Health Information Exchange.

Area of Science:

• Health Informatics
• Health Services Research
• Clinical Information Systems

Background:

• Health Information Exchange (HIE) involves electronic sharing of clinical data across healthcare organizations.
• HIE is promoted to enhance healthcare efficiency, cost-effectiveness, quality, and safety.
• Significant investment is required for HIE implementation, often sponsored by governments and healthcare organizations.

Purpose of the Study:

• To systematically review existing literature on Health Information Exchange (HIE).
• To synthesize research on HIE effectiveness, use, usability, barriers, facilitators, implementation, and sustainability.
• To provide a foundation for future HIE research and expansion.

Main Methods:

• Comprehensive literature searches of multiple electronic databases (MEDLINE, PsycINFO, CINAHL, Cochrane Library, etc.) from 1990 to early 2015.
• Systematic review of 136 included studies, with qualitative analysis tailored to specific topics.
• Data abstraction and verification by two investigators, with a third resolving discrepancies.

Main Results:

• Low-quality evidence suggests HIE may reduce duplicative testing, lower ED costs, and improve public health reporting and ambulatory care quality.
• HIE adoption increased, with 76% of US hospitals exchanging data in 2014, but use within organizations remains low.
• Key barriers to HIE use include lack of critical mass, inefficient workflows, and poor interface design; facilitators for implementation and sustainability were identified but not ranked.

Conclusions:

• The impact of HIE on primary clinical outcomes and harms is inadequately studied.
• Evidence supports HIE's role in resource reduction and quality improvement, but its overall effectiveness and potential harms require further investigation.
• Future research should employ rigorous designs, standardized HIE descriptions, and a coordinated approach to address comprehensive questions and diverse HIE systems.