Interconnected systems for information exchange might improve care and cut costs
In 2009 Congress passed the American Reinvestment and Recovery Act, which amongst other stimulus and savings measures, allocated roughly $26 billion toward investment into health information technology and incentive programs. Health information exchanges (HIEs) were developed to address the fragmented medical records systems characteristic of the United States health care system, with the intent to share information freely between treating physicians at different medical centers and clinics to improve quality, safety, and coordination of care. Although the early data regarding the intuitive benefits of information sharing were at first mixed, a growing body of empiric evidence suggest important benefits.
This study demonstrates a quantifiable relationship between HIE and improved emergency department (ED) care processes and efficient use of resources. The authors performed a retrospective cohort analysis at a large academic medical center comparing HIE (via EPIC's CareEverywhere) with traditional faxed/scanned record requests looking at six predetermined outcome measures. The study was not powered to determine patient outcomes but instead evaluated ED length of stay, ED utilization of CT scans, MRI, and radiography, hospitalization rates, and total charges.
Of the 437 patients enrolled in the HIE wing of the study, the authors estimated that 385 hours of patient time in the ED was saved through the use of HIE. In addition, the authors estimated that HIE obviated the need for CT in at least 11 patients, MRI in 7 patients, radiographs in 11 patients, and inpatient hospital admission for 11 patients. Improved timeliness was associated with a reduction in over half a million dollars in charges. Of note, only 1 out of every 5 information requests were conducted using HIE suggesting (1) that HIE is not the dominant method of information sharing in the ED and (2) that the benefits of HIE noted in the study were likely underestimated.
Although the study was limited by potential selection bias and questions regarding generalizability, it adds to a growing body of evidence that should influence policymakers that are interested in addressing inefficiencies in our healthcare system. Better, faster, and more interconnected systems for information exchange have the potential to make a difference in patient care and in the cost of care provided.
ARTICLE: Knepper MM, Castillo EM, Chan TC, Guss DA. The Effect of Access to Electronic Health Records on Throughput Efficiency and Imaging Utilization in the Emergency Department. Health Serv Res. 2017;April 4:online ahead of print.
OBJECTIVE: To evaluate whether the availability of Electronic Health Records (EHRs) reduces throughput time and utilization of advanced imaging for patients in an academic ED.
STUDY DESIGN: Retrospective noninterventional analysis of patients in an academic ED. The primary independent variable was whether the patient had a prior EHR at the study hospital. Main outcomes were throughput time, number of advanced diagnostic imaging studies (CT, MRI, ultrasound), and the associated cost of these imaging studies. A set of controls, including age, gender, ICD9 codes, acuity measures, and NYU ED algorithm case severity classifications, was used in an ordinary least-squares (OLS) regression framework to estimate the association between EHR availability and the outcome measures.
PRINCIPAL FINDINGS: A patient with a prior EHR experienced a mean reduction in CT scans of 13.9% ([4.9, 23.0]). There was no material change in throughput time for patients with a prior EHR and no difference in utilization of other imaging studies across patients with a prior EHR and those without. Cost savings associated with prior EHRs are $22.52 per patient visit.
CONCLUSION: EHR availability for ED patients is associated with a reduction in CT scans and cost savings but had no impact on throughput time or order frequency of other imaging studies.
EMRA + PolicyRx Health Policy Journal Club: A collaboration between Policy Prescriptions and EMRA
As emergency physicians, we care for all members of society, and as such have a unique vantage point on the state of health care. What we find frustrating in our EDs - such as inadequate social services, the dearth of primary care providers, and the lack of mental health services - are universal problems.
As EM residents and fellows, we learn the management of myocardial infarctions and traumas, and how to intubate, but we are not taught how health policy affects all aspects of our experience in the ED. Furthermore, given our unique position in the health care system, we have an incredible opportunity to advocate for our patients, for society, and for physicians. Yet, with so many competing interests vying for our conference education time, advocacy is often not included in the curricula.
This is the gap this initiative aims to fill. Each month, you will see a review of a new health policy article and how it is applicable to emergency physicians.