Use of Push and Pull Health Information Exchange Technologies by Ambulatory Care Practices and the Impact on Potentially Avoidable Health Care Utilization (Indiana)

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Summary:

Providers’ improved access to electronic patient information through health information exchange (HIE) is a national policy priority and a key infrastructure requirement for the U.S. health care system. Thanks to significant public investments, providers have access to different HIE approaches to meet their information needs. One approach is referred to as “pull,” which allows providers to query community-wide, longitudinal patient records. A second approach is “push,” where key information, such as test results, is automatically delivered to providers. Unfortunately, there is a lack of evidence of the effectiveness of either the “push” or “pull” approach in primary care. In addition, it is unknown which approach to sharing information best fits the primary care environment. Despite the lack of evidence, Federal policy encourages the exchange of patient information based on the assumption that the two approaches are equivalent. The objectives of this project are to clarify the relationship between “pull” and “push” HIE usage in primary care settings and to determine the impact of each approach on potentially avoidable and costly health care utilization.

The specific aims of this project are as follows:

  • Determine whether primary care providers use “push” and “pull” as complementary or alternative approaches to HIE. 
  • Quantify the effect of “push” and “pull” HIE on potentially avoidable health care utilization. 

To test the hypothesis that the receipt of information via “push” will increase the likelihood of “pull” usage during a patient visit, the investigators will analyze 3 years of patient encounters at six Federally Qualified Health Center sites in New York State that have both “push” and “pull” HIE . This dataset includes detailed information on users’ activity within electronic health record and HIE systems including a complete, detailed temporal sequence of providers’ HIE usage for each patient visit. Using the patient visit as the unit of analysis, the investigators will describe the association between “push” and “pull” HIE adjusting for patient and provider characteristics.

To test the hypothesis that HIE usage will be associated with reductions in readmissions and hospitalizations for ambulatory care sensitive conditions, the investigators will model 1) the effect of “push” alone, 2) the effect of “pull” alone, and 3) the effect of “push” and “pull” used together by the same physician using retrospective data from more than 240 ambulatory physicians.

By identifying the relationship of “push” and “pull” information exchange in primary care, the investigators hope to provide evidence to guide policy, the structuring of clinical workflows, and the design of information technology for HIE.

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