Hospitals’ exchange of electronic health information to providers outside their organizations increased by 41 percent between 2008 and 2012, federal researchers report in the August issue of Health Affairs. But the sharing of clinical care summaries and medication lists is lagging.

A team from the Office of the National Coordinator for Health Information Technology (ONC) that included ONC national coordinator Farzad Mostashari,  MD, ScM, wanted to measure the impact of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 on information exchange activity in hospitals. They used national survey data collected through the American Hospital Association’s Annual Survey of Hospitals from 2008 to 2012 to assess exchange activity, variation by type and organizational affiliation and how characteristics affected the exchange activities.

They reasoned their findings would help gauge progress under HITECH and serve as a baseline for tracking the impact of new initiatives. They found that in 2012:

• 58 percent of hospitals exchanged information outside their organizations, a 41 percent increase from 2008;
• 51 percent of hospitals exchanged information with an unaffiliated ambulatory care provider;
• 36 percent exchanged information with other hospitals outside their organization;
• 44 percent adopted a basic EHR, up from 9 percent in 2008;
• 29 percent of hospitals were part of a health information organization (HIO), up from 16 percent in 2008;
• The proportion of hospitals that had an EHR and participated in an HIO increased fivefold in four years;
• Of those hospitals that used both an EHR and HIO, 84 percent exchanged information with providers outside their organization;
• Nonetheless, barely half of hospitals that used both an EHR and HIO exchanged clinical care summaries;
• Participation in an HIO was more closely associated with exchanging laboratory results and radiology reports; and
• Having an EHR was more closely associated with exchanging clinical care summaries.

“Greater EHR adoption and the proliferation of HIOs may broaden the extent of exchange activity and enable exchanges with a greater variety of partners,” they suggested. “In addition, EHR systems and HIOs may serve as complementary mechanisms to enable exchanges.”

They recommended policies needed to be put in place to monitor exchange activity and to ensure that financial incentives are sufficient to overcome organizational impediments. The fact that most hospitals don’t electronically exchange clinical care summaries and medication lists “limits efforts to improve patient safety and coordinate care across settings.”