Topic Refinement and Systematic Review for Health Information Exchange

The use of health information technology (IT) has been promoted as having tremendous promise in improving the efficiency, cost-effectiveness, quality, and safety of medical care delivery in the U.S. health care system. Health IT supports patient care related activities including order communications, results reporting, care planning, and clinical and health documentation. A key challenge to effective use of health IT, however, is that most Americans, especially those with multiple illnesses, receive care in multiple settings with disparate information systems.

To enable patient records to follow patients wherever they receive care, increased attention has been paid to health information exchanges (HIEs) that make health information available electronically across providers and organizations. HIE implementations are often funded by one-time start-up awards, without longer-term support to sustain and evaluate the interventions. Because, the promise for HIE to improve health care delivery is substantial it is critical to be able to determine if HIE does improve health or intermediate outcomes as well as to systematically assess comparative approaches, barriers, return on investment, and sustainability of HIE.

In support, this project looked to answer the following research questions by identifying and synthesizing existing research:

• Is health information exchange (HIE) effective in improving clinical (e.g., mortality and morbidity), economic (e.g., costs and resource use, the value proposition for HIE) and population (e.g., syndromic surveillance) outcomes? 
• What harms have resulted from HIE? (e.g., violations of privacy, errors in diagnosis or treatment from too much, too little or inaccurate information, or patient or provider concerns about HIE)
• Is HIE effective in improving intermediate outcomes such as patient and provider experience perceptions or behavior; health care processes; or the availability, completeness, or accuracy of information? 
• What is the current level of use and primary uses of HIE? 
• How does the usability of HIE impact effectiveness or harms for individuals and organizations? 
• What facilitators and barriers impact implementation of HIE? 
• What facilitators and barriers impact use of HIE? 
• What factors influence sustainability of HIE? 

Key informant interviews were held to refine the research questions and a systematic review was conducted. A technical expert panel (TEP) provided methodological advice and content expertise to the review team as they identified and synthesized studies of HIE. The project team identified and synthesized evidence relevant to the research questions and provided valuable insight for policymakers, funders, and other HIE stakeholders.