# Impact of Provider Health Information Exchange Services on Patient Utilization of Emergency Room and Inpatient Practices in Colorado

## TL;DR

This study found that providers using Health Information Exchange services helped reduce patients' use of emergency rooms and inpatient care, especially for Medicaid patients.

## Contribution

The study shows that HIE adoption by providers leads to significant reductions in ED and inpatient admissions, particularly for Medicaid patients.

## Key findings

- HIE subscription was linked to fewer inpatient admissions across all insurance types.
- Medicaid patients saw the biggest drop in ED and inpatient use when providers used HIE services.
- Combined HIE portal and EHR integration had the strongest effect on reducing admissions.

## Abstract

Background/Objectives: We wished to determine whether patients of providers subscribing to Health Information Exchange (HIE) services experience a reduction in emergency room visits and inpatient admissions compared to those who do not subscribe and whether the type of HIE service (online access to records via an HIE portal and/or integration with their electronic health record (EHR) and push notifications) a provider uses further impacts utilization. Methods: The research team utilized the Colorado All-Payer Claims Database (CO APCD) from 2017 to 2019, intentionally excluding the impact of COVID-19 on HIE services. A pre–post analysis was conducted 15 months before and after the provider subscribed to HIE solutions to quantify the effects when compared to control clinics. Results: Subscription to HIE solutions was associated with lower inpatient (IP) admissions than those in a control group for all insurance payer types (p = 0.001). The reduction in Medicaid patients was more pronounced when their providers subscribed to either service alone or in combination and was associated with significantly fewer ED and IP admissions than those for control clinics (p = 0.003, p < 0.05 for HIE portal alone and p < 0.0001, p = 0.002 for both HIE portal and integrated EHR solutions). HIEs enable providers to coordinate care and access patients’ previous test results and clinical histories, potentially reducing the need for high-cost emergency department and inpatient services. This, in turn, appears to substantially impact low-resource individuals, who have historically been the highest users of these services. Conclusions: HIE provider subscription is associated with a reduction in patients’ use of inpatient care after enrolling in HIE products across all insurance types. Medicaid patients experienced the most significant decrease in both emergency room (ED) visits and inpatient admissions when compared to control clinics.