title: Adoption of clinical data exchange in community settings: a comparison of two approaches.
abstract: Adoption of electronic clinical data exchange (CDE) across disparate healthcare organizations remains low in community settings despite demonstrated benefits. To expand CDE in communities, New York State funded sixteen community-based organizations to implement point-to-point directed exchange (n=8) and multi-site query-based health information exchange (HIE) (n=8). We conducted a cross-sectional study to compare adoption of directed exchange versus query-based HIE. From 2008 to 2011, 66% (n=1,747) of providers targeted for directed exchange and 21% (n=5,427) of providers targeted for query-based HIE adopted CDE. Funding per provider adoptee was almost two times greater for directed exchange (median (interquartile range): $25,535 ($17,391-$42,240)) than query-based HIE ($14,649 ($9,897-$28,078)), although the difference was not statistically significant. Because its infrastructure can cover larger populations using similar levels of public funding, query-based HIE may scale more broadly than directed exchange. To our knowledge, this is among the first studies to compare directed exchange versus query-based HIE.
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York NY ; Department of Pediatrics, Weill Cornell Medical College, New York NY ; Center for Healthcare Informatics and Policy, Weill Cornell Medical College, New York NY ; Health Information Technology Evaluation Collaborative, New York NY.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Campion
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York NY ; Center for Healthcare Informatics and Policy, Weill Cornell Medical College, New York NY ; Health Information Technology Evaluation Collaborative, New York NY.
authors.forename: Joshua R
authors.initials: JR
authors.lastname: Vest
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York NY ; Center for Healthcare Informatics and Policy, Weill Cornell Medical College, New York NY ; Health Information Technology Evaluation Collaborative, New York NY ; Department of Medicine, Weill Cornell Medical College, New York NY.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Kern
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York NY ; Department of Pediatrics, Weill Cornell Medical College, New York NY ; Center for Healthcare Informatics and Policy, Weill Cornell Medical College, New York NY ; Health Information Technology Evaluation Collaborative, New York NY ; Department of Medicine, Weill Cornell Medical College, New York NY ; Komansky Center for Children's Health at NewYork-Presbyterian Hospital, New York NY.
authors.forename: Rainu
authors.initials: R
authors.lastname: Kaushal
mesh_terms: D057171:American Recovery and Reinvestment Act; D003151:Community Health Centers / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D057286:Electronic Health Records; D066275:Health Information Exchange; D006764:Hospitals, Community / Q000458:organization & administration; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration; D009518:New York; D014481:United States