While a key provision of the 2009 HITECH Act was to spur health data exchange within and outside hospitals, only 30 percent of U.S. hospitals are part of a health information exchange today.

This is according to a new study published in Healthcare: The Journal of Delivery Science and Innovation.

Despite an uptick in hospital HIE participation since the start of HITECH, the majority of hospitals still do not engage in HIE, and there exists large state-to-state variation, researchers found. Specific types of hospitals appear to feel that they are better off not engaging in HIE, they wrote.

As for variation by state, the differences were large, with some states achieving more than 70 percent participation (Rhode Island, Delaware and Vermont) and others with minimal participation.

In markets where exchange occurred, for-profit hospitals were far less likely to engage in HIE than non-profit hospitals, according to the study. Hospitals with a larger market share were more likely to engage in exchange, as were hospitals in less competitive markets.

[See also: Vendors missing boat on HIE needs.]

"Part of the challenge is technical: how to interconnect EHRs from hundreds of different vendors," researchers concluded. "The far more difficult set of challenges, however, relate to the financial, cultural, legal and organizational issues that arise when unaffiliated organizations share sensitive patient data with one another. Despite the growing recognition that health information exchange is an essential component of a high-performing healthcare system, it is not clear whether our national approach to foster HIE is successfully tackling the key obstacles."

Among the key findings:

• 37 percent of not-for-profit hospitals participated in an HIE, compared with 21percent of public hospitals and 8 percent of for-profit hospitals;
• 49 percent of hospitals with the largest market share participated in an HIE, compared with 14 percent of those with the smallest market share;
• 49 percent of large hospitals participated in an HIE, compared with 35 percent of medium-sized hospitals and 20 percent of small hospitals; and
• 46 percent of hospitals with at least a basic electronic health record system participated in an HIE, compared with 31 percent of hospitals that did not have basic EHR.

[See also: 'Jury still out' on HIE sustainability.]

To conduct the study, researchers Julia Adler Milstein at the University of Michigan and Ashish K. Jha at Harvard's School of Public Health in Boston used the most recent national data from the American Hospital Association's IT Supplement to assess U.S. hospital participation in HIE and how participation varies by state. They examined whether HIE is being pursued by all types of hospitals, or whether specific types of hospitals are not yet engaged. They focused on for-profit hospitals, those with smaller market share, and those in more competitive markets.