Using electronic health record systems to optimize admission decisions: The Creatinine case study

Abstract

Many medical organizations have implemented electronic health record (EHR) and health information exchange (HIE) networks to improve medical decision-making. This study evaluated the contribution of EHR and HIE networks to physicians by investigating whether health information technology can lead to more efficient admission decisions by reducing redundant admissions in the stressful environment of emergency. Log-files were retrieved from an integrative and interoperable EHR that serves seven main Israeli hospitals. The analysis was restricted to a group of patients seen in the emergency departments who were administered a Creatinine test. The assessment of the contribution of EHR to admission decisions used various statistical analyses and track log-file analysis. We showed that using the EHR contributes to more efficient admission decisions and reduces the number of avoidable admissions. In particular, there was a reduction in readmissions when patient history was viewed. Using EHR can help respond to the international problem of avoidable hospital readmissions.

The implications and impact of 3 approaches to health information exchange: community, enterprise, and vendor‐mediated health information exchange

“…A few studies using qualitative data or small‐group surveys focus on the usability of physician portals and other forms of interorganizational enterprise HIE. Most of what is known about the impact of enterprise HIE comes from studying a few specific hospitals or systems, most notably the Clarit health maintenance organization in Israel …”

“…Studies of Clarit's within‐system HIE showed that information generated outside of the site where the patient was being seen was viewed 4.3% of the time for the entire referral population, and 7% of the time among patients who received a specific lab test . A study in Sweden found that a hospital‐based HIE there was used 7% of the time .…”

“…Many of the assessments of enterprise HIE come from international studies. Four studies on Clarit's HIE demonstrated that using HIE was associated with positive outcomes . One randomized control study in the Netherlands showed that use of an HIE was associated with improved diabetes care .…”

“…Studies of Clarit's within-system HIE showed that information generated outside of the site where the patient was being seen was viewed 4.3% of the time for the entire referral population, and 7% of the time among patients who received a specific lab test. [59][60][61] A study in Sweden found that a hospital-based HIE there was used 7% of the time. 63 Finally, a study in the US examining use of a physician portal focused on 3 separate 6-month time periods and found that only 29% of physicians used the portal in all 3 periods.…”

“…Four studies on Clarit's HIE demonstrated that using HIE was associated with positive outcomes. [59][60][61]67 One randomized control study in the Netherlands showed that use of an HIE was associated with improved diabetes care. 66 US-based studies showed that an HIE link between 2 affiliated academic hospitals reduced redundant imaging and that use of a physician portal was associated with closer adherence to clinical guidelines.…”