US hospital engagement in core domains of interoperability

To assess US hospital engagement in the 4 core domains of interoperability (find, send, receive, integrate) and whether engaging in these domains is associated with electronic availability of clinical data from outside providers.

Retrospective analysis of survey data.

Analysis of the American Hospital Association (AHA) Annual Survey of Hospitals and the American Hospital Association (AHA) Annual Survey of Hospitals - IT Supplement datasets for 2014. Respondents included 3307 US hospitals to the AHA Annual Survey - IT Supplement. We created measures of hospital engagement in 4 core domains of interoperability, as well as access to electronic clinical data from outside providers. Regression analysis was to identify hospital characteristics associated with each measure.

Twenty-one percent of US hospitals engaged in all 4 interoperability domains, and 25% engaged in none. Hospitals engaged in all 4 domains were more likely to have a "basic" (odds ratio [OR], 3.53; P < .01) or "comprehensive" (OR, 5.04; P < .01) electronic health record (EHR) in comparison to a less than "basic" EHR, participate in a Regional Health Information Organization (OR, 4.29; P < .01), use a single EHR vendor (OR, 2.15; P < .01), and have a third-party health information exchange vendor (OR, 2.32; P < .01). They also differed by non-IT characteristics, such as medical home participation (OR, 1.77; P < .01). Hospitals that find (OR, 5.51; P < .01), receive (OR, 2.56; P < .01), or integrate (OR, 2.53; P < .01) information were more likely to report routine clinical information availability from outside providers.

The one-fifth of US hospitals engaged in key domains of interoperability were more likely to have certain information technology infrastructure and participate in delivery reform. Encouragingly, interoperability engagement was associated with routine clinical information availability. Our results point to the need for ongoing efforts to expand interoperability, with the potential benefit of better information availability for clinicians and better care.