Department of Health and Human Services, Office of the National Coordinator for Health Information Technology, Washington, DC, USA.
Department of Health and Human Services, Agency for Healthcare Research and Quality, Rockville, Maryland, USA.
J Am Med Inform Assoc. 2021 Aug 13;28(9):1866-1873. doi: 10.1093/jamia/ocab083.
Most nonfederal acute care hospitals use electronic health records (EHRs) certified by the Office of the National Coordinator for Health Information Technology. In 2015, the Office of the National Coordinator for Health Information Technology finalized the 2015 Health IT Certification Edition and adoption by hospitals began in 2016. We examine the impact of the 2015 Edition on rates of interoperable exchange among nonfederal acute hospitals.
The study applies a standard difference-in-differences design and a recently developed fixed effects estimator that relaxes the assumption of treatment effects being constant across groups and time. In the analysis, we identify separate effects of the 2015 Edition for hospitals that switched EHR developers and forecast hospitals' interoperability over 2015 Edition adoption rates.
The adoption of the 2015 Edition increased hospitals' rates of interoperable exchange and especially benefited hospitals that switched EHR developers in the post-implementation period. Forecasting results indicate that if all hospitals adopted the 2015 Edition, 53% to 61% of hospitals would engage in interoperable health information exchange compared with the current rate of 46%.
Hospitals' levels of interoperability have been rising over the last few years. Adoption of newer technology improved hospitals' interoperability and accounts for up to 12% of the rise in interoperability.
Certified technology is one mechanism to ensure providers use recent and safe technologies for interoperable exchange. Adoption of certified EHRs improves the nation's interoperable exchange; however, it has a clear limited effect. Other mechanisms are necessary for achieving comprehensive interoperable exchange.
大多数非联邦急性护理医院都使用经国家卫生信息技术协调员办公室认证的电子健康记录 (EHR)。2015 年，国家卫生信息技术协调员办公室最终确定了 2015 年健康信息技术认证版，并于 2016 年开始在医院采用。我们研究了 2015 版对非联邦急性医院之间互操作性交换率的影响。
该研究采用标准的差异-差异设计和最近开发的固定效应估计器，放宽了处理效果在组间和时间上保持不变的假设。在分析中，我们确定了 2015 版对切换电子病历开发商的医院的单独影响，并预测了医院在 2015 版采用率下的互操作性。
采用 2015 版提高了医院互操作性交换的速度，尤其是在实施后阶段受益于切换电子病历开发商的医院。预测结果表明，如果所有医院都采用 2015 版，将有 53%至 61%的医院参与互操作性健康信息交换，而目前的比例为 46%。
过去几年来，医院的互操作性水平一直在上升。采用新技术提高了医院的互操作性，占互操作性提高的 12%。
认证技术是确保提供者使用最新和安全技术进行互操作性交换的一种机制。采用认证的电子病历提高了国家的互操作性交换；然而，它的效果是有限的。需要其他机制才能实现全面的互操作性交换。
