The Impact of Health Information Exchanges on Emergency Department Length of Stay

Health information exchanges (HIEs) are expected to improve poor information coordination in emergency departments (EDs); however, whether and when HIEs are associated with better operational outcomes remains poorly understood. In this work, we study HIE and length of stay (LOS) relationship using a large dataset from the Healthcare Cost and Utilization Project consisting of about 7.4 million treat-and-release visits made to 63 EDs in Massachusetts. Overall, we find that HIE adoption is associated with a 10.2% reduction in LOS and the percentage reduction increases to 14.8% when the hospital is part of an integrated health system or to 21.0% when a patient has a previous visit to an HIE-carrying hospital. We further find that (i) teaching hospitals benefit more from HIE adoption compared with non-teaching hospitals, (ii) patients with severe or multiple comorbid conditions spend less time in the ED under HIE presence. Together, these results imply that (i) HIE adoption reduces overall ED LOS, (ii) wider HIE adoption would scale up the benefits for individual hospitals, (iii) magnitude of the association between HIE and LOS is higher when financial incentives for HIE adoption are stronger (e.g., integrated health systems), and (iv) the size of the reduction depends on certain contextual moderating factors. Given that HIEs are a key component of healthcare delivery and ongoing reforms, we believe that our findings have important implications and may inform policymakers regarding the nationwide HIE adoption.