Summary
Background: Health information exchange is a national priority, but there is limited evidence
of its effectiveness.
Objective: We sought to determine the effect of health information exchange on ambulatory quality.
Methods: We conducted a retrospective cohort study over two years of 138 primary care physicians
in small group practices in the Hudson Valley region of New York State. All physicians
had access to an electronic portal, through which they could view clinical data (such
as laboratory and radiology test results) for their patients over time, regardless
of the ordering physician. We considered 15 quality measures that were being used
by the community for a pay-for-performance program, as well as the subset of 8 measures
expected to be affected by the portal. We adjusted for 11 physician characteristics
(including health care quality at baseline).
Results: Nearly half (43%) of the physicians were portal users. Non-users performed at or
above the regional benchmark on 48% of the measures at baseline and 49% of the measures
at follow-up (p = 0.58). Users performed at or above the regional benchmark on 57%
of the measures at baseline and 64% at follow-up (p<0.001). Use of the portal was
independently associated with higher quality of care at follow-up for those measures
expected to be affected by the portal (p = 0.01), but not for those not expected to
be affected by the portal (p = 0.12).
Conclusions: Use of an electronic portal for viewing clinical data was associated with modest
improvements in ambulatory quality.
Keywords
Health care quality - clinical informatics - quality indicators
