Study finds policies related to data protection most affect health information sharing
CAMBRIDGE, Mass., March 9, 2023 /PRNewswire/ -- Health care IT has dramatically increased over the past 15 years. Fewer than 10% of hospitals (and fewer than 20% of doctors) were using electronic health records prior to the 2009 Health Information Technology for Economic and Clinical (HITECH) Act, which allocated $30 billion to increase the adoption of health IT. By 2014, 97% of reporting hospitals had electronic health record technology. Despite this high level of investment and adoption of technology, the actual use of the data and resulting improvements to health care quality and productivity have been limited.
New academic research shows that state legislation can have a substantial impact on the use of health information exchange (HIE)— which, in turn, facilitates the coordination of care across providers and the surveillance of infectious diseases by public health authorities.
The authors of the paper are Joseph Doyle, Erwin H. Schell Professor of Management at MIT Sloan School of Management; John Van Reenen, Digital Fellow in MIT's Initiative for the Digital Economy and the Ronald Coase School Professor at the London School of Economics; Ari Bronsoler, MIT Economics, PhD '22; and Cason Schmit, Research Assistant Professor at the Department of Health Policy and Management at Texas A&M University.
Evidence further suggests that HIE usage can improve quality of care. For example, a study of hospital discharges for heart attack patients in Florida from 2011 to 2014 found that hospitals participating in HIEs had lower readmission rates. In addition, physician offices with strong health information-sharing capabilities have been able to maintain quality with 5% lower Medicare spending. However, surveys of Health Information Organizations reveal substantial ongoing challenges to HIEs, such as financial viability, state regulations and concerns about privacy.
"If states want to increase the use of health information sharing in an effort to improve quality of care, we need to understand how state laws most encourage and discourage the use of HIEs, and then weigh the benefits of information sharing with other goals like the strength of privacy protections," says Doyle.
The researchers built a database of state laws, looking at all 50 states—from 2000 through 2019—and tracking 12 dimensions of policies that may help to increase HIE use. The dimensions fit into four main categories: clarifying HIE governance, strengthening financial stability, specifying the uses and users of an HIE, and protecting the underlying data. Researchers described how state policy environments have changed over time, and then tested whether health information sharing responds to changes in state laws that aim to promote its growth and usage. The results point to which policy decisions can potentially catalyze the use of digital tools to improve health and lower health care costs.
The research shows that policies in the category related to data protection seem to affect health information sharing the most. In states that make the protection of data less costly, HIE usage increases by 18%. Enacting legislation that has patients participate by default leads to a 16% increase in usage.
"When comparing outcomes of policies that had patients 'opting in' or 'opting out' of using health information exchanges, we found that 'opt in' policies resulted in less participation and data sharing," says Doyle.
In terms of financial sustainability, states that set up the ability to charge participant fees are found to increase the HIE Usage Index by 10 percentage points. Adding the ability to request state, federal and private funding led to an increase of six percentage points.
The authors suggest that just as the legal data used in this paper shows substantial legislative activity within states following the passage of the federal HITECH incentives, states may similarly look to adopt new laws to take advantage of data modernization funds made available through the 2020 Coronavirus Aid, Relief, and Economic Security (CARES) Act. The findings of this research can help to inform these laws, helping states to focus on policies that will encourage health data sharing.
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SOURCE MIT Sloan School of Management