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Uncovering differences in interoperability across hospital size.

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  • 1Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services, 330 C St SW, Floor 7, Washington, DC, 20201, USA.

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Summary
This summary is machine-generated.

Small hospitals trail large hospitals in health information exchange due to fewer electronic health record (EHR) functionalities and less network participation. Policies promoting these areas can reduce the interoperability gap.

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Area of Science:

  • Health Informatics
  • Health Services Research
  • Health Information Exchange

Background:

  • Small hospitals demonstrate significant disparities compared to large hospitals in achieving interoperable health information exchange.
  • Key factors influencing these differences include the number of functionalities within electronic health record (EHR) systems, participation in regional and national networks, and the adoption of a dominant EHR system.

Purpose of the Study:

  • To identify and quantify the factors contributing to the differences in health information interoperability between small and large hospitals.
  • To analyze the impact of EHR functionalities, network participation, and EHR dominance on interoperability gaps.

Main Methods:

  • Utilized data from the 2017 American Hospital Association (AHA) Annual Survey Information Technology Supplement (n=2789 hospitals).
  • Applied Blinder-Oaxaca decomposition to explain differences in each domain of hospital interoperability.
  • Defined interoperability as the ability to electronically send, receive, and integrate summary of care records and find external patient health information.

Main Results:

  • While both small and large hospitals increased engagement in interoperability domains from 2015 to 2017, the gap between them remained largely consistent.
  • Differences in hospital characteristics accounted for most of the gap in data integration, reception, and external data finding.
  • Differences in characteristics and returns to characteristics significantly explained the gap in sending data, with EHR functionalities and network participation being major contributors.

Conclusions:

  • Limited participation in multiple networks and fewer EHR functionalities in small hospitals are primary drivers of the interoperability gap.
  • Incentivizing network participation and simplifying electronic exchange processes are recommended policy actions to reduce disparities in interoperability across hospitals of varying sizes.