Health info exchange lags in small hospitals

Small and rural hospitals are still struggling to keep pace with health information exchange (HIE) capabilities, according to the latest data from the Government Accountability Office (GAO). While electronic data exchange has increased somewhat over time, small hospitals are less likely than their larger peers to be members of local and national HIE networks or use EHR-based HIE capabilities to share data across disparate systems. 

GAO conducted extensive interviews and performed additional literature reviews to survey the HIE landscape in seven states that used HITECH Act funding to support HIE development at the beginning of the 2010s.   

The agency cited common and longstanding challenges, including technological barriers, financial concerns, and issues involving state privacy laws, as reasons why HIE is not as robust in some health systems as others. 

Wider adoption of shared interoperability standards, as well as increased investment in technology to enable HIE at the point of care, will be required to advance data exchange in small and rural hospitals over the next several years. 

Identifying gaps in data exchange methods

Small hospitals are significantly less likely to use electronic data exchange methods than medium or large health systems, the report found. 

For example, 47.4% of small hospitals often use snail mail or fax to exchange data, compared to 30.3% of medium/large hospitals. Small and rural hospitals are even more likely to receive data via mail or fax, with 54.5% reporting using these methods often to get data from other entities.  Only 38.5% of larger organizations reported the same. 

Rural hospitals are more likely than small non-rural small hospitals to use mail and fax to send data (42.8% verses 38.4%) and receive data (52.3% verses 44.4%). 

There are even bigger difference in the use of local or national HIE networks.  Just 36.7% of small hospitals often send data through regional, state, or local HIEs, and a mere 23.2% often receive data via these networks. In comparison, 56.4 percent of larger organizations send data through regional HIEs and 40.3% often receive data that way. 

Across all institution times, use of national HIE networks is somewhat lower than participation in more local data exchange utilities.   

However, rural hospitals are among the least likely to be connection to national HIE networks, with only 27.3% saying they often use national networks to send data and 20.8 percent routinely receiving information through this method. More than 43% of medium/large hospitals send data through national HIEs, and 36.5% often receive it. 

Factors influencing variable rates of HIE participation  

GAO highlighted a number of reasons why there are disparities in access to electronic data exchange, including national and state-specific factors, such as differing EHR adoption landscapes and privacy laws that may be confusing or unintentionally restrictive. 

“For example, in Maryland, a state law requires all hospitals, with some exceptions, to use the state’s single HIE organization. Among the eight states, Maryland hospitals “often” used HIE organizations to exchange information at the highest rate,” the report says.   

“In Colorado and Minnesota, we found that most hospitals used the same EHR developer. When compared with the other six selected states, a higher percentage of hospitals in Minnesota and Colorado reported “often” exchanging information using EHR vendor-based networks.” 

In contrast, New Hampshire hospitals are among the lowest users of HIE organizations and national networks. It was the only state included in the report that did not access HITECH funding that could have been used for infrastructure development. 

Other potential barriers include slow adoption of uniform interoperability standards across EHR vendors; uneven ongoing investment in EHR optimization, HIE technologies, and regional data exchange connections; and the difficulty of navigating privacy and consent regulations from both a technical and operational standpoint. 

Expanding HIE in rural regions in the near future

GAO is hopeful that new approaches, such as the TEFCA framework, will encourage continued development of health information exchange and make it easier for small and rural hospitals to engage with the growing HIE ecosystem. However, stakeholders from across the care continuum will need to recognize that small and rural hospitals may require additional resources, training, and funding to fully participate in data exchange.   

Prioritizing these connections will be vital for ensuring access to informed and coordinated care for rural residents and bringing these institutions in line with the successes of other, larger entities across the country.  

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at jennifer@inklesscreative.com.