Editor’s Note: Read Dr. Cedric Dark’s commentary on this EMRA + PolicyRx Health Policy Journal Club article.
Since the passage of the Affordable Care Act (ACA), there have been substantial investments in developing health information exchanges (HIEs) to electronically transfer medical records between health care providers. The goals of using exchanges are to minimize service duplication, length of stay, avoidable admissions, and associated costs. However, studies debate how effective HIEs have been on reaching these goals both within and outside of the emergency department.
A recent study was designed to determine the effect of HIEs on six outcomes: length of stay in the emergency department, medical charges, hospitalization rates, and use of three modes of imaging (CTs, MRIs, and X-rays).1 A unit clerk would fill orders for medical records by either requesting records electronically from hospitals with compatible HIEs or calling to request medical records be faxed, which were then scanned and uploaded.
The study analyzed the use of an HIE within the University of Michigan Health System (UMHS) emergency departments. The UMHS emergency departments have approximately 100,000 visits annually and have Epic’s Care Everywhere, the HIE system used by approximately 20 percent of US hospitals. Of the requests made by HIE, 72 percent (n=566) were completed. Eighty-four percent of fax requests (n=3,082) were completed.
Information from HIEs was returned 51.0 minutes faster (P<0.001), translating to an emergency department visit that was 26.9 minutes shorter (P=0.099). No other outcomes were affected by the use of Care Everywhere. However, the time it took retrieve patient information, regardless of method, was significant. For each hour saved, emergency department visits were 52.9 minutes shorter and patients were 2.5 percent less likely to receive a CT, 1.6 percent less likely to receive an MRI, 2.4 percent less likely to receive a radiograph, and 2.4 percent less likely to be admitted (P<0.001 for all). Charges were 6.3 percent lower than average, resulting in savings of $1,187 per visit (P<.001).
HIEs provide benefit only to the extent that they decrease time to access medical records. Thus, efforts to improve information exchange should focus on improving the speed of health record access. It should also be noted that only 18 percent of requests could be made using Care Everywhere and only 72 percent of HIE requests made were completed. Therefore, universality, interoperability, and completion of requests are other factors upon which vendors should improve.
Ms. Goldstein is a dual-degree student at NYU School of Medicine and the Wagner Graduate School of Public Service in New York City.
- Everson J, Kocher KE, Adler-Milstein J. Health information exchange associated with improved emergency department care through faster accessing of patient information from outside organizations. J Am Med Inform Assoc. 2017;24(e1):e103-110.