Department of Health and Human Services, Office of the National Coordinator for Health Information Technology, Washington, DC.
Department of Medicine, University of California, San Francisco, CA.
Med Care. 2022 Dec 1;60(12):880-887. doi: 10.1097/MLR.0000000000001773. Epub 2022 Sep 2.
Increasing electronic health information exchange (HIE) between provider organizations is a top policy priority that has been pursued by establishing varied types of networks.
To measure electronic connectivity enabled by these networks, including community, electronic health record vendor, and national HIE networks, across US hospitals weighted by the volume of shared patients and identify characteristics that predict connectivity.
Cross-sectional analysis of 1721 hospitals comprising 16,344 hospital pairs and 6,492,232 shared patients from 2018 CareSet Labs HOP data and national hospital surveys.
Pairs of US acute care hospitals that delivered care to 11 or more of the same fee-for-service Medicare beneficiaries in 2018.
Whether a patient was treated by a pair of hospitals connected through participation in the same HIE network ("connected hospitals") or not connected because the hospitals participated in different networks, only 1 participated, or both did not participate.
Sixty-four percent of shared patients were treated by connected hospitals. Of the remaining shared patients, 14% were treated by hospital pairs that participated in different HIE networks, 21% by pairs in which only 1 hospital participated in an HIE network, and 2% by pairs in which neither participated. Patients treated by pairs with at least 1 for-profit hospital, and by pairs located in competitive markets, were less likely to be treated by connected hospitals.
While the majority of shared patients received care from connected hospitals, remaining gaps could be filled by connecting HIE networks to each other and by incentivizing certain types of hospitals that may not participate because of competitive concerns.
增加医疗机构之间的电子健康信息交换（HIE）是一项首要政策，通过建立各种类型的网络来实现这一目标。
通过衡量这些网络（包括社区、电子病历供应商和国家 HIE 网络）在全美医院中的电子连接能力，这些网络以共享患者的数量为权重，并确定预测连接性的特征。
对 2018 年 CareSet Labs HOP 数据和全国医院调查中包含的 1721 家医院、16344 对医院和 6492222 名共享患者进行的横断面分析。
2018 年为 11 名或以上相同医疗保险受益人的同一组患者提供服务的美国急性护理医院对。
患者是否由通过参与相同 HIE 网络而连接的一对医院（“连接医院”）或由于医院参与不同网络、只有 1 家医院参与、或两家医院均不参与而未连接来治疗。
64%的共享患者由连接医院治疗。其余的共享患者中，14%由参与不同 HIE 网络的医院对治疗，21%由仅 1 家医院参与 HIE 网络的医院对治疗，2%由两家医院均未参与的医院对治疗。由至少有 1 家营利性医院的医院对和位于竞争市场的医院对治疗的患者，不太可能由连接医院治疗。
虽然大多数共享患者接受了连接医院的治疗，但通过将 HIE 网络相互连接，并激励那些可能因竞争担忧而不参与的特定类型的医院，可以填补剩余的差距。
