State Policy Linked to Improved Data Sharing, Care Quality

An MIT-Sloan study finds policies in the category related to data protection affect health information sharing the most.

Policies developed by state legislatures can play a critical role in the adoption of health data sharing, which, in turn, will improve care quality, according to a new study from MIT Sloan School of Management.

The MIT Sloan researchers wanted to determine why, despite the high levels of adoption of electronic health records since the 2009 Health Information Technology for Economic and Clinical (HITECH) Act, the actual use of shared data to improve care has sputtered.

"If states want to increase the use of health information sharing in an effort to improve quality of care, we need to understand how state laws most encourage and discourage the use of HIEs, and then weigh the benefits of information sharing with other goals like the strength of privacy protections," says coauthor MIT Sloan Prof.  Joseph Doyle.  

Fewer than 10% of hospitals (and fewer than 20% of doctors) were using EHR before the HITECH Act, which doled out $30 billion to increase the adoption. By 2014, 97% of reporting hospitals had electronic health record technology.

Despite the big investment and adoption, the study notes that the actual use of the data and resulting improvements to healthcare quality and productivity have been tepid.

In particular, the research finds policies in the category related to data protection affect health information sharing the most.

The researchers built a database of laws from 50 states between 2000 and 2019 and tracked 12 policies area that may increase HIE use. In turn, those 12 policy areas were further divided into four main categories: clarifying HIE governance, strengthening financial stability, specifying the uses and users of an HIE, and protecting the underlying data.

MIT-Sloan looked at shifting state policies over the 20-year span and then tested whether health information sharing responds to changes in state laws. The findings identify policies can have the potential to bolster the use of digital tools to improve health and lower costs.

For example, the research shows that data protection policies affect health information sharing the most. In states that make the protection of data less costly, HIE usage increases by 18%. Enacting legislation that has patients participate by default leads to a 16% increase in usage.

"When comparing outcomes of policies that had patients 'opting in' or 'opting out' of using health information exchanges, we found that 'opt in' policies resulted in less participation and data sharing," Doyle says.

The study also found that HIE use can improve care quality. An examination of hospital discharges for heart attack patients in Florida from 2011 to 2014 found that hospitals using HIEs had lower readmission rates.

In addition, physician offices with strong HIE programs have maintained quality with 5% lower Medicare spending.

Even with those measured successes, however, surveys of HIE stakeholders show ongoing and stubborn challenges to HIEs, including financial viability, state regulations and concerns about privacy.