title: The impact of electronic health records on care of heart failure patients in the emergency room.
abstract: OBJECTIVE
  To evaluate if electronic health records (EHR) have observable effects on care outcomes, we examined quality and efficiency measures for patients presenting to emergency departments (ED).
  
  
  METHODS
  We conducted a retrospective study of 5166 adults with heart failure in three metropolitan EDs. Patients were termed internal if prior information was in the EHR upon ED presentation, otherwise external. Associations of internality with hospitalization, mortality, length of stay (LOS), and numbers of tests, procedures, and medications ordered in the ED were examined after adjusting for age, gender, race, marital status, comorbidities and hospitalization as a proxy for acuity level where appropriate.
  
  
  RESULTS
  At two EDs internals had lower odds of mortality if hospitalized (OR 0.55; 95% CI 0.38 to 0.81 and 0.45; 0.21 to 0.96), fewer laboratory tests during the ED visit (-4.6%; -8.9% to -0.1% and -14.0%; -19.5% to -8.1%) as well as fewer medications (-33.6%; -38.4% to -28.4% and -21.3%; -33.2% to -7.3%). At one of these two EDs, internals had lower odds of hospitalization (0.37; 0.22 to 0.60). At the third ED, internal patients only experienced a prolonged ED LOS (32.3%; 6.3% to 64.8%) but no other differences. There was no association with hospital LOS or number of procedures ordered.
  
  
  CONCLUSIONS
  EHR availability was associated with salutary outcomes in two of three ED settings and prolongation of ED LOS at a third, but evidence was mixed and causality remains to be determined.
  
  
  CONCLUSIONS
  An EHR may have the potential to be a valuable adjunct in the care of heart failure patients.
authors.affiliation: Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota 55455, USA. don@umn.edu
authors.forename: Donald P
authors.initials: DP
authors.lastname: Connelly
authors.forename: Young-Taek
authors.initials: YT
authors.lastname: Park
authors.forename: Jing
authors.initials: J
authors.lastname: Du
authors.forename: Nawanan
authors.initials: N
authors.lastname: Theera-Ampornpunt
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Gordon
authors.forename: Barry A
authors.initials: BA
authors.lastname: Bershow
authors.forename: Raymond A
authors.initials: RA
authors.lastname: Gensinger
authors.forename: Michael
authors.initials: M
authors.lastname: Shrift
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Routhe
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Speedie
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D057286:Electronic Health Records; D004630:Emergencies; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008498:Medical Record Linkage; D008910:Minnesota; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D012189:Retrospective Studies; D016019:Survival Analysis; D019564:Unnecessary Procedures / Q000706:statistics & numerical data
references.citation: CMAJ. 2003 Nov 11;169(10):1023-8
references.pmid: 14609971
references.citation: J Emerg Med. 1998 Nov-Dec;16(6):895-7
references.pmid: 9848709
references.citation: J Clin Epidemiol. 1992 Jun;45(6):613-9
references.pmid: 1607900
references.citation: J Chronic Dis. 1987;40(5):373-83
references.pmid: 3558716
references.citation: Health Aff (Millwood). 2010 Apr;29(4):647-54
references.pmid: 20368594
references.citation: Med Care. 2005 Nov;43(11):1130-9
references.pmid: 16224307
references.citation: J Am Med Inform Assoc. 2012 Jan-Feb;19(1):39-44
references.pmid: 21715429
references.citation: AMIA Annu Symp Proc. 2008 Nov 06;:333-7
references.pmid: 18999184
references.citation: Ann Emerg Med. 2002 Jan;39(1):14-23
references.pmid: 11782726
references.citation: J Am Med Inform Assoc. 2007 Nov-Dec;14(6):700-5
references.pmid: 17712079
references.citation: Acad Emerg Med. 2004 Nov;11(11):1162-9
references.pmid: 15528580
references.citation: AMIA Annu Symp Proc. 2009 Nov 14;2009:634-8
references.pmid: 20351932
references.citation: Proc AMIA Symp. 1999;:390-4
references.pmid: 10566387
references.citation: N Engl J Med. 2010 Feb 4;362(5):382-5
references.pmid: 20042745
references.citation: Health Aff (Millwood). 2010 Apr;29(4):639-46
references.pmid: 20368593
references.citation: Emerg Med Australas. 2009 Oct;21(5):373-8
references.pmid: 19840086
references.citation: Am J Med. 2010 Jan;123(1):40-6
references.pmid: 19939343
references.citation: Circulation. 2009 Apr 14;119(14):1977-2016
references.pmid: 19324967
references.citation: J Health Econ. 2001 Jul;20(4):461-94
references.pmid: 11469231
references.citation: J Clin Epidemiol. 2008 Dec;61(12):1234-1240
references.pmid: 18619805
references.citation: Circulation. 2010 Feb 23;121(7):e46-e215
references.pmid: 20019324
references.citation: Am J Med Qual. 2006 Nov-Dec;21(6):415-7
references.pmid: 17077424
references.citation: J Med Syst. 2009 Jun;33(3):223-31
references.pmid: 19408456
references.citation: Eur J Heart Fail. 2008 Oct;10(10):933-89
references.pmid: 18826876
references.citation: Int J Med Inform. 2001 Nov;64(1):39-56
references.pmid: 11673101
references.citation: Ann Emerg Med. 2006 Oct;48(4):426-32
references.pmid: 16997679
references.citation: N Engl J Med. 2009 Apr 2;360(14):1418-28
references.pmid: 19339721