New indices to track interoperability among US hospitals

To develop indices of US hospital interoperability to capture the current state and assess progress over time.

A Technical Expert Panel (TEP) informed selection of items from the American Hospital Association Health IT Supplement survey, which were aggregated into interoperability concepts (components) and then further combined into indices. Indices were refined through psychometric analysis and additional TEP input. Final indices included a "Core Index" measuring adoption of foundational interoperability capabilities, a "Pathfinder Index" representing adoption of advanced interoperability technologies and auxiliary exchange activities, and a "Friction Index" quantifying barriers. The first 2 indices were scored from 0 (no interoperability) to 100 (full interoperability); the Friction Index was scored 0 (no friction) to 100 (maximum friction). We calculated indices annually from 2021 to 2023, stratifying by hospital characteristics.

Items within components created reliable and meaningful measures, and associations between components within indices followed the TEP's expectations. Weighted mean scores for the Core (2023), Pathfinder (2022), and Friction (2023) Indices were 61, 57, and 30, respectively. Hospitals with 500+ beds (large), not designated as critical access, in metropolitan areas, and using market leading electronic health records had statistically significant higher mean scores on all indices. Index values also improved modestly over time.

Hospitals performed best on the Core Index. Given recent policy and programmatic initiatives, we anticipate continued improvement across all indices.

Ongoing index tracking can inform policy impact evaluations and highlight persistent interoperability disparities across hospitals.