Health Information Exchange Utilization and Inter-Hospital Transfer Outcomes

Each year, about 1.6 million patients are transferred between hospitals, a process complicated by the complexity of patient conditions, fragmented health information systems, and indirect communication between hospitals. These high-risk transitions result in higher mortality rates and increased vulnerability to diagnostic errors, as best practices like face-to-face hand-offs and real-time updates are difficult to implement. The lack of interoperability between different electronic health record (EHR) systems further hinders effective information sharing, disrupting continuity of care. Transfers involve multiple assessments within a short timeframe, making them a key opportunity to study how communication errors affect patient outcomes. Given these challenges, efforts to enhance information flow—such as through HIE systems—hold significant potential to reduce risks, improve diagnostic accuracy, and enhance patient safety during these critical transitions. This research addressed the need for better interoperability and communication to improve outcomes for this medically complex and vulnerable population.

The specific aims of the research were as follows:

• Conduct a population study that links hospital participation in an HIE to outcomes and cost of care following an inter-hospital transfer.
• Demonstrate that utilization of tools to promote interoperability between hospital EHR systems improves outcomes and reduces the cost of inter-hospital transfers.
• Determine the impact of seamless EHR integration on the outcomes of patients transferred between two hospitals.

The researchers conducted three parallel studies to evaluate trends, barriers, and outcomes of HIE use in inter-hospital transfers. In the first study, they analyzed HIE participation trends from 2012 to 2015, comparing hospitals with newly adopted HIE systems to matched controls. The second study involved a phased intervention at a single tertiary referral center, piloting improved HIE usability across inpatient services using randomized block assignments. The third study tracked the impact of merging two separate Epic EHR systems over a one-year period, comparing transfer outcomes before and after the merger to assess the effects on information sharing and care coordination.

This research highlighted the complexities of inter-hospital transfers and the role of interoperability and HIE systems in improving care quality. While HIE participation did not consistently reduce mortality, length of stay, or care costs, it enhanced information flow, evidenced by fewer duplicated procedures, lower intensive care unit admissions, and improved outcomes linked to detailed pre-transfer documentation. However, technology alone cannot address the challenges of inter-hospital transfers; the presence of dedicated triaging physicians, who eased the workflow for accepting providers, was crucial to effective hand-offs. Interestingly, increased HIE adoption was associated with higher predicted mortality, as providers prioritized transferring the sickest patients during capacity constraints. The COVID-19 pandemic underscored the value of these transfers, with improved outcomes seen at specialized centers despite interoperability barriers. The study emphasized that mortality rates for transferred patients should not be interpreted in isolation from data at both referring and receiving hospitals. The study also demonstrated the value of embedded research partnerships between clinical researchers and healthcare systems, as the data infrastructure developed through this collaboration played a critical role in managing care during the pandemic and laid the foundation for future innovations in healthcare delivery.