35 The Impact of a Health Information Exchange on the Management of Patients in an Urban Academic Emergency Department: An Observational Study and Cost Analysis

Carr, Christine M.; Krywko, Diann M.; Moore, Haley E.; Saef, S.H.

doi:10.1016/j.annemergmed.2012.06.062

Cited by 6 publications

(4 citation statements)

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“…We previously demonstrated that access to a robust, community-wide HIE avoided redundant labs, imaging studies, consultations, and hospital admissions and improved the throughput for ED patients when information was available in the HIE. 1 , 16 In that study, the HIE was accessed for only 5.4% of encounters and information was present for 77% of patients for whom clinicians completed a survey. Those data reflected only a glimpse of the potential impact of an HIE at one academic institution.…”

Section: Discussionmentioning

confidence: 96%

“…Based on data from the pilot study, we estimated cost savings of $283,477.69 ($2699.77 per patient) and a time savings of 121 minutes per patient who had information in the HIE over the four-month study period. 1 , 16 We hypothesized that the benefits seen in our pilot study would be reproducible in all of the eleven EDs operated by the four major hospital systems in our region through similar avoidance of duplicate testing and treatment and prevention of unnecessary admissions.…”

Section: Introductionmentioning

confidence: 99%

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Impact of a Health Information Exchange on Resource Use and Medicare-Allowable Reimbursements at 11 Emergency Departments in a Midsized City

Saef

Melvin

Carr

2014

WestJEM

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IntroductionUse clinician perceptions to estimate the impact of a health information exchange (HIE) on emergency department (ED) care at four major hospital systems (HS) within a region. Use survey data provided by ED clinicians to estimate reduction in Medicare-allowable reimbursements (MARs) resulting from use of an HIE.MethodsWe conducted the study during a one-year period beginning in February 2012. Study sites included eleven EDs operated by four major HS in the region of a mid-sized Southeastern city, including one academic ED, five community hospital EDs, four free-standing EDs and 1 ED/Chest Pain Center (CPC) all of which participated in an HIE. The study design was observational, prospective using a voluntary, anonymous, online survey. Eligible participants included attending emergency physicians, residents, and mid-level providers (PA & NP). Survey items asked clinicians whether information obtained from the HIE changed resource use while caring for patients at the study sites and used branching logic to ascertain specific types of services avoided including laboratory/microbiology, radiology, consultations, and hospital admissions. Additional items asked how use of the HIE affected quality of care and length of stay. The survey was automated using a survey construction tool (REDCap Survey Software © 2010 Vanderbilt University). We calculated avoided MARs by multiplying the numbers and types of services reported to have been avoided. Average cost of an admission from the ED was based on direct cost trends for ED admissions within the region.ResultsDuring the 12-month study period we had 325,740 patient encounters and 7,525 logons to the HIE (utilization rate of 2.3%) by 231 ED clinicians practicing at the study sites. We collected 621 surveys representing 8.25% of logons of which 532 (85.7% of surveys) reported on patients who had information available in the HIE. Within this group the following services and MARs were reported to have been avoided [type of service: number of services; MARs]: Laboratory/Microbiology:187; $2,073, Radiology: 298; $475,840, Consultations: 61; $6,461, Hospital Admissions: 56; $551,282. Grand total of MARs avoided: $1,035,654; average $1,947 per patient who had information available in the HIE (Range: $1,491 – $2,395 between HS). Changes in management other than avoidance of a service were reported by 32.2% of participants. Participants stated that quality of care was improved for 89% of patients with information in the HIE. Eighty-two percent of participants reported that valuable time was saved with a mean time saved of 105 minutes.ConclusionObservational data provided by ED clinicians practicing at eleven EDs in a mid-sized Southeastern city showed an average reduction in MARs of $1,947 per patient who had information available in an HIE. The majority of reduced MARs were due to avoided radiology studies and hospital admissions. Over 80% of participants reported that quality of care was improved and valuable time was saved.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Impact of a Health Information Exchange on Resource Use and Medicare-Allowable Reimbursements at 11 Emergency Departments in a Midsized City

Saef

Melvin

Carr

2014

WestJEM

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“…7 An estimated annual savings of nearly $1 million was noted at an academic medical center (with a 40% reduction in the length of stay) when an HIE was used for 5.39% of its ED population. 20,21 Bailey et al also demonstrated reduced exposure to ionizing radiation from avoided diagnostic testing, resulting in a decreased lifetime incidence of cancer. 7 …”

Section: Discussionmentioning

confidence: 99%

When Should ED Physicians Use an HIE? Predicting Presence of Patient Data in an HIE

