to propensity score corrected estimates, implemented HIE was associated with the percentage of patients who reported nurses always communicated well and who would definitely recommend the hospital.
Conclusion: Few studies have examined the impact of HIE at the organizational level. This examination provides some evidence that hospitals engaging in HIE are associated with higher patient satisfaction.
- 1 President’s Council of Advisors on Science and Technology.. Report to the President. Realizing the full potential of health information technology to improve healthcare for americans The path forward. Washington, DC: Executive Office of the President,; 2010
- 2 The National Alliance for Health Information Technology.. Report to the Office of the National Coordinator for Health Information Technology on Defining Key Health Information Technology Terms. Department of Health & Human Services; 2008 [updated April 28, 2008March 3 2010]; Available from: http://healthit.hhs.gov/portal/server.pt?open=18&objID=848133&parentname=CommunityPage&parentid=5&mode=2&in_hi_userid=10741&cached=true.
- 3 Institute of Medicine.. Fostering rapid advances in health care: learning from system demonstrations. Corrigan J, Greiner A, Erikson S. editors. Washington, D. C.: National Academy Press; 2003
- 4 Hripcsak G, Kaushal R, Johnson KB, Ash JS, Bates DW, Block R. et al. The United Hospital Fund meeting on evaluating health information exchange. Journal of Biomedical Informatics 2007; 40 (6 S1) S3-S10.
- 5 Walker J, Pan E, Johnston D, Adler-Milstein J, Bates DW, Middleton B. The value of health care information exchange and interoperability. Health Aff 2005; 24 (hlthaff.w5.10) w10-w18.
- 6 Overhage J, Deter P, Perkins S, Cordell W, McGoff J, McGrath R. A randomized, controlled trial of clinical information shared from another institution. Ann Emerg Med 2002; 39 (01) 14-23.
- 7 Branger P, van’t Hooft A, van der Wouden HC. Coordinating shared care using electronic data interchange. Medinfo 1995; 8 Pt 2 1669. Epub 1995/01/01.
- 8 Kern LM, Barron Y, Blair AJ, Salkowe J, Chambers D, Callahan MA. et al. Electronic result viewing and quality of care in small group practices. Journal of General Internal Medicine 2008; 23 (04) 405-410.
- 9 Adler-Milstein J, Landefeld J, Jha AK. Characteristics associated with regional health information organization viability. J Am Med Inform Assoc 2010; 17 (01) 61-65. Epub 2010/01/13.
- 10 Vest JR, Gamm LD. Health information exchange: persistant challenges & new strategies. Journal of the American Medical Informatics Association 2010; 17 (03) 288-2894.
- 11 Vest JR. More than just a question of technology: Factors related to hospitals’ adoption and implementation of health information exchange. International Journal of Medical Informatics 2010; 79 (12) 797-806.
- 12 Menachemi N, Chukmaitov A, Saunders C, Brooks RG. Hospital quality of care: Does information technology matter? The relationship between information technology adoption and quality of care. Health Care Management Review 2008; 33 (01) 51-59. doi:10.1097/01. HMR.0000304497.89684.36.
- 13 Jones SS, Adams JL, Schneider EC, Ringel JS, McGlynn EA. Electronic health record adoption and quality improvement in US hospitals. The American Journal of Managed Care 2010; 16 12 Special issue SP64-SP71.
- 14 Kazley AS, Ozcan YA. Do hospitals with electronic medical records (EMRs) provide higher quality care?. Medical Care Research and Review 2008; 65 (04) 496-513.
- 15 McCullough JS, Casey M, Moscovice I, Prasad S. The effect of health information technology on quality in U. S. hospitals. Health Aff 2010; 29 (04) 647-654.
- 16 Wilcox A, Kuperman G, Dorr DA, Hripcsak G, Narus SP, Thornton SN. et al. Architectural strategies and issues with health information exchange. AMIA AnnuSymp Proc. 2006: 814-818. Epub 2007/01/24.
- 17 Adler-Milstein J, McAfee AP, Bates DW, Jha AK. The state of regional health information organizations: current activities and financing. Health Aff 2008; 27 (01) w60-w69.
- 18 eHealth Initiative. The state of health information exchange in 2010: connecting the nation to achieve meaningful use. Washington, DC: 2010
- 19 Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q 1966; 44 (03) 166-206. Epub 1966/07/01.
- 20 Department of Health & Human Services.. Information for health: a strategy for building the national health information infrastructure. Washington, DC: 2001. Nov 15.
- 21 Patel V, Dhopeshwarkar R, Edwards A, Barrón Y, Sparenborg J, Kaushal R. Consumer support for health information exchange and personal health records: a regional health information organization survey. Journal of Medical Systems 2010: 1-10.
- 22 Frisse ME. Health information exchange in Memphis: Impact on the physician-patient relationship. The Journal of Law, Medicine & Ethics 2010; 38 (01) 50-57.
- 23 Kaelber DC, Bates DW. Health information exchange and patient safety. Journal of Biomedical Informatics 2007; 40 (6, Suppl. 1) S40-S45.
- 24 Dixon BE, Miller T, Overhage JM. Assessing HIE stakeholder readiness for consumer access: lessons learned from the NHIN trial implementations. J HealthcInfManag 2009; 23 (03) 20-25. Epub 2009/08/12.
- 25 Biondich PG, Grannis SJ. The Indiana network for patient care: an integrated clinical information system infomed by over thirty years of experience. J Public Health Management Practice 2004; November (Suppl) S81-S86.
- 26 Cusack CM, Poon EG. Health information exchange toolkit. Rockville, MD: Agency for Healthcare Research & Quality 2007 Contract No.: 08–0026-EF.
- 27 Ash JS, Guappone KP. Qualitative evaluation of health information exchange efforts. Journal of Biomedical Informatics 2007; 40 (6 Suppl. 1) S33-S39.
