Health information exchange associated with improved emergency department care through faster accessing of patient information from outside organizations

Abstract

Objective: To assess whether electronic health information exchange (HIE) is associated with improved emergency department (ED) care processes and utilization through more timely clinician viewing of information from outside organizations.

Materials and methods: Our data included 2163 patients seen in the ED of a large academic medical center for whom clinicians requested and viewed outside information from February 14, 2014, to February 13, 2015. Outside information requests w.ere fulfilled via HIE (Epic's Care Everywhere) or fax/scan to the electronic health record (EHR). We used EHR audit data to capture the time between the information request and when a clinician accessed the data. We assessed whether the relationship between method of information return and ED outcomes (length of visit, odds of imaging [computed tomography (CT), magnetic resonance imaging (MRI), radiographs] and hospitalization, and total charges) was mediated by request-to-access time, controlling for patient demographics, case mix, and acuity.

Results: In multivariate analysis, there was no direct association between return of information via HIE vs fax/scan and ED outcomes. HIE was associated with faster outside information access (58.5 minutes on average), and faster access was associated with changes in ED care. For each 1-hour reduction in access time, visit length was 52.9 minutes shorter, the likelihood of imaging was lower (by 2.5, 1.6, and 2.4 percentage points for CT, MRI, and radiographs, respectively), the likelihood of admission was 2.4 percentage points lower, and average charges were $1187 lower ( P ≤ .001 for all).

Conclusion: The relationship between HIE and improved care processes and reduced utilization in the ED is mediated by faster accessing of information from outside organizations.

Keywords: emergency department; health information exchange; quality of care; timeliness of care.

Figure 1.

Conceptual model: time between outside information request and access as a mediator between HIE and ED outcomes.

Figure 2.

Amount of outside information requested, returned and viewed by HIE method.

Figure 3.

Distribution of time (in minutes) from physician outside information request to access: information returned via HIE (Epic Care Everywhere) vs fax/scan.