How health information exchange impacts referral rates

Physicians see a significant uptick in referrals when they join a health information exchange, and this increase comes at the expense of those who don’t participate in HIE, according to a forthcoming paper in Management Science.  

In a study led by the University of Buffalo’s Ram Ramesh, Ph.D., researchers found that participating in an HIE led to a 44% to 46% increase in the rate of referrals both to and from other physicians. In a statement, Ramesh said this gain “wasn’t an immediate, dramatic shift” but was something that has occurred over time, beginning with the HITECH Act of 2009.

Could evidence of growth in referral rates prove to be a catalyst for what has been lukewarm adoption of HIE for electronic referrals?

A 2021 study led by the Regenstrief Institute reported that providers use HIE in roughly half of referrals. Primary care physicians use HIE for just 43% of referrals, compared to 57% for all other physicians. Researchers concluded that usage patterns tend to be impacted not by large-scale forces, such as competition within a market, but by practice-level preferences.

Related story: How community-based HIEs are supporting value-based care

Slow adoption has led to significant gaps in HIE efforts. A 2018 paper found that nearly all hospitals (97%) share information electronically in accordance with federal mandates. (MIPS, the Merit-Based Incentive Payment System that’s the successor to meaningful use, requires organizations to attest to bidirectional exchange of patient information.) However, only 63% of hospitals routinely share information with the hospital to which they refer the most patients – and those that do tend to find it more difficult to share information with this facility than with the hospitals to which they refer fewer patients. 

One reason for this disconnect, according to another 2018 paper, is that organizations have prioritized sharing information among providers with their network over exchanging information with outside facilities. 

That’s where HIE membership comes into play, as exchanges support a range of referral types. The Michigan Health Information Network supports referrals to behavioral health, community organizations, hospice, and skilled nursing, for example, while the Massachusetts Health Information Highway enables referrals among community health, orthopedic care, and home health. Critically, these connections enable exchange among disparate electronic health record systems – which a 2022 paper indicated is the biggest stumbling block for small practices seeking to support information exchange. 

It’s important for HIE entities as well as the large health systems that support them to tout these benefits to physicians in their communities, Ramesh said. Providers stand to improve care coordination and increase business volume, while exchanges are poised to expand their network – and increase their value proposition to members – as more practices come on board and leverage HIE for electronic referrals.

Brian Eastwood is a Boston-based writer with more than 10 years of experience covering healthcare IT and healthcare delivery. He also writes about enterprise IT, consumer technology, and corporate leadership.