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Member Research and Reports

Member Research and Reports

UAB: Assessing the Impact of Health System Organizational Structure on Hospital Electronic Data Sharing

Dr. Eric Ford, professor in the department of Health Care Organization and Policy at University of Alabama at Birmingham School of Public Health collaborated with Mr. A Jay Holgren, a doctoral student in the health policy management track at Harvard Business School to publish results of their research in the Journal of the American Medical Informatics Association.

[Photo: Dr. Eric Ford]

Horizontal consolidation in the hospital industry has gained momentum in the United States despite concerns over rising costs and lower quality. Hospital systems frequently point to potential gains in interoperability and electronic exchange of patient information as consolidation benefits. Researchers sought to assess whether hospitals in different health system structures varied in their interoperable data sharing.

They created a cross-sectional national hospital sample from the 2014 AHA Annual Survey and 2015 IT Supplement and combined the existing taxonomy of health system organizational forms and the ONC’s functionality-based, technology-agnostic definition of interoperability. Researchers used logistic regression models to assess the relationship between health systems’ organizational forms and interoperability engagement, controlling for hospital characteristics.

They found that interoperability engagement varied greatly across hospitals in different health system structures, with facilities in more centralized health systems more likely to be interoperable. Hospitals in one system type, featuring centralized insurance product development but diverse service offerings across member organizations, had significantly higher odds of being engaged in interoperable data sharing in our multivariate regression results.

The heterogeneity in health system interoperability engagement indicates that incentives to share data vary greatly across organizational strategies and structures. The results suggest that horizontal consolidation in the hospital industry may not bring significant gains in interoperability progress unless that consolidation takes a specific business alignment form.

The authors concluded that policymakers should be wary of claims that horizontal consolidation will lead to interoperability gains. Future research should explore the specific mechanisms that lead to greater interoperability in certain health system organizational structures.

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