ABSTRACT
Accountable models of care delivery demand that health care provider organizations be able to exchange clinical data about the patient. The “Meaningful Use” program is helping to advance health information exchange by requiring physicians and hospitals to exchange clinical data about patients in order to qualify for incentive payments for electronic health records. Early studies demonstrate that the ability to exchange clinical data among provider organizations has the potential to improve clinical care. However, as with any technology, there is a risk of unintended consequences from health information exchange. This manuscript outlines seven aspects of health information exchange that, if not managed properly, may lead to unintended consequences. These categories are: (1) the desire for complete, accurate and timely data for decision making, (2) data management and presentation, (3) assuring routine use of health information exchange, (4) consideration of patient perceptions and concerns, (5) reputational and financial concerns, (6) technical issues and (7) administrative aspects of health information exchange. Education about the capabilities and limitations of health information exchange, along with checklists to support proper implementation and assure that systems are being used as planned, can mitigate risks and help to realize the promise of this powerful technology.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
McClellan M, McKethan AN, Lewis JL, Roski J, Fisher ES. A National Strategy to Put Accountable Care into Practice. Health Aff. 2010;29(5):982–990.
Brennan T, Lee T. Risk Shifting in Health Care and Its Implications: Part 1. Health Affairs Blog. Health Affairs, August 24, 2011. http://healthaffairs.org/blog/2011/08/24/risk-shifting-in-health-care-and-its-implications-part-one . Accessed September 6, 2012.
Brennan T, Lee T. Risk Shifting in Health Care and Its Implications: Part 1. Health Affairs Blog. Health Affairs, August 25, 2011. http://healthaffairs.org/blog/2011/08/24/risk-shifting-in-health-care-and-its-implications-part-two . Accessed September 6, 2012.
Preferred practices and performance measures for measuring and reporting care coordination: a consensus statement. National Quality Forum, 2010. http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=49506 . Accessed September 6, 2012.
McDonald CJ, Overhage JM, Barnes M, Schadow G, Blevins L, Dexter PR, Mamlin B, INPC Management Committee. The Indiana Network for Patient Care: A Working Local Health Information Infrastructure. An Example of an Infrastructure Collaboration That Links Data from Five Health Systems and Hundreds of Millions of Entries. Health Aff. 2005;24:1214–20.
Williams C, Mostashari F, Mertz K, Hogin E, Atwal P. From the Office of the National Coordinator: The Strategy for Advancing the Exchange of Health Information. Health Aff. 2012;31(3):527–536.
Medicare and Medicaid Programs; Electronic Health Records Incentive Program—Stage 2. Centers for Medicare & Medicaid Services (CMS), HHS. August 21, 2012. http://www.ofr.gov/OFRUpload/OFRData/2012-21050_PI.pdf . Accessed August 23, 2012.
Fontaine P, Ross SE, Zink T, Schilling LM. Systematic Review of Health Information Exchange in Primary Care Practices. J Am Board Fam Med. 2010;23:655–670.
Kaelber DC, Bates DW. Health Information Exchange and Patient Safety. J Biomed Inform. 2007;40:S40–S45.
Frisse ME, Johnson KB, Nian H, Davison CL, Gadd CS, Unertl KM, Turri PA, Chen Q. The Financial Impact of Health Information Exchange on Emergency Department Care. J Am Med Inform Assoc. 2012;19:328–333.
Kho AN, Lemmon L, Commiskey M, Wilson SJ, McDonald CJ. Use of a Regional Health Information Exchange to Detect Crossover of Patients with MRSA Between Urban Hospitals. J Am Med Inform Assoc. 2008;15:212–216.
Committee on Patient Safety and Health Information Technology, Board on Health Care Services. Health IT and Patient Safety: Building Safer Systems for Better Care. Washington, DC: The National Academies Press; 2012.
Sittig DF, Singh H. A new Socio-Technical Model for Studying Health Information Technology in Complex Adaptive Healthcare Systems. Qual Saf Healthcare. 2010;Supple 3:68–74.
Grannis SJ, Overhage JM, McDonald CJ. Analysis of identifier performance using a deterministic linkage algorithm. Proc AMIA Symp. 2002:305-9.
Feblowitz JC, Wright A, Singh H, Samal L, Sittig DF. Summarization of Clinical Information: A Conceptual Model. J Biomed Inform. 2011;44:688–99.
Health Information Technology: Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information. Office of the National Coordinator for Health Information Technology (ONC), HHS. September 4, 2012. http://www.ofr.gov/OFRUpload/OFRData/2012-20982_PI.pdf . Accessed November 15, 2012.
Moore T, Shapiro J, Doles L, et al. Event Detection: A Clinical Notification Service on a Health Information Exchange Platform. Proc AMIA Annu Symp, 2012. In press.
HEALTHeLINK. Home/Patients. http://wnyhealthelink.com/Patients. Accessed November 15, 2012.
Funding/Support
Dr. Kuperman and Dr. McGowan are supported in part by Task Order HHSP23337003T from Westat under Contract HHSP23320095655WC from the Office of the National Coordinator for Health Information Technology.
Acknowledgement
We gratefully acknowledge the contributions of the other participants in the Health Information Exchange Unintended Consequences Workgroup.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kuperman, G.J., McGowan, J.J. Potential Unintended Consequences of Health Information Exchange. J GEN INTERN MED 28, 1663–1666 (2013). https://doi.org/10.1007/s11606-012-2313-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-012-2313-0