Carr¹,

Saef²,

Zhang³

et al. 2016

Southern Medical Journal

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Objectives Health information exchanges (HIEs) make possible the construction of databases to characterize patients as multisystem users (MSUs), those visiting emergency departments (EDs) of more than one hospital system within a region during a 1-year period. HIE data can inform an algorithm highlighting patients for whom information is more likely to be present in the HIE, leading to a higher yield HIE experience for ED clinicians and incentivizing their adoption of HIE. Our objective was to describe patient characteristics that determine which ED patients are likely to be MSUs and therefore have information in an HIE, thereby improving the efficacy of HIE use and increasing ED clinician perception of HIE benefit. Methods Data were extracted from a regional HIE involving four hospital systems (11 EDs) in the Charleston, South Carolina area. We used univariate and multivariable regression analyses to develop a predictive model for MSU status. Results Factors associated with MSUs included younger age groups, dual-payer insurance status, living in counties that are more rural, and one of at least six specific diagnoses: mental disorders; symptoms, signs, and ill-defined conditions; complications of pregnancy, childbirth, and puerperium; diseases of musculoskeletal system; injury and poisoning; and diseases of the blood and blood-forming organs. For patients with multiple ED visits during 1 year, 43.8% of MSUs had ≥4 visits, compared with 18.0% of non-MSUs (P < 0.0001). Conclusions This predictive model accurately identified patients cared for at multiple hospital systems and can be used to increase the likelihood that time spent logging on to the HIE will be a value-added effort for emergency physicians.

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“…For people to achieve a safe, effective, and efficient health care, a coordinated effort is often required among unaffiliated providers. Lack of care coordination may lead to medication errors, avoidable hospital readmissions, duplicated testing, and delays in understanding the patient condition [3][4][5][6][7][8][9][10]. Since 2009, to support improvements in care coordination, the federal government has been stimulating the adoption and use of health information exchange (HIE).…”

Section: Introductionmentioning

confidence: 99%

Uncovering Hospitalists’ Information Needs from Outside Healthcare Facilities in the Context of Health Information Exchange Using Association Rule Learning

et al. 2015

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KeywordsHealth information exchange, medical record linkage, medical decision making, patient handoff, medical informatics applications SummaryBackground: Important barriers to health information exchange (HIE) adoption are clinical workflow disruptions and troubles with the system interface. Prior research suggests that HIE interfaces providing faster access to useful information may stimulate use and reduce barriers for adoption; however, little is known about informational needs of hospitalists. Objective: To study the association between patient health problems and the type of information requested from outside healthcare providers by hospitalists of a tertiary care hospital. Methods: We searched operational data associated with fax-based exchange of patient information (previous HIE implementation) between hospitalists of an internal medicine department in a large urban tertiary care hospital in Florida, and any other affiliated and unaffiliated healthcare provider. All hospitalizations from October 2011 to March 2014 were included in the search. Strong association rules between health problems and types of information requested during each hospitalization were discovered using Apriori algorithm, which were then validated by a team of hospitalists of the same department. Results: Only 13.7% (2 089 out of 15 230) of the hospitalizations generated at least one request of patient information to other providers. The transactional data showed 20 strong association rules between specific health problems and types of information exist. Among the 20 rules, for example, abdominal pain, chest pain, and anaemia patients are highly likely to have medical records and outside imaging results requested. Other health conditions, prone to have records requested, were lower urinary tract infection and back pain patients. Conclusions:The presented list of strong co-occurrence of health problems and types of information requested by hospitalists from outside healthcare providers not only informs the implementation and design of HIE, but also helps to target future research on the impact of having access to outside information for specific patient cohorts. Our data-driven approach helps to reduce the typical biases of qualitative research. Citation: Martinez DA, Mora E, Gemmani M, ZayasCastro J. Uncovering hospitalists' information needs from outside healthcare facilities in the context of health information exchange using association rule learning. Appl Clin Inform 2015; 6: 684-697 http://dx Research Article D.A. Martinez et al.: Hospitalist information needs and HIE

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35 The Impact of a Health Information Exchange on the Management of Patients in an Urban Academic Emergency Department: An Observational Study and Cost Analysis

Cited by 6 publications

References 0 publications

Impact of a Health Information Exchange on Resource Use and Medicare-Allowable Reimbursements at 11 Emergency Departments in a Midsized City

Impact of a Health Information Exchange on Resource Use and Medicare-Allowable Reimbursements at 11 Emergency Departments in a Midsized City

When Should ED Physicians Use an HIE? Predicting Presence of Patient Data in an HIE

Uncovering Hospitalists’ Information Needs from Outside Healthcare Facilities in the Context of Health Information Exchange Using Association Rule Learning

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