Health Information Exchange, System Size and Information Silos

There are many technology platforms that bring benefits only when users share data. In healthcare, this is a key policy issue, because of the potential cost savings and quality improvements from 'big data' in the form of sharing electronic patient data across medical providers. Indeed, one criterion used for federal subsidies for healthcare information technology is whether the software has the capability to share data. We find empirically that larger hospital systems are more likely to exchange electronic patient information internally, but are less likely to exchange patient information externally with other hospitals. This pattern is driven by instances where there may be a commercial cost to sharing data with other hospitals. Our results suggest that the common strategy of using 'marquee' large users to kick-start a platform technology has an important drawback of potentially creating information silos. This suggests that federal subsidies for health data technologies based on 'meaningful use' criteria, that are based simply on the capability to share data rather than actual sharing of data, may be misplaced.

[1]  C. Shapiro,et al.  Network Externalities, Competition, and Compatibility , 1985 .

[2]  D. Brailer Interoperability: the key to the future health care system. , 2005, Health affairs.

[3]  Jennie Harvell,et al.  Hospitals ineligible for federal meaningful-use incentives have dismally low rates of adoption of electronic health records. , 2012, Health affairs.

[4]  Amalia R. Miller,et al.  Encryption and the Loss of Patient Data , 2011, Journal of policy analysis and management : [the journal of the Association for Public Policy Analysis and Management].

[5]  D. Blumenthal,et al.  Health information technology: laying the infrastructure for national health reform. , 2010, Health affairs.

[6]  Joseph Farrell,et al.  Standardization, Compatibility, and Innovation , 1985 .

[7]  Catherine E. Tucker,et al.  Electronic Discovery and the Adoption of Information Technology , 2012 .

[8]  Eric C. Pan,et al.  The value of health care information exchange and interoperability. , 2005, Health affairs.

[9]  R. Saunders,et al.  Best Care at Lower Cost: The Path to Continuously Learning Health Care in America , 2013 .

[10]  Thomas R. Eisenmann,et al.  Staging Two-Sided Platforms , 2007 .

[11]  Catherine Tucker,et al.  Identifying Formal and Informal Influence in Technology Adoption with Network Externalities , 2008, Manag. Sci..

[12]  U. Doraszelski,et al.  Avoiding market dominance: product compatibility in markets with network effects , 2009 .

[13]  Catherine E. Tucker,et al.  Can Health Care Information Technology Save Babies? , 2011, Journal of Political Economy.

[14]  Shane Greenstein,et al.  Coordination versus Differentiation in a Standards War , 2006 .

[15]  Dahlia Remler,et al.  Information and communications technology in U.S. health care: why is adoption so slow and is slower better? , 2009, Journal of health politics, policy and law.

[16]  Emmett Keeler,et al.  The effects of multi-hospital systems on hospital prices. , 2007, Journal of health economics.

[17]  Stuart J. H. Graham,et al.  Competing on Standards? Entrepreneurship, Intellectual Property and the Platform Paradox , 2007 .

[18]  Kathleen Carey,et al.  The effect of network arrangements on hospital pricing behavior. , 2005, Journal of Health Economics.

[19]  Julia Adler-Milstein,et al.  Health information exchange among US hospitals. , 2011, The American journal of managed care.

[20]  Thomas R. Eisenmann,et al.  Strategies for Two Sided Markets , 2006 .

[21]  J. Cantor,et al.  Emergency department utilization and capacity. , 2009, The Synthesis project. Research synthesis report.

[22]  D. Blumenthal,et al.  The "meaningful use" regulation for electronic health records. , 2010, The New England journal of medicine.

[23]  Marc Rysman,et al.  Coordination vs. Differentiation in a Standards War: 56k Modems , 2004 .

[24]  Kate Ho Insurer-Provider Networks in the Medical Care Market , 2005, The American economic review.

[25]  F. Mair,et al.  Why is it difficult to implement e-health initiatives? A qualitative study , 2011, Implementation science : IS.

[26]  P. Klemperer,et al.  Chapter 31 Coordination and Lock-In: Competition with Switching Costs and Network Effects , 2007 .

[27]  Han Bleichrodt,et al.  Handbook of Health Economics , 2001 .

[28]  Kristin Madison,et al.  Multihospital system membership and patient treatments, expenditures, and outcomes. , 2004, Health services research.

[29]  Oz Shy,et al.  The Economics of Network Industries , 2002 .

[30]  Julia Adler-Milstein,et al.  Sharing clinical data electronically: a critical challenge for fixing the health care system. , 2012, JAMA.

[31]  Stuart J. H. Graham,et al.  Competing on Standards? Entrepreneurship, Intellectual Property, and Platform Technologies , 2009 .

[32]  A. Bower The Diffusion and Value of Healthcare Information Technology , 2005 .

[33]  Revisiting the relationship between managed care and hospital consolidation. , 2007, Health services research.

[34]  A. Jha,et al.  Meaningful use of electronic health records: the road ahead. , 2010, JAMA.

[35]  Federico Ciliberto Does Organizational Form Affect Investment Decisions? , 2006 .

[36]  Catherine Tucker,et al.  Active Social Media Management: The Case of Health Care , 2012, Inf. Syst. Res..

[37]  Kim M. Unertl,et al.  The financial impact of health information exchange on emergency department care , 2011, J. Am. Medical Informatics Assoc..

[38]  Catherine Tucker,et al.  Privacy Protection and Technology Diffusion: The Case of Electronic Medical Records , 2009, Manag. Sci..

[39]  William L. Fuerst,et al.  Information technology and sustained competitive advantage: a resource-based analysis , 1995 .

[40]  N. Economides The Economics of Networks , 1995 .

[41]  LeighAnne Olsen,et al.  Clinical Data as the Basic Staple of Health Learning: Creating and Protecting a Public Good: Workshop Summary , 2011 .

[42]  P. Klemperer,et al.  Coordination and Lock-In: Competition with Switching Costs and Network Effects , 2006 .

[43]  C. Manski Identification of Endogenous Social Effects: The Reflection Problem , 1993 .

[44]  G. Gowrisankaran,et al.  Network Externalities and Technology Adoption: Lessons from Electronic Payments , 2002 .

[45]  McCullough Steve Parente,et al.  The Impact of Health Information Technology on Patient Outcomes , 2011 .