A study of hospital emergency departments has found that hospitals can significantly improve both the quality of care and operational efficiency when their physicians access a patient’s medical records in the health information exchange (HIE).
Specifically, the study—based on the HIE operated by HealthlinkNY—showed that HIE use reduced the patient’s length of stay in the ER and in-patient stay; the likelihood that the patient would be readmitted to an ER within 30 days; and the number of physicians who needed to examine the patient.
The study, “The Effects of Health Information Exchange Access on Healthcare Quality and Efficiency: An Empirical Investigation,” looked at nearly 86,000 emergency department encounters at four emergency rooms. The study investigated 46,270 patient visits over a period of 19 months, from July 1, 2012 to January 31, 2014, with a total of 326 attending doctors. All four emergency departments had the ability to access the HealthlinkNY HIE, which HealthlinkNY operates under contract by the New York State Department of Health.
HealthlinkNY is a Qualified Entity (QE), funded by the New York State Department of Health (NYS DOH), which operates the HIE connecting providers and patients in 13 counties in the Hudson Valley and Southern Tier of New York. New York State is the first large state in the country to build a public network of regional HIEs. The HIEs are linked together through SHIN-NY, the Statewide Health Information Network of New York, thus allowing providers across the state to exchange patient data.
Drilling down, the study’s authors, from Texas A&M University, University of South Carolina, and SUNY at Binghamton, focused on the following three measures of healthcare delivery quality and efficiency:
- 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 percent, from 22 hours and 23 minutes on average, to approximately 20 hours and 48 minutes.
- 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 percent. The researchers also compared readmission rates over a 60-day period, and the number remained consistent.
- Number of doctors involved in the patient’s visit. HIE use reduced the odds of a patient being seen by multiple physicians by 12 percent. 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.
Christina Galanis, president and CEO of HealthlinkNY, called the study a “shot heard ‘round the world.” Galanis stressed the importance of the results. “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.”
Emre M. Demirezen, Ph.D., study co-author and assistant professor of operations and supply chain management at SUNY Binghamton’s School of Management, added, “The results of our study leave no doubt that HIE access improves quality of healthcare and operational efficiency. 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.”
Demirezen added, “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. 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.”
What’s more, Demirezen noted that physicians who use the HIE regularly, and are therefore more comfortable in using it, exhibited better outcomes than novice users. “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,” he said.
