JMIR Publications

ABSTRACT

Background:

Not all provider groups may exchange health information with one another without difficulty, despite the vast array of benefits that interoperability and health information exchange (HIE) entail for patient care. Accordingly, the Centers for Medicare and Medicaid Services (CMS) measure the performance of provider groups in sending and receiving health information.

Objective:

To examine the correlation between sending health information and receiving health information along with the symmetries and asymmetries that exist among both. Additionally, to describe how sending health information and receiving health information vary based on provider group type, with primary care providers (PCPs) and specialty providers, and provider group size.

Methods:

We used CMS data from QPP MIPS of 2,033 provider groups to analyze performance rates for sending and receiving health information, when unsegmented and when segmented by provider group type and provider group size. In addition to descriptive statistics, we conducted a cluster analysis to identify differences among provider groups – particularly with respect to asymmetric interoperability.

Results:

Sending health information and receiving health information have relatively low bivariate correlation (0.4147) with a significant number of observations (42.5%) exhibiting asymmetric interoperability. Additionally, PCPs are more likely than specialty providers to exchange information asymmetrically, being more inclined to receive health information than to send health information. Finally, larger provider groups are significantly less likely to be interoperable than smaller groups, although both engage in HIE asymmetrically at similar rates.

Conclusions:

Adoption of interoperability by provider groups is more nuanced than expected and should not be seen as a binary determination (i.e. to be interoperable or to not). Asymmetric interoperability reiterates how HIE is a strategic choice, which may lead to asymmetries in addition to variation by provider group type and provider group size. Differences in the operational paradigms among provider groups of varying types and sizes may explain their varying extents of HIE usage for sending and receiving health information. It is clear that there continues to remain significant room for improvement on the path to achieving a fully interoperable healthcare ecosystem.