title: 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.
  
  
  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).
  
  
  CONCLUSIONS
  The relationship between HIE and improved care processes and reduced utilization in the ED is mediated by faster accessing of information from outside organizations.
authors: Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor.
authors: Jordan
authors: J
authors: Everson
authors: Department of Emergency Medicine, School of Medicine, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor.
authors: Keith E
authors: KE
authors: Kocher
authors: School of Information and Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor.
authors: Julia
authors: J
authors: Adler-Milstein
mesh_terms: D000046:Academic Medical Centers; D057286:Electronic Health Records; D004636:Emergency Service, Hospital; D004638:Emergency Treatment; D066275:Health Information Exchange; D006801:Humans; D033181:Information Dissemination; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D011787:Quality of Health Care; D013997:Time Factors
keywords: emergency department; health information exchange; quality of care; timeliness of care