1. Costs of Technological Frictions: Evidence from EHR (Non-)Interoperability 2. Sharing is Caring: The Role of Health Information Exchange on Patient Care
Two research presentations:
1. Interoperability of U.S. hospital electronic health record (EHR) systems remains limited, especially across vendors. We study how these frictions affect patients through a direct effect on information exchange and an allocative effect on patient flows. When hospitals switch to the same vendor, charges and readmissions fall 4% and 11% for transferred and referred patients, and transfers and referrals between them rise 8-10%. Patient reallocation improves outcomes when hospitals switch to vendors used by higher-quality providers and worsens outcomes otherwise. Eliminating frictions would redirect 7.5% of transfer patients and increase welfare 21%. Welfare increases from 2013–2019 achieved one-third of this potential.
2. Healthcare has been transformed by health information technology over the past two decades, but the impact of such digital technologies on health outcomes remains a long-standing and controversial question. In this project, we focus on the role of Health Information Exchange (HIE), an innovation designed to improve communication between healthcare systems and one that has been heavily subsidized and promoted as a way to improve quality of care. Using a newly compiled database of annual, state-level health information exchange laws, we show these laws strongly influence the adoption of HIE. Instrumental variable estimates that exploit state law changes show that HIE adoption reduces county-level mortality rates from flu and pneumonia by 18%. Hospital-level readmission rates for common conditions also fall by 4-5%. Given that the proportion of hospitals with HIE capability rose by 50 percentage points over the period in which we find these effects, we estimate that this diffusion saved 27,000 lives per year. We attribute the health improvements to enhanced public health response to infectious disease and improved care coordination.