Electronic Health Records

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NY Health Information Exchange Improves ED Quality, Efficiency

A study of four emergency departments in the HealthlinkNY health information exchange showed access to patient EHRs markedly improves patient care.

Health Information Exchange

Source: Thinkstock

By Kate Monica

- A recent study of hospital emergency departments found that health information exchange (HIE) use significantly improves operational efficiency and quality of patient care.

The study by Janakiraman et al. found physician HIE access to EHRs reduces the length of patient stay in emergency departments, the likelihood of ER readmission within 30 days, and the number of physicians needed to deliver patient care.

“Now providers have the evidence they need to make HIE use a priority for their organizations. The study proves that New York State’s visionary investment in HIEs is really paying off,” said Christina Galanis, President and CEO of HealthlinkNY, the HIE observed in the study.

HealthlinkNY is part of the state’s network of networks connected through the Statewide Health Information Network of New York (SHIN-NY), making New York the first large state in the nation to successfully implement a public network of regional HIEs.

 “The results of our study leave no doubt that HIE access improves quality of healthcare and operational efficiency,” said study co-author Emre M. Demirezen, PhD. “While common sense tells us that access to the patient’s entire medical history would benefit both the patient and the healthcare provider, my co-authors and I have confirmed that it does by conducting one of the first empirical investigations into the benefits of HIE use at the individual patient level.”

The team of reseachers observed 326 doctors during 86,000 ED visits in four emergency rooms over the course of 19 months in which all departments had access to the HealthlinkNY HIE.

 “We chose to examine emergency room visits because ER clinicians deal with a diversity of clinical conditions in a very high-pressure environment, and they need to gather as much information about a patient as quickly as possible,” Demirezen said. “If the attending physician has a question, the answer might already exist in the patient’s medical record. Looking up the record in the HIE saves a lot of time.”

Janakiraman et al. drew conclusions from the study using the following three metrics:

1. Length of Stay. The study found that HIE use reduced the average length of stay (LOS) in the hospital (including time spent both as an emergency department and inpatient patient) by 7.04%, from 22 hours and 23 minutes on average, to approximately 20 hours and 48 minutes. Using the HIE saves time because it can reduce the need for duplicate laboratory and imaging tests, procedures, diagnostic tests, and medication ordering and prescriptions. HIE use also can help physicians understand the underlying causes and complications contributing to the patient’s condition, and help clinicians deliver a more efficient treatment, according to the study.

2. Readmission Risk. The study concluded that accessing patient records through the HIE reduced the odds of readmission to any emergency department, not just the initial facility, within 30 days of discharge by 4.5%. The researchers also compared readmission rates over a 60-day period, and the number remained consistent.

3. Number of Doctors Involved in the Patient’s Visit.  HIE use reduced the odds of a patient being seen by multiple physicians by 12%. Typically, when attending physicians encounter a patient with a chronic condition beyond their area of expertise, a specialist is brought in to evaluate the patient. If, however, the attending physician can look up the patient’s history and review recent encounters with the patient’s own specialists, a specialist consultation in the ED may not be necessary.

 “The conclusion we drew is that providers should actively promote and support clinician use of the HIE and invest time and effort into training them on its use,” said Demirezen.

The regional HIE has been notably successful since its inception in connecting clinicians across the state to facilitate the secure sharing of patient health information and promote coordinated care. With patient-facing HIE functions, patient education and empowerment tools, and substantial funding to back the resources necessary to continue expanding and maintaining their services, HealthlinkNY is ahead the curve when it comes to facilitating health data exchange. 

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