The impact of EHR and HIE on reducing avoidable admissions: controlling main differential diagnoses

Abstract

BackgroundMany medical organizations have invested heavily in electronic health record (EHR) and health information exchange (HIE) information systems (IS) to improve medical decision-making and increase efficiency. Despite the potential interoperability advantages of such IS, physicians do not always immediately consult electronic health information, and this decision may result in decreased level of quality of care as well as unnecessary costs. This study sought to reveal the effect of EHR IS use on the physicians' admission decisions. It was hypothesizing the using EHR IS will result in more accurate and informed admission decisions, which will manifest through reduction in single-day admissions and in readmissions within seven days.MethodsThis study used a track log-file analysis of a database containing 281,750 emergency department (ED) referrals in seven main hospitals in Israel. Log-files were generated by the system and provide an objective and unbiased measure of system usage, Thus allowing us to evaluate the contribution of an EHR IS, as well as an HIE network, to decision-makers (physicians). This is done by investigating whether EHR IS lead to improved medical outcomes in the EDs, which are known for their tight time constraints and overcrowding. The impact of EHR IS and HIE network was evaluated by comparing decisions on patients classified by five main differential diagnoses (DDs), made with or without viewing the patients' medical history via the EHR IS.ResultsThe results indicate a negative relationship between viewing medical history via EHR systems and the number of possibly redundant admissions. Among the DDs, we found information viewed most impactful for gastroenteritis, abdominal pain, and urinary tract infection in reducing readmissions within seven days, and for gastroenteritis, abdominal pain, and chest pain in reducing the single-day admissions' rate. Both indices are key quality measures in the health system. In addition, we found that interoperability (using external information provided online by health suppliers) contributed more to this reduction than local files, which are available only in the specific hospital. Thus, reducing the rate of redundant admissions by using external information produced larger odds ratios (of the β coefficients; e.g. viewing external information on patients resulted in negative associations of 27.2% regarding readmissions within seven days, and 13% for single-day admissions as compared with viewing local information on patients respectively).ConclusionsViewing medical history via an EHR IS and using HIE network led to a reduction in the number of seven day readmissions and single-day admissions for all patients. Using external medical history may imply a more thorough patient examination that can help eliminate unnecessary admissions. Nevertheless, in most instances physicians did not view medical history at all, probably due to the limited resources available, combined with the stress of rapid turnover in ED units.

The potential for community-based health information exchange systems to reduce hospital readmissions

“…Until now, the studies that have been published about HIE interventions have not reported any association with reductions in readmissions, 15 and in fact, only a few studies have shown that hospitalizations, in general, may be reduced with HIE. [12][13][14] This study may have been able to identify an association because we examined the relationship between HIE system usage and outcomes at an individual patient level in a community with robust HIE. The level of usage that we found in our study is consistent with usage of other contemporary HIE systems.…”

“…10,11 Despite these potential benefits, reports on the effectiveness of HIE for reducing hospital admissions and readmissions have been mixed. A few studies have identified reductions in hospital admissions, [12][13][14] but several studies have found no effect. [15][16][17][18][19] However, the studies published to date have been heterogeneous, varying in settings, patient populations, types of exchange partners, and technology platforms.…”

Electronic health records, adoption, quality of care, legal and privacy issues and their implementation in emergency departments

“…Ben-Assuli et al [105] studied ED admission patterns in seven Israeli hospitals, and found that using EHR was associated with a significant reduction in single-day admissions and readmissions. To collect their data, they used log-files from the system (log-files are a documentation of events occurring in the EHR).…”

Cross-border Healthcare Access in South Asian Countries: Learnings for Sustainable Healthcare Tourism in India

“…With the rolling out of the Clinical Establishment Act 2010 and many state governments accepting it standardization would be greatly enhanced. The Health ministry's role of initiating Standard Treatment Guidelines (STGS) across 20 disease specialities is realty appreciated and would help in ensuring more predictability of outcomes(FICCI Health insurance group-A report,2009).With the access of electronic health records , monitoring and portability of diagnostic records would further help in containing cost by reducing uncalled for investigations (Assuli et al, 2013).The Insurance sector would play a major role through the Insurance Regulator and Development Authority in standardizing various healthcare operations right from patient entry, billing, agreements between payers and providers to further contain cost and increase accessible global Healthcare. (IRDA)…”