Do EHR and HIE deliver on their promise? Analysis of Pennsylvania acute care hospitals

Background: The HITECH Act of 2009 promoted the use of health information technology (HIT). There is limited research on the effect of health information exchange (HIE) on healthcare outcomes and cost. Analyzing data from the recent past provides us an excellent opportunity to determine EHR and HIE's impact on hospital operations. Purpose: To investigate association between HIT (EHR and HIE) and quality of care, hospital efficiency, and patient flow. Methodology: Multivariable regression models using panel data with year fixed effects and hospital individual effects were used. Outcome variables were readmission index and mortality index (quality of care), cost per inpatient day and cost per inpatient admission (hospital efficiency), and average length of stay (patient flow). We use two variables to measure HIT usage – proportion of functionalities owned/utilized under electronic health records (EHR) and HIE. We use four years of data (2014-17) on 115 acute care hospitals in Pennsylvania from five different data sources. Results: We find evidence for efficiency (lower costs) improvement associated with HIE and for EHR associated with reduced mortality. Also, HIE is adversely associated with mortality. Other effects were not significant. Conclusion: EHR and HIE usage in the hospitals may not be enough or optimal. The healthcare system may also suffer from integration issues. Diffusion of technology is a slow process and users may take time to understand and learn how to apply effectively. Managers and policy makers must be wary of the short- and long-term effect of technology investments on hospital efficiency and quality of care.