Abstract: Electronic health records (EHR) are often presumed to reduce the significant and accelerating health care costs and increase the health care quality in the US. However, evidence on these relationships is mixed, leading to skepticism about the effectiveness of EHR. We argue that information and patient sharing are the key factors that shape up the effects of EHR on health care costs and quality.
When patients move between hospitals, timely sharing of patient information can improve decision-making, diagnoses and care plans at the point of care, allow providers to avoid medication errors and readmissions, and decrease unnecessary tests and procedures. Simply looking at the hospital-level effects can be misleading because the benefits of EHR can go beyond the adopting hospital. First, using hospital level data from the entire United States, we provide evidence that although EHR adoption increases the costs of the adopting hospital, it has significant spillover effects by reducing the costs of neighboring hospitals. We further show that these spillovers are linked to information and patient sharing. Additionally, to analyze information and patient sharing in more detail, we utilize a rich data set on Health Information Exchange (HIE) use and medical information of over 80,000 unique patients and 4 million events for these patients such as visits and procedures, courtesy of HealthLinkNY, an HIE provider in New York. A unique feature of our data is that we have information on HIE use at the patient-visit level. This measure provides a detailed understanding of the extent of HIE use going beyond hospital level adoption.
We examine the impact of HIE use on the management of three chronic diseases, cardiovascular and circulatory diseases, cancer, and diabetes, through several future and current health outcomes. Given the frequent encounters of chronic disease patients with hospitals, information sharing can be especially critical for their care coordination. Our results show that HIE use decreases future readmissions and total number of future encounters after the focal visit. HIE use also decreases length of stay and number of procedures of the focal visit. Additionally, the benefits of HIE use are stronger for patients who visit different hospitals. Facility changes decrease quality and efficiency, however, HIE use reverses these effects and leads to net benefits. These effects are significantly stronger for chronic patients compared to non-chronic patients. Results from these studies have important implications for policy makers, health care providers, and patients.
A buffet lunch will be available at 11:45 a.m. The talk will begin at 12:00 p.m.