Utilization of an Electronic Health Record Embedded Enterprise Health Data Exchange: A Single Institute Experience

Evaluate the demand, volume, and institutional utilization of an EHR-based platform for health data exchange in a single US academic system. A retrospective review (3/2023-4/2024) spanned 11 hospitals and over 500 outpatient sites. Analytic reports from the Epic Care Everywhere Image Exchange Advanced Platform (Verona, WI) captured inbound (requested internally) and outbound (accessed externally) data volumes, including thumbnails and subsequent reference-quality key image retrievals. Data types were categorized as DICOM or non-DICOM (e.g., JPG, PDF). Counts, retrieval rates, and geographic patterns were analyzed. Inbound data involved 1.6 million patients from 370 external organizations, generating 5% for DICOM and 3% for non-DICOM; 77% of inbound thumbnails originated in-state. From 3/2023 to 4/2024, 1.9 million outbound thumbnails were accessed by 1478 external institutions, with a 78% reference-quality key image retrieval rate. Most outbound thumbnails were non-DICOM (66%); however, overall DICOM retrieval rates (5%) were higher than non-DICOM (3%). In-state institutions retrieved the most thumbnails (1,156,896/59%), whereas out-of-state sites requested more reference-quality key images (1,034,614/67%). Top users included various private and public health sectors. Findings show a growing reliance on EHR-embedded health data exchange. The abundance of inbound non-DICOM underscores interoperability challenges, while high DICOM retrieval rates emphasize clinical importance. Geographic disparities highlight the need for standardized solutions to improve continuity of care. Moreover, the upcoming HTI-2 bill mandates stronger data exchange measures, reinforcing the urgency for scalability. Health data exchange is in high demand as patients increasingly seek care across the US.