Observational Study and Estimate of Cost Savings from Use of a Health Information Exchange in an Academic Emergency Department

Carr, Christine M.; Gilman, Charles Samuel; Krywko, Diann M.; Moore, Haley E.; Walker, B.J.; Saef, S.H.

doi:10.1016/j.jemermed.2013.05.068

Cited by 28 publications

(29 citation statements)

References 10 publications

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“…Use of an HIE can prevent duplicate testing, which consumes time and resources, is costly, and has a significant impact on patient well-being. 19–21 A survey of clinicians using an HIE in 11 EDs (4 disparate hospital systems) in a mid-sized southeastern US city demonstrated a potential reduction of Medicare-allowable reimbursements of more than $1 million ($2700 per patient who had information in the HIE). 19–22 Frisse et al calculated that an annual savings of $1.07 million would be realized if all regional hospitals in a single city participated in and used their HIE.…”

Section: Discussionmentioning

confidence: 99%

“…7 An estimated annual savings of nearly $1 million was noted at an academic medical center (with a 40% reduction in the length of stay) when an HIE was used for 5.39% of its ED population. 20,21 Bailey et al also demonstrated reduced exposure to ionizing radiation from avoided diagnostic testing, resulting in a decreased lifetime incidence of cancer. 7 …”

Section: Discussionmentioning

confidence: 99%

“…25 Literature describing the potential for HIE to avoid duplication of diagnostic tests, avoid unneeded hospital admissions, reduce costs, and improve quality and efficiency is emerging quickly. 21,22,25 The power of HIE to assist with the coordination and delivery of acute and postacute care is being explored, along with approaches to efficiently expand HIE for other uses.…”

Section: Discussionmentioning

confidence: 99%

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When Should ED Physicians Use an HIE? Predicting Presence of Patient Data in an HIE

Carr¹,

Saef²,

Zhang³

et al. 2016

Southern Medical Journal

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Objectives Health information exchanges (HIEs) make possible the construction of databases to characterize patients as multisystem users (MSUs), those visiting emergency departments (EDs) of more than one hospital system within a region during a 1-year period. HIE data can inform an algorithm highlighting patients for whom information is more likely to be present in the HIE, leading to a higher yield HIE experience for ED clinicians and incentivizing their adoption of HIE. Our objective was to describe patient characteristics that determine which ED patients are likely to be MSUs and therefore have information in an HIE, thereby improving the efficacy of HIE use and increasing ED clinician perception of HIE benefit. Methods Data were extracted from a regional HIE involving four hospital systems (11 EDs) in the Charleston, South Carolina area. We used univariate and multivariable regression analyses to develop a predictive model for MSU status. Results Factors associated with MSUs included younger age groups, dual-payer insurance status, living in counties that are more rural, and one of at least six specific diagnoses: mental disorders; symptoms, signs, and ill-defined conditions; complications of pregnancy, childbirth, and puerperium; diseases of musculoskeletal system; injury and poisoning; and diseases of the blood and blood-forming organs. For patients with multiple ED visits during 1 year, 43.8% of MSUs had ≥4 visits, compared with 18.0% of non-MSUs (P < 0.0001). Conclusions This predictive model accurately identified patients cared for at multiple hospital systems and can be used to increase the likelihood that time spent logging on to the HIE will be a value-added effort for emergency physicians.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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When Should ED Physicians Use an HIE? Predicting Presence of Patient Data in an HIE

Carr¹,

Saef²,

Zhang³

et al. 2016

Southern Medical Journal

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“…Survey items 5, 12, 13, 15 through 17, 20, 21, and 23 assessed respondent agreement with CeHA functionality as described in prior publications. 1,7,9,12,13 For example, a stated system need was that available information from participating healthcare systems should be present in CeHA. The corresponding survey item was “Information about my patient was present most of the time when I queried CeHA.” Other functionality attributes included whether CeHA was perceived as easy to use, whether the user was able to quickly find what he or she was looking for, and whether available CeHA data improved the quality of care provided.…”

Section: Methodsmentioning

confidence: 99%

“…7–9 Despite demonstrated benefits, ED clinician HIE use remains unexpectedly low, at 2% to 26% of ED encounters. 10,11 Factors other than technology have been important to HIE adoption; hospitals in areas with high levels of competition for patients were less likely to implement an HIE, whereas public hospitals, nonprofit hospitals, and network members were more likely to adopt an HIE.…”

mentioning

confidence: 99%

Health Information Exchange in the ED: What Do ED Clinicians Think?

Melvin¹,

Saef²,

Pierce³

et al. 2016

Southern Medical Journal

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Objectives Our regional health information exchange (HIE), known as Carolina eHealth Alliance (CeHA)-HIE, serves all major hospital systems in our region and is accessible to emergency department (ED) clinicians in those systems. We wanted to understand reasons for low CeHA-HIE utilization and explore options for improving it. Methods We implemented a 24-item user survey among ED clinician users of CeHA-HIE to investigate their perceptions of system usability and functionality, the quality of the information available through CeHA-HIE, the value of clinician time spent using CeHA-HIE, the ease of use of CeHA-HIE, and approaches for improving CeHA-HIE. Results Of the 231 ED clinicians surveyed, 51 responded, and among those, 48 reported having used CeHA-HIE and completed the survey. Conclusions Results show most ED clinicians believed that CeHA-HIE was easy to use and added value to their work, but they also desired better integration of information available from CeHA-HIE into their system’s electronic medical record.

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