Observational study and estimate of cost savings from use of a health information exchange in an academic emergency department.
BACKGROUND
Federal initiatives to improve health care information sharing have led to the development of a new type of regional electronic medical record known as a health information exchange (HIE).


OBJECTIVE
Our aim was to investigate the ability of an HIE to decrease health services use for emergency department (ED) patients.


METHODS
We performed an observational, prospective study using a voluntary, anonymous survey among clinicians at an urban academic ED. All ED clinicians were eligible to participate. Survey items addressed clinician perception of whether information from the HIE avoided the use of hospital resources, improved quality of care, and reduced length of stay (LOS). Cost savings were estimated by multiplying the number of services the clinicians completing our survey reported they avoided through use of the HIE by the costs of those services at our facility. The study was approved by the Institutional Review Board at the study site.


RESULTS
The study was conducted between August and December of 2011. There were 18,529 patient encounters during the study period and 60 clinicians at the study site who were eligible to participate. The clinicians consulted the HIE for 5.39% of these encounters (998 patients). Surveys were completed by the clinicians caring for 13.8% (n = 138) of these patients. Of the completed surveys, 76% (105 surveys) referenced patients for whom the HIE was found to contain information on the patient under care by the clinician participant. These 105 patients formed the sample on which our analysis was based. Within this sample of patients, the following studies were reported to have been avoided by the clinicians participating in our survey: values are percent of patients for whom a study was reported to have been avoided (actual number of studies avoided): laboratory/microbiology: 30.5% (32 studies); radiologic studies: 47.6% (50 studies); consultations: 19% (20 consultations); and admissions: 11.4% (12 admissions). Calculated cost savings based on these estimates were as follows: laboratory/microbiology: $462.85; radiologic studies: $160,893.00; consultations: $3,990.00; and admissions: $118,131.84. Total savings: $283,477. Clinicians participating in the study reported improved quality of care for 86.7% of their patients, as well as a mean time savings of 120.8 minutes.


CONCLUSIONS
According to clinician estimates, use of an HIE in this urban academic ED resulted in reduced use of hospital resources, noteworthy cost savings, decreased LOS, and improved quality of care. Limitations included the observational nature of the study, selection bias, the Hawthorne effect, and cost estimates being from a single institution. Allowance was not made for additional services used because of information obtained from the HIE.
Division of Emergency Medicine, Department of Medicine.
Christine Marie
CM
Carr
Division of Emergency Medicine, Department of Medicine.
Charles Samuel
CS
Gilman
Division of Emergency Medicine, Department of Medicine.
Diann Marie
DM
Krywko
Division of Emergency Medicine, Department of Medicine.
Haley Elizabeth
HE
Moore
Office of the Chief Information Officer, Medical University of South Carolina, Charleston, South Carolina.
Brenda J
BJ
Walker
Division of Emergency Medicine, Department of Medicine.
Steven Howard
SH
Saef
D000328:Adult; D001291:Attitude of Health Personnel; D057286:Electronic Health Records / Q000191:economics*; D004636:Emergency Service, Hospital / Q000191:economics* / Q000458:organization & administration; D017048:Health Care Costs; D063005:Health Information Systems / Q000191:economics*; D017721:Hospital Costs; D006784:Hospitals, Teaching / Q000191:economics; D006801:Humans; D007902:Length of Stay; D010865:Pilot Projects; D011446:Prospective Studies; D011787:Quality of Health Care; D011795:Surveys and Questionnaires
HIE; HITECH; administration; cost analysis; health information technology