Health information exchange between hospital and skilled nursing facilities not associated with lower readmissions

Dori A. Cross, Jeffrey S. McCullough, Jane Banaszak-Holl, Julia Adler-Milstein

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Objective: To assess whether an electronic health record (EHR) portal to enable health information exchange (HIE) between a hospital and three skilled nursing facilities (SNFs) reduced likelihood of patient readmission. Setting/Data: Secondary data; all discharges from a large academic medical center to SNFs between July 2013 and March 2017, combined with portal usage records from SNFs with HIE access. Design: We use difference-in-differences to determine whether portal implementation reduced likelihood of readmission over time for patients discharged to HIE-enabled SNFs, relative to those discharged to nonenabled facilities. Additional descriptive analyses of audit log data characterize portal use within enabled facilities. Data Collection: Encounter-level clinical EHR data were merged with EHR audit log data that captured portal usage in the timeframe associated with a patient transition from hospital to SNF. Principal Findings: Declines in likelihood of 30-day readmission were not significantly different for patients in HIE-enabled vs control SNFs (diff-in-diff = 0.022; P =.431). We observe similar null effects with shorter readmission windows. The portal was used for 46 percent of discharges, with significant usage pattern variation within/across facilities. Conclusions: Implementation of a hospital-SNF EHR portal did not reduce readmissions from enabled SNFs. Emergent HIE use cases need to be better defined and leveraged for design and implementation that generates value in the context of postacute transitions.

Original languageEnglish (US)
Pages (from-to)1335-1345
Number of pages11
JournalHealth services research
Issue number6
StatePublished - Dec 1 2019

Bibliographical note

Funding Information:
Joint Acknowledgment/Disclosure Statement : Dori Cross was supported by a Rackham Predoctoral Fellowship from the University of Michigan to complete this work. Disclosures : Julia Adler‐Milstein now holds a Hartford Foundation grant on the topic of information sharing between hospitals and skilled nursing facilities.


  • care transitions
  • electronic health records
  • health information exchange
  • postacute care


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