Since the passage of the Affordable Care Act (ACA), there have been substantial investments in developing health information exchanges (HIEs) to electronically transfer medical records between health care providers. The goals of using exchanges are to minimize service duplication, length of stay, avoidable admissions, and associated costs. However, studies debate how effective HIEs have been on reaching these goals both within and outside of the emergency department.
This study was designed to determine the effect of HIEs on six outcomes: length of stay in the emergency department, medical charges, hospitalization rates, and use of three modes of imaging (CTs, MRIs, and X-rays). A unit clerk would fill orders for medical records by either (a) requesting records electronically from hospitals with compatible HIEs or (b) calling to request medical records be faxed, which were then scanned and uploaded.
The study analyzed the use of an HIE within the University of Michigan Health System (UMHS) emergency department. The UMHS emergency department has approximately 100,000 visits annually and has Epic’s CareEverywhere, the health information exchange system used by approximately 20% of US hospitals. Of the requests made by HIE, 72% (n=566) were completed. Eighty-four percent of fax requests (n=3,082) were completed.
Information from HIEs were returned 51.0 minutes faster (p<0.001), translating to an emergency department visit which was 26.9 minutes shorter (p=0.099). No other outcomes were affected by the use of CareEverywhere. However, the time it took retrieve patient information, regardless of method, was significant. For each hour saved, ED visits were 52.9 minutes shorter, and patients were 2.5% less likely to receive a CT, 1.6% less likely to receive an MRI, 2.4% less likely to receive a radiograph, and 2.4% less likely to be admitted (p<0.001 for all). Charges were 6.3% lower than average, resulting in savings of $1187 per visit (p<.001).
HIEs provide benefit only to the extent that they decrease time to access medical records. Thus, efforts to improve information exchange should focus on improving the speed of health record access. It should also be noted that only 18% of requests could be made using CareEverywhere and only 72% of HIE requests made were completed. Therefore, universality, interoperability, and completion of requests are other factors upon which vendors should further improve.
This Health Policy Journal Club review is a collaboration between Policy Prescriptions® and the Emergency Medicine Residents’ Association. It is written by Erica Goldstein. She is a dual degree student at NYU School of Medicine and the Wagner School of Public Service. She intends to pursue a career in emergency medicine.
Objective: To assess whether electronic health information exchange (HIE) is associated with improved emergency department (ED) care processes and utilization through more timely clinician viewing of information from outside organizations.
Materials and Methods: Our data included 2163 patients seen in the ED of a large academic medical center for whom clinicians requested and viewed outside information from February 14, 2014, to February 13, 2015. Outside information requests w.ere fulfilled via HIE (Epic’s Care Everywhere) or fax/scan to the electronic health record (EHR). We used EHR audit data to capture the time between the information request and when a clinician accessed the data. We assessed whether the relationship between method of information return and ED outcomes (length of visit, odds of imaging [computed tomography (CT), magnetic resonance imaging (MRI), radiographs] and hospitalization, and total charges) was mediated by request-to-access time, controlling for patient demographics, case mix, and acuity.
Results: In multivariate analysis, there was no direct association between return of information via HIE vs fax/scan and ED outcomes. HIE was associated with faster outside information access (58.5?minutes on average), and faster access was associated with changes in ED care. For each 1-hour reduction in access time, visit length was 52.9?minutes shorter, the likelihood of imaging was lower (by 2.5, 1.6, and 2.4 percentage points for CT, MRI, and radiographs, respectively), the likelihood of admission was 2.4 percentage points lower, and average charges were $1187 lower ( P ???.001 for all).
Conclusion: The relationship between HIE and improved care processes and reduced utilization in the ED is mediated by faster accessing of information from outside organizations.