Thursday, December 24, 2015

More Evidence That Health Information Exchange My Not Be All That Beneficial. Worth A Read.

This appeared a little while ago:

Health Information Exchanges Show Little Evidence of Benefits

MAR 27, 2015 7:42am ET
Though health information exchanges are supposed to improve the speed, quality, safety and cost of patient care, there is little evidence of these benefits in existing HIE studies.
That is the conclusion of a research paper, published in this month’s issue of the journal Health Affairs, in which researchers reviewed 27 studies looking for evidence that HIEs increased efficiency, reduced healthcare costs or improved outcomes.
While researchers found that 57 percent of published analyses reported some benefit from HIE, they also reported that articles employing study designs having strong internal validity—such as randomized controlled trials or quasi-experiments—were significantly less likely than others to associate HIE with benefits.
 “Among six articles with strong internal validity, one study reported paradoxical negative effects, three studies found no effect, and two studies reported that HIE led to benefits,” state the researchers. “Furthermore, these two studies had narrower focuses than the others.”
Two of the six studies found beneficial effects largely as a result of a reduction in diagnostic and imaging tests, associated costs or both, and these studies were based in a single clinic affiliated with an Indiana hospital or in one healthcare system in Israel. Overall, the paper found that “little generalizable evidence currently exists regarding benefits attributable to HIE.”
More here:
Here is the free abstract:

Despite The Spread Of Health Information Exchange, There Is Little Evidence Of Its Impact On Cost, Use, And Quality Of Care

  1. Nir Menachemi3,*

Abstract

Health information exchange (HIE), which is the transfer of electronic information such as laboratory results, clinical summaries, and medication lists, is believed to boost efficiency, reduce health care costs, and improve outcomes for patients. Stimulated by federal financial incentives, about two-thirds of hospitals and almost half of physician practices are now engaged in some type of HIE with outside organizations. To determine how HIE has affected such health care measures as cost, service use, and quality, we identified twenty-seven scientific studies, extracted selected characteristics from each, and meta-analyzed these characteristics for trends. Overall, 57 percent of published analyses reported some benefit from HIE. However, articles employing study designs having strong internal validity, such as randomized controlled trials or quasi-experiments, were significantly less likely than others to associate HIE with benefits. Among six articles with strong internal validity, one study reported paradoxical negative effects, three studies found no effect, and two studies reported that HIE led to benefits. Furthermore, these two studies had narrower focuses than the others. Overall, little generalizable evidence currently exists regarding benefits attributable to HIE.
Here is the link:
Looks like we will need to wait a little longer to be sure we have HIEs that are working or we need to carefully rethink what is likely to make a real positive difference.
David.

1 comment:

Andrew McIntyre said...

I don't think your average Australian GP would cope without electronic pathology and I certainly would not cope without the ability to onsend pathology, referrals and images to surgeons. This however, is point to point messaging which is not same as the HIE concept which is more of a regional exchange setup.

I don't need a study to show the benefits as I was motivated to develop medical objects because of the inefficiency of referring complex patients, often with serious and urgent problems. If I find someone how eg needs a whipples procedure for a bile duct cancer I can have the pathology and notes and ERCP images in the hands of a hepatobiliary surgeon 100km away before the patient wakes up. I quick phone call then setups up a management plan in an informed way. Previously I would go through the chart with post it notes and get someone to photocopy the relevant information and fax it, a process that could take days. Giving people the full electronic information allows them to make informed decisions and speeds up the process and saves me a lot of time.

The key is the ability to move information in a standards based format with good speed, security and respect the privacy implications. If we actually focused on that then the patient would just be another endpoint. The architecture of the PCEHR does not achieve any of these features. Its a privacy nightmare and the information looses its atomic structure and does not actually deliver results to the intended recipient. The centralized EHR model is not the answer to the problem. The answer is high quality information that is mobile and accurately targeted wrt the recipient.

Good eHealth has been delivering real gains for years. Its time we stopped the managerialism that threatens to derail progress.