Health Information Exchange among U.S. Hospitals

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First Review

This is a review for Adler-Milstein's paper "Health Information Exchange Among US Hospitals". [1]


The purpose of this study was to determine the proportion of US hospitals engaged in HIE with unaffiliated providers and to identify key hospital-level and market-level factors associated with participating in exchange.


Logistic regression models were used to determine hospital-level characteristics and market-level characteristics associated with hospitals’ likelihood of participating in HIE.


The authors found that 10.7% of US hospitals engaged in HIE with unaffiliated providers. In communities where exchange occurred, for-profit hospitals and those with a small market share were far less likely to engage in HIE than non- profit hospitals or those with a larger market share. Hospitals in more concentrated markets were more likely to exchange and hospitals in markets with higher Medicare spending were less likely to exchange.


The findings of the study suggest that hospital participation in HIE is low, with only 1 in 9 US hospitals engaged. Concerns about competitive implications regarding HIE may be to blame. Hospitals do not want to share their clinical data with other providers that are seen as competitors. The low rate of participation is a challenge states will face as they build out HIE capabilities.


The new HIE capabilities need to address the concerns hospitals have regarding the sharing of clinical data with competitors in order to facilitate and encourage participation in HIE. HIE is a vital component of healthcare reform and must be suitable to providers' expectations if we expect hospital participation to increase.

Second Review

Add review here.


  1. Health Information Exchange Among US Hospitals. American Journal Of Managed Care, 17(11), 761-768.