Health Information Exchange among U.S. Hospitals Continues to Grow, but Significant Work Remains

Matthew Swain and Erica Galvez | May 5, 2014

Hospitals across the country continue to adopt health IT such as electronic health record (EHRs) to improve the health and health care of their patients. ONC posted the latest results [PDF – 933kb] from the 2013 American Hospital Association’s (AHA) Annual Health IT Survey, which show that more than nine out of ten hospitals possess certified EHR technology, and nearly six in ten hospitals adopted an EHR with advanced functionalities (classified as a Basic EHR). This represents a significant increase from 2012 to 2013, and a five-fold increase since 2008.

Many of these hospitals also securely shared patients’ clinical information electronically with authorized hospitals and ambulatory providers outside of their organization, which is the first step toward broader interoperability. Updating an analysis published last August in Health Affairs External Links Disclaimer, this data brief [PDF – 699kb] indicates that more than six in ten hospitals electronically exchanged health information with outside providers, representing a 51 percent increase since 2008.

Figure contains three line charts. The first describes the percent of hospitals that exchange health information with any providers outside their organization from 2008 to 2013 (2008, 41%; 2009, 45%; 2010, 44%; 2011, 50%; 2012, 58%; 2013, 62%). The second describes the percent of hospitals that exchange health information with ambulatory providers outside their organization from 2008 to 2013 (2008, 36%; 2009, 40%; 2010, 38%; 2011, 44%; 2012, 51%; 2013, 57%). The third describes the percent of hospitals that exchange health information with other hospitals outside their organization from 2008 to 2013 (2008, 15%; 2009, 17%; 2010, 19%; 2011, 25%; 2012, 36%; 2013, 40%).

Select image for larger view

The types of information that hospitals exchanged was variable. While more than half of hospitals exchanged laboratory results (57 percent) and radiology reports (55 percent) with outside providers, fewer exchanged clinical care summaries (42 percent) and medication history (37 percent).

New analyses this year also show that only four in ten hospitals could send and receive secure electronic messages containing patient health information to and from external systems; while more than half were able to electronically request and retrieve patient health information from sources outside their organization.

Drivers of Health Information Exchange

Our previous analysis of AHA survey data found that EHR adoption, in combination with participation in a regional health information organization was associated with the highest rates of exchange of different types of health information across organizations. We anticipate that the exchange of care summaries among hospitals will increase as hospitals implement EHRs certified to meet ONC’s 2014 health IT certification regulation, which require secure messaging functionality and standardized clinical care summary structure and content. Meaningful use-eligible hospitals must use this certified functionality (or services from an eHealth Exchange participant) to achieve meaningful use stage 2 transition of care requirements.

Areas for improvement

The AHA survey also provides the opportunity to gauge whether hospitals electronically notify a patient’s primary care provider of an emergency room encounter and if the hospital provides patients with the ability to transmit their health information. In 2013, less than half of hospitals routinely electronically notified a patient’s primary care provider inside their system when they entered an emergency room, and roughly one-quarter notified primary care providers outside of their system.  Only one in ten hospitals provided their patients with the ability to transmit information from their medical record to a third party.

Looking Ahead

ONC continues to encourage the exchange of health information and interoperability through the advancement of electronic notification services that can help create continuity of care and reduce hospital readmissions. We continue to focus on strengthening common trust frameworks that support exchange, and to develop and define technical standards that advance interoperability. These frameworks will ensure that health information can be exchanged in a secure manner that respects the privacy of patients, while fitting into optimal clinical workflow.

ONC, along with other federal agencies, is encouraging the exchange of health information to support public health, collaborating with state partners to advance regional and state-level HIE, and determining whether technology for data exchange and aggregation supports delivery system transformation.

Collectively, and in partnership with public and private stakeholders, these efforts will increase the exchange of essential health information across the care continuum. ONC continues to monitor trends in hospital exchange activity to make sure that interoperability-related efforts promote an environment where health care providers can securely exchange and use patients’ health information across care settings. Through these efforts, we hope to improve care quality, lower health care costs and improve individual and population health.