title: Association between use of a health information exchange system and hospital admissions.
abstract: OBJECTIVE
  Relevant patient information is frequently difficult to obtain in emergency department (ED) visits. Improved provider access to previously inaccessible patient information may improve the quality of care and reduce hospital admissions. Health information exchange (HIE) systems enable access to longitudinal, community-wide patient information at the point of care. However, the ability of HIE to avert admissions is not well demonstrated. We sought to determine if HIE system usage is correlated with a reduction in admissions via the ED.
  
  
  METHODS
  We identified 15,645 adults from New York State with an ED visit during a 6-month period, all of whom consented to have their information accessible in the HIE system, and were continuously enrolled in two area health plans. Using claims we determined if the ED encounter resulted in an admission. We used the HIE's system log files to determine usage during the encounter. We determined the association between HIE system use and the likelihood of admission to the hospital from the ED and potential cost savings.
  
  
  RESULTS
  The HIE system was accessed during 2.4% of encounters. The odds of an admission were 30% lower when the system was accessed after controlling for confounding (odds ratio = 0.70; 95%C I= 0.52, 0.95). The annual savings in the sample was $357,000.
  
  
  CONCLUSIONS
  These findings suggest that the use of an HIE system may reduce hospitalizations from the ED with resultant cost savings. This is an important outcome given the substantial financial investment in interventions designed to improve provider access to patient information in the US.
authors.forename: J R
authors.initials: JR
authors.lastname: Vest
authors.forename: L M
authors.initials: LM
authors.lastname: Kern
authors.forename: T R
authors.initials: TR
authors.lastname: Campion
authors.forename: M D
authors.initials: MD
authors.lastname: Silver
authors.forename: R
authors.initials: R
authors.lastname: Kaushal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D066275:Health Information Exchange / Q000706:statistics & numerical data*; D063005:Health Information Systems / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D055815:Young Adult
keywords: Health information exchange; admission; computerized patient records; emergency department; information systems
references.citation: CMAJ. 2003 Nov 11;169(10):1023-8
references.pmid: 14609971
references.citation: J Am Med Inform Assoc. 2011 Mar-Apr;18(2):143-9
references.pmid: 21262919
references.citation: J Med Syst. 2012 Oct;36(5):3195-204
references.pmid: 22127521
references.citation: J Med Syst. 2009 Jun;33(3):223-31
references.pmid: 19408456
references.citation: J Gen Intern Med. 2013 Feb;28(2):176-83
references.pmid: 22648609
references.citation: J Am Med Inform Assoc. 2011 Sep-Oct;18(5):690-7
references.pmid: 21846788
references.citation: Am J Med. 2008 May;121(5):433-443.e4
references.pmid: 18456040
references.citation: J Med Syst. 2012 Aug;36(4):2455-61
references.pmid: 21523428
references.citation: Int J Med Inform. 2013 Sep;82(9):810-20
references.pmid: 23743323
references.citation: J Am Med Inform Assoc. 2013 Nov-Dec;20(6):1137-42
references.pmid: 23698257
references.citation: Ann Emerg Med. 2006 Oct;48(4):426-32
references.pmid: 16997679
references.citation: Int J Med Inform. 2011 Nov;80(11):775-81
references.pmid: 21956001
references.citation: Cochrane Database Syst Rev. 2010 Aug 04;(8):CD007228
references.pmid: 20687083
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: Health Aff (Millwood). 2009 Mar-Apr;28(2):493-504
references.pmid: 19276009
references.citation: Fed Regist. 2010 Jul 28;75(144):44313-588
references.pmid: 20677415
references.citation: AMIA Annu Symp Proc. 2011;2011:644-53
references.pmid: 22195120
references.citation: AMIA Annu Symp Proc. 2003;:235-8
references.pmid: 14728169
references.citation: J Biomed Inform. 2007 Dec;40(6 Suppl):S17-20
references.pmid: 17945542
references.citation: BMC Med Inform Decis Mak. 2011 Dec 30;11:78
references.pmid: 22208182
references.citation: Qual Saf Health Care. 2006 Feb;15(1):23-31
references.pmid: 16456206
references.citation: Health Aff (Millwood). 2012 Mar;31(3):488-96
references.pmid: 22392659
references.citation: Int J Med Inform. 2011 Dec;80(12):849-62
references.pmid: 22000677
references.citation: BMC Med Inform Decis Mak. 2013 Apr 17;13:49
references.pmid: 23594488
references.citation: Ann Emerg Med. 2013 Jul;62(1):16-24
references.pmid: 23465552
references.citation: J Am Med Inform Assoc. 2007 Mar-Apr;14(2):235-8
references.pmid: 17213496
references.citation: J Biomed Inform. 2007 Dec;40(6 Suppl):S3-10
references.pmid: 17919986
references.citation: Med Care. 2006 Aug;44(8):745-53
references.pmid: 16862036
references.citation: J Biomed Inform. 2007 Dec;40(6 Suppl):S27-32
references.pmid: 17942374
references.citation: CMAJ. 2006 Jan 31;174(3):313-8
references.pmid: 16399880
references.citation: J Am Med Inform Assoc. 2012 May-Jun;19(3):328-33
references.pmid: 22058169
references.citation: Appl Clin Inform. 2011 Nov 30;2(4):499-507
references.pmid: 23616891