title: Health information exchange among US hospitals.
abstract: OBJECTIVE
  To determine the proportion of US hospitals engaged in health information exchange (HIE) with unaffiliated providers and to identify key hospital-level and market-level factors associated with participating in exchange.
  
  
  METHODS
  Using the 2009 American Hospital Association Information Technology survey, supplemented by Dartmouth Atlas, Area Resource File, and other national data, we examined which hospitals participated in regional efforts to electronically exchange clinical data.
  
  
  METHODS
  We used logistic regression models to determine hospital-level characteristics and market-level characteristics associated with hospitals' likelihood of participating in HIE.
  
  
  RESULTS
  We found that 10.7% of US hospitals engaged in HIE with unaffiliated providers. In communities where exchange occurred, for-profit hospitals and those with a small market share were far less likely to engage in HIE than nonprofit hospitals or those with a larger market share. Hospitals in more concentrated markets were more likely to exchange and hospitals in markets with higher Medicare spending were less likely to exchange.
  
  
  CONCLUSIONS
  At the start of implementation of the Health Information Technology for Economic and Clinical Health (HITECH) Act, only a small minority of US hospitals electronically exchange clinical data with unaffiliated providers. Health information exchange is a key part of reforming the healthcare system, and factors related to competitiveness may be holding some providers back.
authors.affiliation: Harvard Medical School, Boston Veterans Affairs Hospital, Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Adler-Milstein
authors.forename: Catherine M
authors.initials: CM
authors.lastname: DesRoches
authors.forename: Ashish K
authors.initials: AK
authors.lastname: Jha
mesh_terms: D022126:Access to Information; D000573:American Hospital Association; D057171:American Recovery and Reinvestment Act / Q000458:organization & administration*; D016001:Confidence Intervals; D019538:Health Care Surveys; D006761:Hospitals; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D016015:Logistic Models; D008490:Medical Informatics / Q000458:organization & administration*; D013223:Statistics as Topic; D014481:United States