Researchers: Bruce Rosen¹, Ofir Ben-Assuli², Joseph Rosenblum³, Ohad Hochman⁴, Julian Zelingher⁵

Background: Israel is a pioneer in the implementation of large-scale health information exchanges (HIEs), which facilitate the sharing across organizations of patient-level data on symptoms, diagnostic test results, diagnoses, and treatments.

Objectives: To explore how senior managers perceive the contributions of HIE and the steps they have taken to promote HIE use.
To analyze the extent of use of the HIE system in the hospitals.

Method: The study was based on in-depth interviews with senior managers in health plans and hospitals, an e-mail survey among hospital CEOs, and system-generated data on hospital HIE use.

Findings: There was a consensus among the managers interviewed that Israel’s HIE has the potential to contribute significantly - primarily to quality improvement and secondarily to cost containment.
Hospitals and health plans have taken a variety of steps to promote the use of HIE data, but these have not been particularly intensive. Respondents emphasized the importance of preserving physician autonomy in deciding when to use the HIE in particular cases.
The extent to which clinicians actually make use of the HIE was highest for inpatients, lowest for outpatient clinic patients and intermediate for emergency department patients.
The survey of hospital CEOs revealed that they think that coverage rates should be at levels that are significantly higher than current levels.

Conclusions: There is substantial variation with regard to the extent of HIE implementation, the intensity of the investment in encouraging HIE use and the extent of actual HIE use. This may be due in part to the lack of clarity regarding the types of patients for whom HIE use is particularly important.

Research end date: 11/2017