Electronic health record developer market segmentation contributes to divide in physician interoperable exchange

Area of Science:

• Health Informatics
• Health Services Research
• Physician Practice Management

Background:

• Interoperable exchange of health data is crucial for coordinated care.
• Previous studies indicated differences in interoperable exchange based on physician practice size.
• The influence of electronic health record (EHR) developers, federal incentives, and value-based care on these differences required further investigation.

Purpose of the Study:

• To determine if disparities in interoperable exchange by physician practice size persisted in 2019.
• To identify the roles of federal incentive programs, value-based care, and EHR developer selection in shaping interoperable exchange.
• To understand factors influencing health data exchange across practices of varying sizes.

Main Methods:

• Cross-sectional analysis of a 2019 physician survey.
• Multivariable Poisson models were used to estimate the relative risk of interoperable exchange.
• Models accounted for physician characteristics, federal incentives, value-based care, and EHR developer.

Main Results:

• In 2019, 17% of solo practices and 51% of large practices integrated outside data.
• Federal incentive programs partially mediated the relationship between practice size and interoperable exchange.
• EHR developer was strongly associated with interoperable exchange, and practice size was no longer an independent predictor.

Conclusions:

• The choice of EHR developer significantly impacts a practice's ability to engage in interoperable exchange.
• Addressing the interoperability gap requires a dual approach targeting both small EHR developers and small practices.
• Policies and initiatives should aim to increase the benefits and reduce the costs of interoperable exchange for smaller entities.