Health Information Exchange among U.S. Hospitals Grew Significantly in 2014

Matthew Swain and Erica Galvez | April 15, 2015

Advancing secure and interoperable exchange is a core component of the Federal Health IT Strategic Plan 2015-2020 and the focus of the Nationwide Interoperability Roadmap. A key goal of both plans is to increase interoperable exchange of health information across the care continuum, and advance better care, spending health care dollars more wisely, and a healthier nation by enabling providers and individuals to send, find, receive, and use health information when and where it matters most.

Results from the American Hospital Association’s (AHA) Annual Health IT Supplement, a nationwide survey of non-federal acute care hospitals, highlight a surge in health information exchange compared to previous years. In 2014, three-quarters of hospitals reported that they electronically exchanged health information with outside ambulatory providers or hospitals. This represents a 23 percent increase since 2013 and an 85 percent increase since 2008, the year AHA started collecting this information.

Hospital-to-Hospital Electronic Health Information Exchange Substantially Increased

AHAs survey captures information on exchange of health information between hospitals and ambulatory providers that are not part of the hospital’s organization. Health information that is available when, where, and how it is needed can greatly improve care coordination, leading to better health outcomes.

Our past analysis showed steady growth among hospitals with both trading partners; however, we found substantial deficits with hospital-to-hospital exchange. Prior research studies suggested that this was due to competition and a weak business model. And our prior results substantiated those findings. However, now this gap is rapidly closing.

  • In 2014, more than six in ten hospitals electronically exchanged health information with outside hospitals, a one-year increase of 55 percent.
  • Close to seven in ten hospitals (69 percent) exchanged health information with outside ambulatory providers, a 21 percent increase since 2014. This growth in both measures now puts the gap between them at a mere 7 percentage points.

Clinical Care Summary Exchange Accelerated

We also examined the types of information hospitals exchanged with outside providers, which include laboratory results, radiology reports, clinical care summaries, and medication history.

Our prior research found that exchange among all data types have increased since 2011; however, we also observed a gap in regards to the type of data exchanged. In last year’s data brief, we reported that hospitals exchanged laboratory results and radiology reports at much higher rates than clinical care summaries and medication lists. Now this gap has shrunk significantly. Each measure is no more than four percentage points from one another; except for medication histories, which still fall a little behind (though closer than previous years).

In our blog post last year, we anticipated that the exchange of care summaries among hospitals would increase as hospitals implement EHRs certified to meet ONC’s 2014 health IT certification regulation, which requires secure messaging functionality and standardized clinical care summary structure and content.

  • In 2014, the exchange of clinical care summaries among hospitals with outside ambulatory providers or hospitals increased substantially from 42 percent to 64 percent, a one-year increase of 52 percent.
  • Similarly, the exchange of medication history grew from 37 percent to 58 percent.

Rates of Health Information Exchange among Hospitals Grew Across States

Launched in 2010, ONC’s State Health Information Exchange Cooperative Agreement Program funded states’ efforts to rapidly build capacity for exchanging health information across the health care system both within and across states. Awardees were responsible for increasing connectivity and enabling patient-centric information flow to improve the quality and efficiency of care.

One of the key performance measures of the program was to increase the percent of hospitals sharing electronic care summaries with outside hospitals and providers. The year the program began, less than a quarter of hospitals exchanged clinical care summaries with outside providers. Not a single state had the majority of hospitals in their states exchanging care summaries.

  • In 2014, most states (42) had at least the majority of hospitals across their states exchanging care summaries.
  • Additionally, close to all states (44) and the District of Columbia doubled the rates of clinical care summary exchange during this time.

A key research question of the ONC-funded program evaluation, conducted by NORC at the University of Chicago, is to assess whether program factors influenced exchange progress. NORC is currently exploring that question and we expect to release the final evaluation report this summer.

Looking Ahead

HHS recently launched efforts to address the barrier of competition, shifting care reimbursement from fee-for-service to value-based care. Key to making care better, smarter, and healthier is to accelerate the availability of health information to guide decision making. While these survey results are promising, there is plenty of room for progress. These results capture exchange activity among hospitals; however, these results do not assess exchange volume, whether the exchange is interoperable, and if information is available to providers at the point of care.

The public comment periods recently concluded for both the Federal Health IT Strategic Plan 2015-2020 and the Nationwide Interoperability Roadmap. ONC and our federal partners will use the valuable feedback received during both comment periods to inform strategies to unlock health information, thereby advancing an interoperable learning health system that improves individual, community and population health.

Read our latest ONC Data Brief (24): Health Information Exchange among U.S. Non-federal Acute Care Hospitals: 2008-2014.