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Tag: Railroad analogies

The Little Exchange that Could…Transform the U.S. Health Care System

flying cadeuciiWhat do the classic children’s’ book “The Little Engine that Could” and federal investment in health information exchanges have in common? More than you’d think.

Much has been said about the fragmentation of the U.S. health care system and how this fragmentation can result in higher costs and worse outcomes for patients. Health Information Exchanges (HIEs) – organizations that facilitate the secure sharing of health information – are one effort to improve communication among providers, better coordinate care, boost patient satisfaction, and reduce health care costs.

To spur these exchanges the federal government has invested nearly $600 million to support the development of statewide HIEs. But, what has been the return on this investment and are the results worth the expense? This month, Sens. Lamar Alexander, Richard Burr, and Mike Enzi asked the Government Accountability Office to examine that very question.

The senators’ goal to learn more about what the government received in return for its investment is certainly a worthy one, but it is a difficult question to answer. To date, there has been very little research on the effect of HIEs on health outcomes, costs, or patient and provider attitudes toward HIEs. In fact, according to a recent RAND review of the existing research supporting the efficacy of HIEs, very few of the more than 100 existing operational HIEs have been evaluated. Without evaluation, it’s difficult to draw conclusions about what works and what doesn’t and to ensure that any future investment on the part of federal or state government is made wisely. By not building evaluation into this program, we’re missing opportunities to improve the health care system by learning from experience.

Here’s an analogy that is useful in thinking about federal investment in HIEs. Imagine that 150 years ago, the United States decided to build a national rail network to connect all major U.S. cities at an estimated total cost of $60 billion (in today’s dollars). What if five years into the effort $600 million had been spent to build portions of the tracks between Chicago and Pittsburgh, New York and Boston, and Washington and Philadelphia?

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