Technology, Incentives, or Both? Factors Related to Level of Hospital Health Information Exchange

Objective: To assess whether the level of health information exchange (HIE) in U.S. hospitals is related to technology capabilities, incentives to exchange, or both. Study Setting: A total of 1,812 hospitals attesting to stage 2 of Medicare's Meaningful Use Incentive Program through April 2016. Study Design: Hospital-level, multivariate OLS regression with state fixed effects was used to analyze the relationship between technology capability and incentives measures, and percent of care transitions with summary of care records (SCRs) sent electronically to subsequent providers. Principal Findings: Stage 2 hospitals reported sending SCRs electronically for an average of 41 percent (median = 33 percent) of transitions. HIE level is related to four capability measures, one incentive measure, and one measure that is related to both capability and incentive. Percent of transitions with SCRs sent electronically was 3 percentage points higher (95 percent CI: 0.1–5.1) for hospitals with a third-party HIE vendor, 3 percentage points higher (95 percent CI: 0.5–5.4) for hospitals with an EHR vendor as their HIE vendor, and 3 percentage points higher (95 percent CI: 0.4–5.4) for hospitals that automatically alert primary care providers. The direction and statistical significance of the relationships between specific EHR vendor and electronic SCR transmission level varied by vendor. Nonprofits and government hospitals performed 5 percentage points higher (95 percent CI: 1.5–9.1) and 8 percentage points higher (95 percent CI: 3.4–12.3) than for-profits. Hospitals in systems performed 3 percentage points higher (95 percent CI: 0.8–6.1). Conclusion: The overall level of HIE is low, with hospitals sending an SCR electronically for less than half of patient transitions. Specific hospital characteristics related to both technology capabilities and incentives were associated with higher levels of HIE.