Health Information Exchanges May Grow Digital Divide in Referrals

Health information exchanges can create a digital divide in the referral market as participating physicians benefit from the increased patient referrals at the expense of non-participating physicians.

By participating in health information exchanges (HIEs), physicians can increase their rate of referrals from and to other members by 44 percent to 46 percent. However, researchers suggest these benefits can grow the digital divide as they are at the expense of non-participating physicians.

More than a third of all patients are referred to a specialist each year, underscoring the significance of referrals on the healthcare system.

The study by researchers from the University at Buffalo School of Management looked at the impact HIE adoption can have on patient referral patterns.

Researchers used publicly available datasets of 22,000 Medicare beneficiaries in the Western New York region between 2009 and 2012 to analyze patient referral data over time 

“Referrals have a significant impact on the cost and quality of health care services,” Ram Ramesh, PhD, professor of management science and systems in the UB School of Management, said in a press release. “In the context of referrals, health information exchanges tend to divide the physician community into ‘technology-haves and have-nots,’ where those who participate benefit from increased referrals among themselves at the expense of those who haven’t joined an exchange.”

Ever since the HITECH Act was passed in 2009, the implementation of HIEs has been integral to the healthcare system. HIEs support interoperability and allow physicians to digitally access and share patient data within their network.  

“The concept of a health information exchange was born out of a federal mandate, so it’s different from other innovations because of how it was created, supported, and developed,” said Ramesh. “As a result, there wasn’t an immediate, dramatic shift in referrals when exchanges launched, but over time they stand to yield significant benefits to patients and insurance companies by improving the quality and reducing the cost of health care.”

Ramesh stated that the study findings highlight the importance of HIEs as they enable physicians to communicate better, resulting in greater referral rates.

“To ensure referral service quality, and consequently, be able to sustain and increase their business volume, providers should become more aware of the benefits of joining an exchange—and the possible loss of patients they face if they don’t join,” Ramesh stated.

Despite the benefits of HIEs, less than 50 percent of providers use HIES in referrals. According to a study published in the Journal of the American Medical Informatics Association (JAMIA), factors such as EHR vendor and patient characteristics were associated with HIE use.

Researchers found that primary care providers (PCPs) have a 42.7 percent HIE use level compared to 57 percent among non-PCPs. In fact, PCPs sent 2.1 million more referrals during the 90-day research period.

In addition, larger health systems with more than 50 providers also had a 3.8 percent higher HIE use level than smaller health systems. Providers with an older patient population and a greater proportion of patients with diabetes had larger HIE use than other practice factors.

HIE depends on robust health IT infrastructure to connect providers and hospitals, the study stated. Not only do HIEs improve provider communication, but HIEs are vital to effective care coordination and provider cost savings.

The Statewide Health Information Network for New York (SHIN-NY), the NYC HIE, saved The New York Health Collaborative (NYeC) nearly $195 million annually in healthcare spending.

These cost savings are mainly associated with duplicate testing, avoidable hospitalizations and readmissions, and preventable emergency department visits, allowing for an estimated $1 billion in savings if current participants used the NYeC’s full capabilities. 

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