Browsing by Author "Unruh, Mark Aaron"

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    The associations between query-based and directed health information exchange with potentially avoidable use of health care services
    (Wiley, 2019-05-21) Vest, Joshua R.; Unruh, Mark Aaron; Shapiro, Jason S.; Casalino, Lawrence P.; Health Policy and Management, School of Public Health
    Objective To quantify the impact of two approaches (directed and query‐based) to health information exchange (HIE) on potentially avoidable use of health care services. Data Sources/Study Setting Data on ambulatory care providers’ adoption of HIE were merged with Medicare fee‐for‐service claims from 2008 to 2014. Providers were from 13 counties in New York served by the Rochester Regional Health Information Organization (RHIO). Study Design Linear regression models with provider and year fixed effects were used to estimate changes in the probability of utilization outcomes for Medicare beneficiaries attributed to providers adopting directed and/or query‐based HIE compared with beneficiaries attributed to providers who had not adopted HIE. Data Collection Providers’ HIE adoption status was determined through Rochester RHIO registration records. RHIO and claims data were linked via National Provider Identifiers. Principal Findings Query‐based HIE adoption was associated with a 0.2 percentage point reduction in the probability of an ambulatory care sensitive hospitalization and a 1.1 percentage point decrease in the likelihood of an unplanned readmission. Directed HIE adoption was not associated with any outcome. Conclusions The Centers for Medicare & Medicaid Services’ (CMS) EHR certification criteria includes requirements for directed HIE, but not query‐based HIE. Pending further research, certification criteria should place equal weight on facilitating query‐based and directed exchange.
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    Health systems’ use of enterprise health information exchange vs single electronic health record vendor environments and unplanned readmissions
    (Oxford University Press, 2019-10-01) Vest, Joshua R.; Unruh, Mark Aaron; Freedman, Seth; Simon, Kosali; Health Policy and Management, School of Public Health
    Objective: Enterprise health information exchange (HIE) and a single electronic health record (EHR) vendor solution are 2 information exchange approaches to improve performance and increase the quality of care. This study sought to determine the association between adoption of enterprise HIE vs a single vendor environment and changes in unplanned readmissions. Materials and methods: The association between unplanned 30-day readmissions among adult patients and adoption of enterprise HIE or a single vendor environment was measured in a panel of 211 system-member hospitals from 2010 through 2014 using fixed-effects regression models. Sample hospitals were members of health systems in 7 states. Enterprise HIE was defined as self-reported ability to exchange information with other members of the same health system who used different EHR vendors. A single EHR vendor environment reported exchanging information with other health system members, but all using the same EHR vendor. Results: Enterprise HIE adoption was more common among the study sample than EHR (75% vs 24%). However, adoption of a single EHR vendor environment was associated with a 0.8% reduction in the probability of a readmission within 30 days of discharge. The estimated impact of adopting an enterprise HIE strategy on readmissions was smaller and not statically significant. Conclusion: Reductions in the probability of an unplanned readmission after a hospital adopts a single vendor environment suggests that HIE technologies can better support the aim of higher quality care. Additionally, health systems may benefit more from a single vendor environment approach than attempting to foster exchange across multiple EHR vendors.
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    Strategic use of health information exchange and market share, payer mix, and operating margins
    (Wolters Kluwer, 2022) Vest, Joshua R.; Freedman, Seth; Unruh, Mark Aaron; Bako, Abdulaziz T.; Simon, Kosali; Health Policy and Management, School of Public Health
    Background: Health information exchange (HIE) capabilities are tied to health care organizations' strategic and business goals. As a technology that connects information from different organizations, HIE may be a source of competitive advantage and a path to improvements in performance. Purpose: The aim of the study was to identify the impact of hospitals' use of HIE capabilities on outcomes that may be sensitive to changes in various contracting arrangements and referral patterns arising from improved connectivity. Methodology: Using a panel of community hospitals in nine states, we examined the association between the number of different data types the hospital could exchange via HIE and changes in market share, payer mix, and operating margin (2010-2014). Regression models that controlled for the number of different data types shared intraorganizationally and other time-varying factors and included both hospital and time fixed effects were used for adjusted estimates of the relationships between changes in HIE capabilities and outcomes. Results: Increasing HIE capability was associated with a 13 percentage point increase in a hospital's discharges that were covered by commercial insurers or Medicare (i.e., payer mix). Conversely, increasing intraorganizational information sharing was associated with a 9.6 percentage point decrease in the percentage of discharges covered by commercial insurers or Medicare. Increasing HIE capability or intraorganizational information sharing was not associated with increased market share nor with operating margin. Conclusions: Improving information sharing with external organizations may be an approach to support strategic business goals. Practice implications: Organizations may be served by identifying ways to leverage HIE instead of focusing on intraorganizational exchange capabilities.
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    Usage of query-based health information exchange after event notifications
    (Oxford University Press, 2019-08-01) Vest, Joshua R.; Ellis Hilts, Katy; Ancker, Jessica S.; Unruh, Mark Aaron; Jung, Hye-Young; Health Policy and Management, School of Public Health
    ABSTRACT Objectives: This study sought to quantify the association between event notifications and subsequent querybased health information exchange (HIE) use among end users of three different community health information organizations. Materials and Methods: Using system-log data merged with user characteristics, regression-adjusted estimates were used to describe the association between event notifications and subsequent query-based HIE usage. Results: Approximately 5% of event notifications were associated with query-based HIE usage within 30 days. In adjusted models, odds of query-based HIE usage following an event notification were higher for older patients and for alerts triggered by a discharge event. Query-based HIE usage was more common among specialty clinics and Federally Qualified Health Centers than primary care organizations. Discussion and Conclusion: In this novel combination of data, 1 in 20 event notifications resulted in subsequent query-based HIE usage. Results from this study suggest that event notifications and query-based HIE can be applied together to address clinical and population health use cases.