The relationship between hospital and ehr vendor market dynamics on health information organization presence and participation

Rapid adoption of electronic health record and health information exchange among assisted living communities, 2010-2018

Adoption of electronic health records (EHRs) and health information exchange (HIE) is a key tool to improving the quality of care in assisted living communities (ALC). We examined whether EHRs were being used in ALC to support HIE in 2010 and 2018. We found that adoption of EHR and HIE functions increased substantially over the study period. However, adoption of HIE functions lagged significantly behind EHR functions in both 2010 and 2018 and was accompanied by growing disparities in the adoption of EHR functions among smaller, nonchain, and for-profit communities. To improve the quality of care for this important and growing population, targeted policies are needed to support the adoption of both EHR and HIE functions in ALC.

The effect of participation in accountable care organization on electronic health information exchange practices in U.S. hospitals

BACKGROUND

Accountable care organizations (ACOs) are a recent incentive program that are designed to address inefficiencies in the U.S. health care sector. To meet their design objectives, ACO participants must engage in greater electronic health information exchange (HIE) practices both internally and externally with care participants, such as patients and other providers.

PURPOSE

The aim of this study was to examine the relationship between hospital participation in ACOs and electronic HIE practices with different participants of care and how these practices vary differentially across market types.

APPROACH

Grounding our work in the reward-motivational view of organizational action, we proposed hypotheses that linked hospital participation in ACOs to three dimensions of HIE practices (intraorganizational, interorganizational, and provider-patient HIE practices). We tested our hypotheses by analyzing a sample of 1,926 hospitals.

RESULTS

Hospital participation in ACOs is associated with greater intraorganizational and provider-patient HIE practices, but not interorganizational HIE practices. We also found that whereas the relationship between ACO participation and intra- and interorganizational HIE practices remains unchanged irrespective of the degree of competition in the health care market, the relationship between ACO participation and provider-patient HIE practices holds true only for hospitals operating in noncompetitive markets.

PRACTICE IMPLICATIONS

Our results showed that hospitals participating in ACOs vary in their HIE practices, and attributes of the local market in which ACO participants operate in contribute to this variation. These insights should provide guidance to researchers, policymakers, and hospital administrators who aim to improve the effectiveness of ACOs.

Practice and market factors associated with provider volume of health information exchange

OBJECTIVE

To assess the practice- and market-level factors associated with the amount of provider health information exchange (HIE) use.

MATERIALS AND METHODS

Provider and practice-level data was drawn from the Meaningful Use Stage 2 Public Use Files from the Centers for Medicare and Medicaid Services, the Physician Compare National Downloadable File, and the Compendium of US Health Systems, among other sources. We analyzed the relationship between provider HIE use and practice and market factors using multivariable linear regression and compared primary care providers (PCPs) to non-PCPs. Provider volume of HIE use is measured as the percentage of referrals sent with electronic summaries of care (eSCR) reported by eligible providers attesting to the Meaningful Use electronic health record (EHR) incentive program in 2016.

RESULTS

Providers used HIE in 49% of referrals; PCPs used HIE in fewer referrals (43%) than non-PCPs (57%). Provider use of products from EHR vendors was negatively related to HIE use, while use of Athenahealth and Greenway Health products were positively related to HIE use. Providers treating, on average, older patients and greater proportions of patients with diabetes used HIE for more referrals. Health system membership, market concentration, and state HIE consent policy were unrelated to provider HIE use.

DISCUSSION

HIE use during referrals is low among office-based providers with the capability for exchange, especially PCPs. Practice-level factors were more commonly associated with greater levels of HIE use than market-level factors.

CONCLUSION

This furthers the understanding that market forces, like competition, may be related to HIE adoption decisions but are less important for use once adoption has occurred.

Factors influencing the selection of a picture archiving and communication system: A qualitative study

BACKGROUND

Picture Archiving and Communication System (PACS) is an evolving technology in health care domains that is used for storage, management, retrieval, transfer, and delivery of medical images. Some medical centers in Iran have installed the PACS in recent years but have not used it appropriately. One of the problems in implementing this system is inability to select appropriate PACS. Several factors are involved in the selection process. The objective of this study was to determine the factors that influence PACS selection.

METHODS

This qualitative study aimed to identify factors influencing the PACS selection. Data were collected through semistructured interviews with 10 experts in three educational hospitals and in the position to make decision for the purchase of PACS. Data were analyzed by the conventional qualitative content analysis method proposed by Lundman and Graneheim.

RESULTS

Analyses achieved 11 subcategories in two specific and general categories that influence PACS selection. The specific category of this study included six subcategories, and the general category included five subcategories.

CONCLUSION

The results of this study determined that usability was the most important factor from the perspective of participants. Since the main users of a system have a critical role in adoption or rejection of a system, ease of use (usability) is significant and must be considered in system selection as a significant factor.

Alternative payment models and hospital engagement in health information exchange

OBJECTIVES

To assess whether hospital participation in alternative payment models (APMs) is associated with greater engagement in health information exchange (HIE) along 4 dimensions: volume of patients for whom information is exchanged, diversity of information types, breadth of partner types, and depth of technical approach.

STUDY DESIGN

Pooled, cross-sectional analysis of data on US hospitals from 2014 to 2015.

METHODS

APM participation came from Leavitt Partners data, Medicare public use files, and the American Hospital Association (AHA) Annual Survey. We used Medicare data to measure HIE volume for 798 hospitals attesting to stage 2 Meaningful Use and the AHA Information Technology Supplement to measure HIE diversity, breadth, and depth for 1730 hospitals. We used mixed-effects regression to estimate the association between participation in APMs and each dimension of HIE.

RESULTS

Compared with nonparticipating hospitals, full-year APM participation was associated with lower HIE volume (data were sent for 11 percentage points fewer discharges; P = .003), greater HIE diversity (of 4 data types, 0.3 more were transmitted; P <.001), greater HIE breadth (of 3 partner types, data were sent to 0.3 more; P <.001), and greater HIE depth (the odds of using a push and pull approach were 1.68 times greater; P = .004).

CONCLUSIONS

Our finding that APM participation was associated with greater HIE diversity, breadth, and depth suggests that value-based payment may be spurring improvements in HIE infrastructure. However, our finding that APM participation is associated with lower HIE volume suggests that there may be an incentive to focus HIE investments on a limited number of partners.