title: Can a health information exchange save healthcare costs? Evidence from a pilot program in South Korea.
abstract: OBJECTIVE
  Governments and institutions across the world have made efforts to adopt and diffuse the health information exchange (HIE) technology with the expectation that the technology would improve the quality and efficiency of care by allowing providers online access to healthcare information generated by other providers at the point of care. However, evidence concerning the effectiveness of the technology is limited hindering the wide adoption of a HIE. The objective of this study was to assess impacts of a HIE on healthcare utilization and costs of patient episodes at a tertiary care hospital following referrals by clinic physicians.
  
  
  METHODS
  We studied 1265 HIE and 2702 non-HIE episodes after physicians referred patients from 35 HIE and 59 non-HIE clinics to Seoul National University Bundang Hospital (SNUBH) during a 17-month period from June 2009. We examined 9 measures of healthcare utilization and the magnitude of clinical information exchanged in 4 categories. We estimated the savings resulting from HIE use through linear regression models with dummy variables for HIE participation and patient classification codes controlling the case-mix differences between HIE and non-HIE cases.
  
  
  RESULTS
  The total charges incurred by the HIE group during episodes at SNUBH were approximately 13% lower (P<0.001), and the charges for clinical laboratory tests, pathological diagnosis, function tests, and diagnostic imaging were 54% (P<0.001), 76% (P<0.001), 73% (P<0.001), and 80% (P<0.001) lower for the HIE group than for the non-HIE group. SNUBH physicians had access to more clinical information for HIE than for non-HIE patients.
  
  
  CONCLUSIONS
  HIE technology improved physicians' access to past clinical information, which appeared to reduce diagnostic test utilization and healthcare costs. The payer was the major beneficiary of HIE cost savings whereas providers paid for the technology. Fair allocation of benefits and costs among stakeholders is needed for wide HIE adoption.
authors.affiliation: Technology Management, Economics, and Policy Graduate Program, Seoul National University, 1 Kwanak-ro, Kwanak-gu, Seoul 151-015, Republic of Korea. Electronic address: hayoungpark@snu.ac.kr.
authors.forename: Hayoung
authors.initials: H
authors.lastname: Park
authors.affiliation: Department of Preventive Medicine, College of Medicine, University of Ulsan, 86 Asan Byungwon-gil, Songpa-gu, Seoul 138-736, Republic of Korea. Electronic address: sleemd@amc.seoul.kr.
authors.forename: Sang-Il
authors.initials: SI
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, College of Medicine, Seoul National University and Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si 463-707, Republic of Korea. Electronic address: neuroandy@snubh.org.
authors.forename: Hee
authors.initials: H
authors.lastname: Hwang
authors.affiliation: Department of Health Policy and Management, College of Medicine, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 110-799, Republic of Korea. Electronic address: yoonkim@snu.ac.kr.
authors.forename: Yoon
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Department of Medical Informatics, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si 463-707, Republic of Korea. Electronic address: emily728@nate.com.
authors.forename: Eun-Young
authors.initials: EY
authors.lastname: Heo
authors.affiliation: Department of Otorhinolaryngology, College of Medicine, Seoul National University and Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si 463-707, Republic of Korea. Electronic address: kimemail@naver.com.
authors.forename: Jeong-Whun
authors.initials: JW
authors.lastname: Kim
authors.affiliation: Department of Psychiatry, College of Medicine, Seoul National University and Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si 463-707, Republic of Korea. Electronic address: kyooha@snu.ac.kr.
authors.forename: Kyooseob
authors.initials: K
authors.lastname: Ha
mesh_terms: D000328:Adult; D005260:Female; D017048:Health Care Costs; D066275:Health Information Exchange / Q000191:economics*; D063005:Health Information Systems / Q000191:economics*; D006801:Humans; D008297:Male; D010358:Patient Participation / Q000706:statistics & numerical data*; D010820:Physicians / Q000523:psychology*; D010865:Pilot Projects; D056910:Republic of Korea
keywords: Community networks; Electronic health records; Health information exchange; Health information technology; Healthcare cost