The Impact of a Health Information Exchange on Resource Use and Medicare-Allowable Charges at Eleven Emergency Departments Operated by Four Major Hospital Systems in a Midsized Southeastern City: An Observational Study Using Clinician Estimates

Saef, S.H.; Bourne, Christina L.; Bush, Jeffrey S.; Scott, L; Gaafary, H.C.; Keenan, Kaitlin; Walters, J; Kriza, Karen; Walker, B.J.; Carr, Christine M.

doi:10.1016/j.annemergmed.2013.07.090

Cited by 3 publications

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“…This study is among the first to demonstrate that clinicians associate MHR use with diagnostic accuracy benefits and efficiency gains (through the reduced utilisation of tests and time savings, particularly where a patient’s condition is considered complex). This finding is consistent with research conducted outside of Australia involving regional centralised [ 13 ] and decentralised [ 42 ] EHR networks in the United States. The potential benefits demonstrated in this study, and in previous research, strengthen the need for MHR uptake and use in the ED setting.…”

Section: Discussionsupporting

confidence: 89%

Physicians’ and pharmacists’ use of My Health Record in the emergency department: results from a mixed-methods study

Mullins

Morris

Bailey

et al. 2021

Health Inf Sci Syst

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Purpose This study aimed to explore pharmacists’ and physicians’ perceptions of use, barriers to use and the healthcare outcomes associated with use of Australia’s national personally controlled electronic health record—known as My Health Record—in the emergency department. Methods A mixed methods approach was deployed, including surveys and individual semi-structured interviews. All physicians and pharmacists who work in the emergency department at Cabrini Health (a non-for-profit healthcare provider in Victoria, Australia) were invited to participate. Due to the timing of elective blocks, physician trainees were excluded from interviews. Results A total of 40 emergency medicine clinicians responded to the survey. Over 50% (n = 22) of all respondents had used My Health Record in the emergency department at least once. A total of 18 clinicians participated in the semi-structured interviews, which led to the identification of three themes with multiple sub-themes regarding My Health Record: (1) benefits; (2) effectiveness; and; (3) barriers. Conclusion Participants reported My Health Record use in the emergency department delivers efficiencies for clinicians and has a heightened utility for complex patients, consistent with previous research conducted outside of the Australian setting. Barriers to use were revealed: outdated content, a lack of trust, a low perception of value, no patient record and multiple medical record systems. The participants in this study highlighted that training and awareness raising is needed in order to improve My Health Record use in the emergency department, a need stressed by physician’s. Further observational research is required to explores meaningful MHR use at scale.

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Section: Discussionsupporting

confidence: 89%

Physicians’ and pharmacists’ use of My Health Record in the emergency department: results from a mixed-methods study

Mullins

Morris

Bailey

et al. 2021

Health Inf Sci Syst

View full text Add to dashboard Cite

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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%

“…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. 9 These authors also showed a significant reduction in number of admissions and computed tomographic scans across 12 EDs when an HIE was accessed.…”

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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“…Evaluations of HIE and the benefits and challenges of exchanging health information have been studied in various contexts. For example, a 2011 study suggested that US $2 million in uncompensated care cost recovery is achievable with use of the nationwide HIE (now eHealth Exchange) as applied to disability determination [ 43 ]; and a more recent study estimated the resource utilization impacts resulting from using eHealth Exchange for emergency department visits [ 44 ]. Yet, few studies exist regarding the value of HIE at a statewide level.…”

Section: Introductionmentioning

confidence: 99%

Health Information Exchange Implementation: Lessons Learned and Critical Success Factors From a Case Study

Feldman¹,

Schooley²,

Bhavsar³

2014

JMIR Med Inform

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BackgroundMuch attention has been given to the proposition that the exchange of health information as an act, and health information exchange (HIE), as an entity, are critical components of a framework for health care change, yet little has been studied to understand the value proposition of implementing HIE with a statewide HIE. Such an organization facilitates the exchange of health information across disparate systems, thus following patients as they move across different care settings and encounters, whether or not they share an organizational affiliation. A sociotechnical systems approach and an interorganizational systems framework were used to examine implementation of a health system electronic medical record (EMR) system onto a statewide HIE, under a cooperative agreement with the Office of the National Coordinator for Health Information Technology, and its collaborating organizations.ObjectiveThe objective of the study was to focus on the implementation of a health system onto a statewide HIE; provide insight into the technical, organizational, and governance aspects of a large private health system and the Virginia statewide HIE (organizations with the shared goal of exchanging health information); and to understand the organizational motivations and value propositions apparent during HIE implementation.MethodsWe used a formative evaluation methodology to investigate the first implementation of a health system onto the statewide HIE. Qualitative methods (direct observation, 36 hours), informal information gathering, semistructured interviews (N=12), and document analysis were used to gather data between August 12, 2012 and June 24, 2013. Derived from sociotechnical concepts, a Blended Value Collaboration Enactment Framework guided the data gathering and analysis to understand organizational stakeholders’ perspectives across technical, organizational, and governance dimensions.ResultsSeveral challenges, successes, and lessons learned during the implementation of a health system to the statewide HIE were found. The most significant perceived success was accomplishing the implementation, although many interviewees also underscored the value of a project champion with decision-making power. In terms of lessons learned, social reasons were found to be very significant motivators for early implementation, frequently outweighing economic motivations. It was clear that understanding the guides early in the project would have mitigated some of the challenges that emerged, and early communication with the electronic health record vendor so that they have a solid understanding of the undertaking was critical. An HIE implementations evaluation framework was found to be useful for assessing challenges, motivations, value propositions for participating, and success factors to consider for future implementations.ConclusionsThis case study illuminates five critical success factors for implementation of a health system onto a statewide HIE. This study also reveals that organizations have varied motivations and value pr...

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The Impact of a Health Information Exchange on Resource Use and Medicare-Allowable Charges at Eleven Emergency Departments Operated by Four Major Hospital Systems in a Midsized Southeastern City: An Observational Study Using Clinician Estimates

Cited by 3 publications

References 0 publications

Physicians’ and pharmacists’ use of My Health Record in the emergency department: results from a mixed-methods study

Physicians’ and pharmacists’ use of My Health Record in the emergency department: results from a mixed-methods study

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

Health Information Exchange Implementation: Lessons Learned and Critical Success Factors From a Case Study

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