Health Information Exchange Volume Demonstrates Varying Impact Within VHA and Community Care

Key Takeaways:

• Within US Veterans Health Administration (VHA) facilities, centers with a higher volume of health information exchange (HIE) had a greater number of patients and more vulnerable veterans compared to centers with low HIE volume.
• Within community care, an increase in HIE volume was associated with reduced 30-day readmissions, less avoidable hospitalizations, and fewer inpatient deaths.
• Within VHA care, the same increase in HIE volume was associated with higher rates of 30-day readmissions and inpatient mortality, indicating the need for further research to explain this discrepancy.

While electronic HIE allows physicians access to patient information across organizations and possibly improve care coordination, its real-world impact on health outcomes is unclear, especially within VHA and community care settings.

Study Methods and Outcomes

Researchers used 2022-2023 electronic health records (EHRs) from VHA administrative databases to analyze the relationship between HIE and health care utilization within VHA and community care.

HIE volume was measured by the number of unique patient-days with completed exchanges between a VHA center and community organizations.

Outcomes included rates of 30-day readmissions, avoidable hospitalizations, and avoidable inpatient deaths.

Inconsistent HIE Impact Between VHA and Community Centers

HIE data included 3144 medical center-months and 2.4 million unique patients per month.

Volume of HIE varied greatly across VHA centers, ranging from 0.01 to 19.84 with a median of 1.27. Compared to centers with low HIE volume, centers with higher HIE volume had more enrollees, 73 441 vs 31 560, respectively. Furthermore, facilities with higher HIE volume had more veterans in priority groups 1 and 2, fewer rural veterans, younger patients, and more Hispanic veterans.

Within community settings, instrumental variable (IV) estimates found that a 1-SD increase in HIE volume resulted in 4.07 fewer 30-day readmissions, 1.45 fewer avoidable hospitalizations, and 0.25 fewer inpatient deaths

Conversely, IV estimates for VHA care found that an increase in HIE volume was associated with increased readmissions and inpatient mortality, 7.07 and 0.19, respectively. HIE had no significant impact on rates of avoidable hospitalizations.

Explanations for Findings

The authors suggested 3 possible explanations for the significant difference in impact between VHA and community care:

1. The longitudinal histories outbound from VHA may be more valuable than the episodic summaries inbound to VHA.
2. The community care interface may be more user-friendly than the read-only Joint Legacy Viewer used by VHA facilities.
3. HIE enables VHA reclamation of community patients, which could increase the number of patients under VHA care.

Implications for Veterans Care

These findings suggest that increasing HIE volume could reduce unnecessary health care utilization in community care settings.

More research is needed to understand the findings within VHA care and further explore the impact of HIE on physician workflows and patient outcomes.

According to the authors, “Realizing the full potential of HIE will require additional evaluations that go beyond adoption metrics to examine health information flow, provider experience, and the conditions under which HIE translates into meaningful improvements in care.”

Reference

Zhang A, Lipsey D, Figueroa S, et al. Veteran health information exchange volume and 30-day readmissions, avoidable hospitalizations, and in-hospital mortality: evidence from community and Veterans Health Administration direct care. J Am Med Inform Assoc. 2026;33(9):1770-1779. doi:10.1093/jamia/ocag125