title: Use and perceived value of health information exchange: one public healthcare system's experience.
abstract: OBJECTIVE
  To describe health information exchange (HIE) use and providers' perceptions of value in a public healthcare system using a commercial electronic health record (EHR).
  
  
  METHODS
  Observational study of HIE implementation and cross-sectional provider survey.
  
  
  METHODS
  We identified characteristics (age, gender, race/ethnicity, insurance type, comorbid conditions) and the care setting (primary care; emergency department [ED] or inpatient care; or specialty care) for patients with and without HIE. Associations between patient characteristics and HIE were examined using a multivariate logistic regression. Provider perceptions were assessed via confidential survey.
  
  
  RESULTS
  During its first 14 months, 11,960 HIEs occurred among 9399 patients. Rates of HIE use were 13/1000 visits overall (20/1000 in primary care, 36/1000 in the ED/inpatient setting, and 5/1000 in specialty settings [P <.001]). Patients with HIE were older, more often female, African American, had more chronic conditions, and more often had Medicaid or Medicare insurance (P <.001). HIE was used least among commercially insured (odds ratio, 0.78, 95% confidence interval,0.73-0.83, compared with uninsured). Among the 18% (74/412) of survey respondents, 93% "disagreed/strongly disagreed" that obtaining consent was difficult and 97% reported no patient refusals. Respondents "agreed/strongly agreed" that HIE fostered more efficient care (93%), saved time (85%), decreased laboratory (84%) and imaging (74%) use, and 15% stated that HIE prevented an unnecessary admission.
  
  
  CONCLUSIONS
  Early HIE use varied by care setting, patient characteristics, and insurance. Providers perceived HIE acceptable to patients, and helpful in avoiding redundant testing and unnecessary hospitalizations. Lower HIE use among commercially insured patients reinforces concerns that financial incentives may inhibit adoption.
authors: 3158 Kingsley Rd, Shaker Heights, OH 44122. E-mail: David.kaelber@case.edu.
authors: David C
authors: DC
authors: Kaelber
authors: Rehan
authors: R
authors: Waheed
authors: Doug
authors: D
authors: Einstadter
authors: Thomas E
authors: TE
authors: Love
authors: Randall D
authors: RD
authors: Cebul
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D066275:Health Information Exchange / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009820:Ohio; D011320:Primary Health Care / Q000706:statistics & numerical data; D019564:Unnecessary Procedures