HIEs still lack an evidence base

Researchers who made an extensive probe of health information exchange data have come to the conclusion that “little generalizable evidence currently exists regarding benefits attributable to HIE.”
Nir Menachemi, chair at the Department of Health Policy and Management at the Indiana University in Indianapolis, and colleagues at Health Affairs combed through 27 studies and 94 analyses of HIE costs and outcomes.
They found that 57 percent of the studies  reported some benefit from HIE, like reduced imaging utilization or coordination of care. But 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 studies with such internal validity, one actually showed “paradoxical negative effects,” three studies found no effect, and two studies reported benefits. One of those positive studies came from 30 years ago, examining a clinic in Indiana using a proto-HIE system, and the other was more recently from Israel finding benefits in HIE used across clinics in a large health maintenance organization — and both studies showed benefits in reduced overuse of diagnostics and imaging.
“There is no strong documented evidence in the studies that health care benefits are directly attributable to the use of HIE, rather than being correlated or incidentally related," Menachemi said in a media release.
It’s not that there aren’t benefits. “It's simply premature to say if we have or have not gotten our money's worth out of HIE,” he said. "We need to eliminate any confounding issues implicating the correlation between benefits and HIE," Menachemi said. "For example, how do we know that the correlation between computerization and good outcomes isn't really just being driven by the fact that early adopters of HIE are exemplary healthcare providers? We need to rule out those kinds of things."