- 28 Dixon BE, Zafar A, Overhage JM. A Framework for evaluating the costs, effort, and value of nationwide health information exchange. Journal of the American Medical Informatics Association 2010; 17 (03) 295-301.
- 29 Freedman I, Diamond J. Strategies for success. Health Management Technology 2007; 28 (07) 30-31.
- 30 EMRDaily News.. Health information technology enhances exchange capabilities. 2011 [cited 2011 6/18/2011]; Available from: http://emrdailynews.com/2011/01/11/health-information-technology-enhances-exchange-capabilities/ Archived at http://www.webcitation.org/5zZUbOx0f.
- 31 Restuccia M. Get ready for a national network. InformationWeek Healthcare [Internet]. 2010. Available from: http://www.informationweek.com/news/healthcare/EMR/227800022 Archived at http://www.webcitation.org/5zZW0xGAE.
- 32 Healthcare Information & Management Systems Society. Health information exchanges: similarities and differences. HIMSS HIE Common Practices Survey Results White Paper Chicago, IL: 2009
- 33 Pevnick JM, Claver M, Dobalian A, Asch SM, Stutman HR, Tomines A. et al. Provider stakeholders’ perceived benefit from a nascent health information exchange: a qualitative analysis. Journal of Medical Systems. 2010
- 34 California Health & Human Services Agency.. California health information exchange cooperative agreement program. Sacramento; CA2009.
- 35 Oregon Health Authority and Health Information Technology Oversight Council.. Health information exchange: an operational plan for Oregon. Salem: OR2010.
- 36 Greenway Medical Technologies I. Health information exchange: interoperability and data liquidity for HIE Success. Carrolton, GA2011 [cited 2011 6/18/2011]; Available from: http://www.greenwaymedical.com/solutions/greenway-hie/ Archived at: http://www.webcitation.org/5zZU1sAF7.
- 37 Accenx. Solutions for Hospitals. 2011 [cited 2011 6/18/2011]; Available from: http://accenxtechnologies.com/Solutions/Hospitals.php Archived at http://www.webcitation.org/5zZUsIzKT.
- 38 Adler-Milstein J, Bates DW, Jha AK. U. S. regional health information organizations: progress and challenges. Health Aff 2009; 28 (02) 483-492.
- 39 eHealth Initiative.. Results of 2009 survey on health information exchange. Washington, DC2009 [cited 2009 Aug 21]; Available from: http://www.ehealthinitiative.org/HIESurvey.
- 40 Klein KJ, Sorra JS. The challenge of innovation implementation. The Academy of Management Review 1996; 21 (04) 1055-1080.
- 41 Tornatzky LG, Klein KJ. Innovation characteristics and innovation adoption-implementation: a meta-analysis of findings. IEEE Transactions on Engineering Management 1982; 29 (01) 28-45.
- 42 Rogers EM. Diffusion of innovations. 5th ed. New York: Free Press; 2003
- 43 Department of Health & Human Services [Internet].. Note to Hospitals. 2001 [cited 1/25/2011]; Available from: http://www.hospitalcompare.hhs.gov/staticpages/help/Note-Hospitals.aspx.
- 44 Jha AK, Orav EJ, Zheng J, Epstein AM. Patients’ perception of hospital care in the United States. New England Journal of Medicine 2008; 359 (18) 1921-1931.
- 45 StataCorp. Stata base reference manual: Release 11. College Station, TX: StataCorp LP; 2009
- 46 Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika 1983; 70 (01) 41-55.
- 47 Rosenbaum PR, Rubin DB. Reducing bias in observational studies using subclassification on the propensity score. Journal of the American Statistical Association 1984; 79 (387) 516-524.
- 48 Spreeuwenberg MD, Bartak A, Croon MA, Hagenaars JA, Busschbach JJV, Andrea H. et al. The multiple propensity score as control for bias in the comparison of more than two treatment arms: an introduction from a case study in mental health. Medical Care 2010; 48 (02) 166-174. doi:10.1097/MLR.0b013e3181c1328f.
- 49 Caliendo M, Kopeinig S. Some practical guidance for the implementation of propensity score matching. Bonn, Germany: Institute for the Study of Labor 2005 Report No.: IZA DP No. 1588.
- 50 Elliott MN, Lehrman WG, Goldstein EH, Giordano LA, Beckett MK, Cohea CW. et al. Hospital survey shows improvements in patient experience. Health Aff (Millwood) 2010; 29 (11) 2061-2067.
- 51 O’Donnell H, Patel V, Kern L, Barrón Y, Teixeira P, Dhopeshwarkar R. et al. Healthcare consumers’ attitudes towards physician and personal use of health information exchange. Journal of General Internal Medicine 2011: 1-8.
- 52 Markle Foundation.. Attitudes of Americans regarding personal health records and nationwide electronic health information exchange. New York, NY: 2005
- 53 Young GJ, Meterko M, Desai KR. Patient satisfaction with hospital care: effects of demographic and institutional characteristics. Medical Care 2000; 38 (03) 325-334.
- 54 Kutney-Lee A, McHugh MD, Sloane DM, Cimiotti JP, Flynn L, Neff DF. et al. Nursing: a key to patient satisfaction. Health Aff (Millwood) 2009; 28 (04) w669-w677.
- 55 Centers for Medicare & Medicaid Services. http://www.hcahpsonline.org. Baltimore, MD2010 [cited 2011 March 1 2011].
- 56 Lehrman WG, Elliott MN, Goldstein E, Beckett MK, Klein DJ, Giordano LA. Characteristics of hospitals demonstrating superior performance in patient experience and clinical process measures of care. Medical Care Research and Review 2010; 67 (01) 38-55.