Beyond Borders: Evaluating the Impact of Health Information Exchange on Resource Utilization in the United Arab Emirates – A Longitudinal Study

Abstract

The body of knowledge on the benefits of Health Information Exchange (HIE) services primarily consists of studies that are conducted on HIEs in the US. The important legal and economic differences between the US market and the rest of the world, significantly reduce the generalizability of the current insights on HIEs. In this research we intend to examine if the HIE adoption and usage would lead to substantial changes in resource utilization in settings outside of the US, hence improving the generalizability and external validity of the literature on HIE effectiveness. We conducted a longitudinal study of all medical providers in Abu Dhabi, United Arab Emirates between January 2019, and May 2022. Using HIE system log data, and insurance claims data we implemented Difference-in-Differences models to estimate the impact of HIE adoption reducing utilization of laboratory and pathology, and radiology imaging services as well as surgery procedures at both individual clinician and hospital levels. We further implemented panel data regression models to estimate the gradual increase in the benefits of HIE for users. On average, at the hospital level, adoption of HIE services has resulted in 24.7% reduction in pathology and laboratory orders, and 11.2% reduction in radiology imaging. At the clinician level, on average, HIE adoption leads to 7.8% reduction in pathology and laboratory orders, and 5.6% reduction in surgery procedures. These reductions are relative to the predicted increase in outcomes which would have occurred had the HIE not been implemented. We also show that the benefits of HIE happens gradually over time and as users gain more experience with the HIE, they observe better results. While our findings are consistent with the prior literature and show that HIE adoption significantly reduces the utilization of medical services, we uncover that the magnitude of these savings are different from those in the US.