All ETDs from UAB

Advisory Committee Chair

Nir Menachemi

Advisory Committee Members

Justin L Blackburn

Darrell E Burke

Stephen T Mennemeyer

Joshua R Vest

Document Type


Date of Award


Degree Name by School

Doctor of Public Health (DrPH) School of Public Health


The purpose of this dissertation is to examine the effects of Health Information Exchange (HIE) as well to evaluate hospital and market characteristics related to trends in HIE adoption. Widespread HIE is believed to boost efficiency, reduce health care costs, and improve outcomes; as such numerous efforts have aimed to promote and facilitate HIE by providers. Despite this, over a quarter of all hospitals in the U.S. do not participate in HIE and thus it is essential to examine the evidence for the theorized benefits from HIE. As such, the first paper systematically reviews the literature examining the relationship of HIE and its effects on health care outcomes. We find that although majority (57%) of published analyses reported some benefit from HIE, those with stronger study designs were significantly less likely to do so. Overall, little generalizable evidence currently exists regarding benefits attributable to HIE. The second paper in this dissertation examines the association between hospital-level characteristics and HIE adoption over time. We found that HIE participation for each year until 2013 was greater compared to 2009. System hospitals had lower odds of HIE participation (OR: 0.80; p<0.001) but exchanged more data elements (IRR: 1.05; p=0.04). Over time, system hospitals had greater odds for HIE participation (OR: 1.85; p<0.001) while also exchanging more data elements (IRR: 1.07; p=0.05). For-profit hospitals in contrast, had lower odds of HIE participation (OR: 0.37; p<0.001), exchanged fewer data elements (IRR: 0.83; p<0.001) and over time had a decreasing likelihood for participation (OR: 0.73; p<0.10). Lastly, the third paper in this dissertation examines the relationship between market factors and hospital HIE adoption. Hospitals in less competitive markets had higher odds of HIE participation (OR: 1.57; p=0.03) and exchanged more data elements (IRR: 1.17; p=0.04). Hospitals in markets with greater health care facility internet speed had higher odds for HIE participation (OR: 1.06; p<0.001). Overall, understanding the impact of HIE on important outcomes and determining factors associated with HIE adoption in hospitals will facilitate a deeper understanding of the HIE landscape and thus will guide managers and policy-makers towards more evidence-informed decisions.

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