Emergency Departments Reduced Length of Stay by 7% and Odds of Readmission by 4.5% when Attending Physician used the HIE to Find Patient Records
A new groundbreaking 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 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.
Christina Galanis, President and CEO of HealthlinkNY, which operates the HIE upon which this latest research is based, 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.”
An HIE allows different provider organizations to share information back and forth electronically, including hospitals, primary care practices, specialists, diagnostic laboratories, and imaging centers. This connectivity allows providers to see a more complete picture of a patient’s comprehensive medical history. 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.
“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, Assistant Professor of Operations and Supply Chain Management at SUNY Binghamton’s School of Management. Dr. Demirezen co-authored the study with Ramkumar Janakiraman, PhD, Associate Professor of Marketing/Business Partnership Foundation Research Fellow, Darla Moore School of Business, University of South Carolina; Eunho Park, Doctoral Candidate, Marketing, Mays Business School, Texas A&M University; and Subodha Kumar, PhD, Carol and G. David Van Houten, Jr. ’71 Professor of Information and Operations Management, Mays Business School, Texas A&M University.
Dr. Demizeren said, “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.”
86,000 ER VISITS STUDIED
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. The total number of attending doctors was 326. 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.
“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,” Dr. 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.”
THREE KEY FINDINGS
The authors focused on the following three measures of healthcare delivery quality and efficiency:
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.
FURTHER EFFICIENCIES ARE LIKELY
Dr. 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.
Ms. Galanis pointed out that HIE use will produce further efficiencies and greater value to patients, providers, and payers as providers continue to embrace its use and contribute their data to the exchange. “This study clearly states that the benefits of using the HIE are greater when it contains a robust amount of patient data and when the physician has had experience using the HIE,” she said. “The best is yet to come.”
“Study on the Effects of Health Information Exchange Access on Healthcare Quality and Efficiency: An Empirical Investigation” has been peer-reviewed and is now available online on SSRN.com. (https://ssrn.com/abstract=2915190)