title: Short-Term Medical Costs of a VHA Health Information Exchange: A CHEERS-Compliant Article.
abstract: The Virtual Lifetime Electronic Record (VLER) Health program provides the Veterans Health Administration (VHA) a framework whereby VHA providers can access the veterans' electronic health record information to coordinate healthcare across multiple sites of care. As an early adopter of VLER, the Indianapolis VHA and Regenstrief Institute implemented a regional demonstration program involving bi-directional health information exchange (HIE) between VHA and non-VHA providers.The aim of the study is to determine whether implementation of VLER HIE reduces 1 year VHA medical costs.A cohort evaluation with a concurrent control group compared VHA healthcare costs using propensity score adjustment. A CHEERs compliant checklist was used to conduct the cost evaluation.Patients were enrolled in the VLER program onsite at the Indianapolis VHA in outpatient clinics or through the release-of-information office.VHA cost data (in 2014 dollars) were obtained for both enrolled and nonenrolled (control) patients for 1 year prior to, and 1 year after, the index date of patient enrollment.There were 6104 patients enrolled in VLER and 45,700 patients in the control group. The annual adjusted total cost difference per patient was associated with a higher cost for VLER enrollees $1152 (95% CI: $807-1433) (P < 0.01) (in 2014 dollars) than VLER nonenrollees.Short-term evaluation of this demonstration project did not show immediate reductions in healthcare cost as might be expected if HIE decreased redundant medical tests and treatments. Cost reductions from shared health information may be realized with longer time horizons.
authors.affiliation: From the Department of Ophthalmology and the Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, and the Veterans Affairs Health Services Research and Development Service, in Chicago, IL (DDF); Department of BioHealth Informatics, Indiana University School of Informatics and Computing, VHA Health Services Research and Development Center for Health Information and Communication, and Regenstrief Institute, Inc., (BED); Department of Biostatistics, Indiana University School of Medicine, (SMP); Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service; Division of General Internal Medicine, Department of Medicine, Indiana University School of Medicine, and Regenstrief Institute, Inc. (LJM, MW, DAH); and Center for Health Information and Communication, Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service,; Regenstrief Institute, Inc.; Indiana University Center for Health Services and Outcomes Research, Indianapolis, IN; College of Pharmacy, Purdue University, West Lafayette, IN (AJZ).
authors.forename: Dustin D
authors.initials: DD
authors.lastname: French
authors.forename: Brian E
authors.initials: BE
authors.lastname: Dixon
authors.forename: Susan M
authors.initials: SM
authors.lastname: Perkins
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Myers
authors.forename: Michael
authors.initials: M
authors.lastname: Weiner
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Zillich
authors.forename: David A
authors.initials: DA
authors.lastname: Haggstrom
mesh_terms: D015331:Cohort Studies; D017046:Cost Savings / Q000639:trends; D057286:Electronic Health Records / Q000458:organization & administration*; D005260:Female; D017048:Health Care Costs; D066275:Health Information Exchange; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D033181:Information Dissemination / Q000379:methods; D007902:Length of Stay / Q000191:economics*; D008297:Male; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration*