The Impact of a National Health Information Exchange Program Under a Single-payer System

Objective: This study aimed to evaluate the impact of the PharmaCloud program, a health information exchange program implemented in 2013, on medication duplication under a single-payer, universal health insurance program in Taiwan. Study Design: This study employed a retrospective pre-post study design and used nationwide health insurance claim data from 2013 to 2015. A difference-in-difference analysis was conducted to evaluate the effects of inquiry rate on the probability of receiving duplicate medications and on the number of days of overlapping medication prescriptions after implementation of the PharmaCloud program. Results: The study subjects included patients receiving medications in 7 categories: antihypertension drugs, 217,200; antihyperlipidemic drugs, 69,086; hypoglycemic agents, 103,962; antipsychotic drugs, 15,479; antidepressant drugs, 12,057; sedative and hypnotic drugs, 56,048; and antigout drugs, 18,250. Up to 2015, the overall PharmaCloud inquiry rate has increased to 55.36%-69.16%. Compared with subjects in 2013, subjects in 2014 and 2015 had a significantly lower likelihood of receiving duplicate medication in all 7 medication groups; for instance, for antihypertension drug users, the odds ratio (OR) was 0.91 with 95% confidence interval (CI)=0.90-0.92 in 2014, and the OR was 0.81 with 95% confidence interval=0.81-0.82 in 2015. However, a higher inquiry rate led to a lower likelihood of receiving duplicate medication and shorter periods of overlapping medications only in some of the medication groups. Conclusions: The health information exchange program has reduced medication duplication, yet the reduction was not entirely associated with record inquiries. The hospitals have responded to the challenge of medication duplication by enhancing internal prescription control via a prescription alert system, which may have contributed to the reduction in duplicate medications and is a positive, unintended consequence of the intervention.