title: Efficiency and economic benefits of a payer-based electronic health record in an emergency department.
abstract: OBJECTIVE
  The objective was to evaluate the use of a payer-based electronic health record (P-EHR), which is a clinical summary of a patient's medical and pharmacy claims history, in an emergency department (ED) on length of stay (LOS) and plan payments.
  
  
  METHODS
  A large urban ED partnered with the dominant health plan in the region and implemented P-EHR technology in September 2005 for widespread use for health plan members presenting to the ED. A retrospective observational study design was used to evaluate this previously implemented P-EHR. Health plan and electronic hospital data were used to identify 2,288 ED encounters. Encounters with P-EHR use (n = 779) were identified between September 1, 2005, and February 17, 2006; encounters from the same health plan (n = 1,509) between November 1, 2004, and March 31, 2005, were compared. Outcomes were ED LOS and plan payment for the ED encounter. Analyses evaluated the effect of using the P-EHR in the ED setting on study outcomes using multivariate regressions and the nonparametric bootstrap.
  
  
  RESULTS
  After covariate adjustment, among visits resulting in discharge (ED-only), P-EHR visits were 19 minutes shorter (95% confidence interval [CI] = 5 to 33 minutes) than non-P-EHR visits. Among visits resulting in hospitalization, the P-EHR was associated with an average 77-minute shorter ED LOS (95% CI = 28 to 126 minutes), compared to non-P-EHR visits. The P-EHR was associated with an average of $1,560 (95% CI = $43 to $2,910) lower total plan expenditures for hospitalized visits. No significant difference in total payments was observed among discharged visits.
  
  
  CONCLUSIONS
  In the study ED, the P-EHR was associated with a significant reduction in ED LOS overall and was associated with lower plan payments for visits that resulted in hospitalization.
authors.affiliation: HealthCore, Inc., Wilmington, DE, USA. gdaniel@healthcore.com
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Daniel
authors.forename: Edward
authors.initials: E
authors.lastname: Ewen
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Willey
authors.forename: Charles L
authors.initials: CL
authors.lastname: Reese Iv
authors.forename: Farshad
authors.initials: F
authors.lastname: Shirazi
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Malone
mesh_terms: D000328:Adult; D017281:Cost of Illness; D003691:Delaware; D017598:Efficiency, Organizational / Q000191:economics*; D057286:Electronic Health Records / Q000191:economics / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000191:economics* / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D007348:Insurance, Health / Q000191:economics; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult