Impact of standards adoption on healthcare transaction performance: The case of HIPAA

The Health Insurance Portability and Accountability Act (HIPAA) is a standard for the healthcare industry mandating, in part, use of the EDI X12 protocol set for data exchanges among industry members. The motivation underlying this change was the view that lack of a standard format for healthcare data created significant inefficiencies, resulting in increased costs within the industry. With regulators' supposition that the standard would improve data exchange performance, we set out to determine the actual performance implications of HIPAA. Using data on transactions occurring over 106 months from 1998 to 2004, we study the impact of the HIPAA standardization requirement on transaction performance in the form of transaction delivery time and transaction quality measured as percentage errors. Performance is expected to deteriorate immediately following HIPAA compliance, due to system disruption, before a longer-term trend toward improved performance. Transaction performance immediately following HIPAA compliance shows deterioration in transaction delivery time, as expected, but a surprising improvement in transaction quality. The longer-term trends associated with HIPAA compliance for both transaction quality and transaction delivery time show that both are trending toward improvement. However, when we compare performance three, six, and 12 months before and after HIPAA compliance, we find that neither delivery time nor quality has improved. The implications for practice and theory are discussed.