In the emergency department (ED), it’s well known that speed affects patient care—and that includes rapid data retrieval. Recently, a team from the University of Michigan set out to study the effectiveness of two data exchange systems and the impact of data availability.
Their results, which were published in the Journal of the American Medical Informatics Association, showed that ED providers received patient data faster through one of the country’s largest health information exchanges (HIEs) than by having data faxed or scanned to their electronic health record systems. How much faster? More than 58 minutes from request to data access.
“When we’re in the emergency department, being able to access information for patients who’ve been transferred from other hospitals … it saves redundant work,” explains Dr. Michael Dailey, Chief of the Division of Prehospital Emergency Medicine and an emergency medicine attending physician at Albany Medical Center. “We don’t have to redo the same complex tasks that have been performed at other institutions, which makes providing care much more efficient.”
For Dr. Todd Duthaler, Vice President of Saratoga Emergency Physicians and Saratoga Hospital’s Chief Medical Informatics Officer, the issue of time translates to sharper thinking. “When you can access somebody’s complete record right away, while you’re thinking about it, your thought process is more cohesive than when you have to wait 45 minutes or an hour for faxes to come in and then readdress the whole thought process. By using an HIE, we can eliminate some of the downstream interruptions that are very problematic.”
Time Has Its Benefits
That specific factor—the reduced request-to-access time provided by the HIE—turned out to be the key to several efficiencies in the ED. In fact, for every hour saved by using the HIE:
- The patient stayed in the ED 52.9 minutes less.
- Estimated charges dropped by $1,187.
- The patient was 2.4 percent less likely to be admitted to the hospital.
“Recently, I evaluated someone who had chest pain,” describes Duthaler, reflecting on the potential reduction of duplicate procedures. “They said, ‘I was at this other hospital a week ago.’ I asked, ‘What did they do?’ and they said, ‘Oh, this and that, and they sent me home.’ So I accessed their records and, sure enough, they had a cardiac catheterization done that showed normal coronary arteries. That dramatically changed the way I evaluated them for the same complaint. And it was all done instantaneously, within a very short time after their arrival.”
The possibility of reducing imaging resonates strongly with Dailey. “Every time we image somebody, it gives them a significant amount of radiation, and when we can avoid giving them radiation, we should. This especially holds true for young patients and complex patients who may get many images anyway.”
In conducting the study, researchers evaluated all requests for information (4,451) placed by the ED to outside sources over the course of a year. Through rigorous analysis, the team identified six outcome measures and tested the correlation of HIE use and request-to-access time against each one.
The Bottom Line
From a clinical perspective, when time is critical, office and organization protocols should make an HIE (like Hixny) the first place to find information. Phone, fax and scan protocols should become the second line of data access, put into play only if the necessary information isn’t available through the HIE.
From a patient satisfaction perspective, Dailey explains that going to the HIE first allows an emergency department to provide care that’s tailored to the individual. “We talk about hospital records—but they’re really patient records. Having the information exchange allows us to provide individualized care based on records that they’ve received previously, which improves efficiency throughout the system—especially for complex patients moving between facilities.”
“It makes people understand that we really do care about all their problems,” Duthaler agrees. “When I can walk into a room and say, ‘I’ve already seen your records from when you were at X hospital last week,’ they kind of look at that and say, ‘Wow, he really took the time to research this. He’s not going to just listen to my story today and make a quick decision.’ So I think it shows the public that you’re a more engaged practitioner.”