title: Health Information Exchange Readiness for Demonstrating Return on Investment and Quality of Care.
abstract: OBJECTIVE
  To study the extent to which community health information exchanges (HIEs) deliver and measure return on investment (ROI) and improvements in the quality of care.
  
  
  METHODS
  We surveyed operational HIEs for their characteristics, information domains, impact on quality of care, and ROI.
  
  
  RESULTS
  A 60 percent response rate was achieved. Two-thirds of respondents agreed that community HIEs demonstrated a positive ROI, while one-third had no opinion or disagreed. One-fourth or fewer respondents reported using various metrics to calculate ROI. Most respondents agreed that HIEs improve the quality of care, though several were not sure and were awaiting further evidence. Most respondents indicated that they did not deliver reports on quality measures (76 percent) and that data were not being used to measure quality performance of participating providers (73 percent).
  
  
  CONCLUSIONS
  Respondents from most HIEs believe that the HIEs are demonstrating a positive ROI; however, a minority of them indicated they had used or will use specific metrics to calculate ROI. HIE representatives overwhelmingly reported that they believe the HIE activities improve the quality of healthcare delivered, but only a few are using data to evaluate provider performance or generate reports on quality measures.
  
  
  CONCLUSIONS
  This study demonstrates the challenge faced by policy makers and healthcare organizations that are investing millions of dollars in HIEs that are believed to improve health outcomes and increase efficiency, but still need more time to develop the evidence to confirm that belief. Our study shows that calculating ROI for HIEs or their impact on quality of care remains a secondary priority for most HIEs. This finding raises serious questions for the sustained support of HIEs, both financially and as a policy lever, given the end of Health Information Technology for Economic and Clinical Health (HITECH) Act funding.
authors.affiliation: Anjum Khurshid, PhD, MPAff, MBBS, is a senior health systems strategist at the Louisiana Public Health Institute in New Orleans, LA.
authors.forename: Anjum
authors.initials: A
authors.lastname: Khurshid
authors.affiliation: Mark L. Diana, PhD, MSIS, MBA, is an associate professor in the School of Public Health and Tropical Medicine at Tulane University in New Orleans, LA.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Diana
authors.affiliation: Rahul Jain, MPH, CPHIMS, is a digital health analytics manager at the Louisiana Public Health Institute in New Orleans, LA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Jain
mesh_terms: D001291:Attitude of Health Personnel; D003365:Costs and Cost Analysis; D057286:Electronic Health Records / Q000191:economics; D066275:Health Information Exchange / Q000191:economics*; D006801:Humans; D008145:Louisiana; D011787:Quality of Health Care / Q000191:economics* / Q000706:statistics & numerical data*
keywords: HITECH; Health information exchange; New Orleans; quality measures; return on investment