EXPRESS: Bridging the Divide? The Differential Impact of Health Information Exchange (HIE) on Healthcare Professionals’ Productivity in Urban and Rural Settings

Health information exchanges (HIEs) facilitate the secure, electronic sharing of patient medical information/records across providers, enabling healthcare professionals to access timely, comprehensive data and thereby improve care coordination and quality. Yet, despite these expected benefits, empirical evidence shows that healthcare professionals often spend substantial time and effort interacting with HIE platforms without discernible productivity gains. Moreover, although HIEs are promoted as a potential solution for addressing geospatial disparities in healthcare, their impact on healthcare professionals’ productivity across urban and rural hospitals remains unclear. Using data envelopment analysis (DEA) to construct a measure of healthcare professionals’ productivity and applying the difference-in-differences (DiD) approach, we investigate the impact of HIE adoption on healthcare professionals’ productivity in urban and rural hospitals in the United States (U.S.). Our findings show that hospitals that have adopted HIE experience a significant increase in healthcare professionals’ productivity. However, this effect is more pronounced in urban hospitals than in rural hospitals. We attribute this result to urban healthcare professionals having workflows with greater information intensity and higher technology capabilities than healthcare professionals in rural hospitals. Furthermore, our study reveals that HIE adoption improves communication and the quality of clinical decision-making among urban healthcare professionals, but not among those in rural hospitals. We also find that the productivity gains from HIE adoption are greater for nurses than for physicians. We discuss the theoretical and practical implications of these findings.