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UCSF interoperability study: California hospitals report high HIE participation but social‑service exchange and outcomes measurement lag
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Summary
UCSF researcher AJ Holmberg told HCAI''s DXF advisory committee that California hospitals report higher health information exchange participation than national averages, TEFCA participation has surged, but social‑service data sharing, measurement of outcomes and HIO sustainability remain concerns.
AJ Holmberg, an assistant professor at the University of California, San Francisco, told the advisory committee that California has made large strides on hospital participation in health information exchange (HIE) — but that connectivity does not equal outcomes.
Holmberg summarized the study's headline findings: hospital participation in HIEs in California is reported at roughly 93% compared with about 84% nationally; national network participation and TEFCA interest grew sharply over the past year; and California hospitals reported comparatively higher exchange of social‑determinants‑of‑health data than the national average. "California has made up significant ground from a very low starting position in 2014," Holmberg said, describing strong growth in hospital HIE participation.
The research also identified ongoing challenges. Health information organizations (HIOs) reported difficulty finding sustainable business models and variability in data normalization and cleansing practices. Holmberg said HIO participation in TEFCA is higher in California than nationally but that many HIOs remained uncertain how to fit into TEFCA. He also said vendor‑side issues matter: hospitals using Epic, Oracle (formerly Cerner) or Meditech report higher participation rates than smaller vendor users.
On information blocking, Holmberg said vendor reporting indicated some decline since 2023 but that concerns persist, especially around commercial payers and labs as reported by some HIOs. He recommended moving beyond infrastructure metrics to outcome‑focused evaluations — measuring hospital readmissions, ED revisits and ambulatory quality — to show whether interoperability improves care and reduces costs.
Committee reaction: Members asked for more granular denominators (how many organizations exist in each sector), inclusion of safety‑net and community clinics in future analyses and clarity on how participation is defined (contractual participation vs. active exchange). Holmberg and staff said future work will try to tie DXF implementation measures to outcomes and recommended leveraging QHIO operational data to do so.
Why it matters: The study provides a baseline showing widespread technical connectivity among hospitals in California but flags the integration challenge for social‑service organizations, smaller ambulatory providers and the need to demonstrate improvements in patient outcomes beyond connectivity metrics.
