| Summary: | Indiana University-Purdue University Indianapolis (IUPUI) === The United States has invested over $40 billion in digitizing the health care
system, yet the anticipated gains in improved care coordination, quality, and cost savings
remain largely unrealized. This is due in part to limited interoperability and low rates of
health information exchange (HIE) use, which can support care coordination and improve
provider decision-making. Primary care providers are central to the US health care
delivery system and frequently function as care coordinators, yet capability and HIE use
gaps among these providers limit the potential of these digital systems to achieve their
intended goals.
I study HIE use in the context of primary care to examine 1) factors associated
with provider HIE use, 2) the extent and nature of team-based HIE use, and 3) differences
in HIE system use patterns across discrete groups of system users. First, I use a national
sample of primary care providers to analyze market and practice factors related to HIE
use for patient referrals. Overall, I find that only 43% of primary care provider referrals
used HIE. Furthermore, I find substantial variation in HIE use rates across electronic
health record (EHR) vendors. Second, I use HIE system log data to understand the
breadth and depth of HIE use among teams, a care model underpinning primary care
delivery reform efforts. I find that although use of HIE systems remains low, in primary
care settings it overwhelmingly takes place in a manner consistent with team-based care
workflows. Furthermore, team-based use does not differ in breadth from single provider
HIE use, but illustrates less depth before and after visits. Third, I apply cluster analysis to
16 HIE use measures representing 7 use attributes, and identify 5 discrete user groups. I
then compare two of these user groups and find user-level variation in volume and
efficiency of use, both of which have implications for HIE system design and usability
improvements. Ultimately, these findings help to inform how HIE use can be increased
and improved in primary care, moving the US health care system closer to realizing the
coordination, quality, and cost savings made possible by a digitized delivery system.
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