title: The Effect of Access to Electronic Health Records on Throughput Efficiency and Imaging Utilization in the Emergency Department.
abstract: To evaluate whether the availability of Electronic Health Records (EHRs) reduces throughput time and utilization of advanced imaging for patients in an academic ED.
  
  
  
  All patients arriving at an academic Emergency Department (ED) via ambulance between June 1, 2011, and June 4, 2012, were included in the study. This accounted for 9,970 unique ambulance patient visits.
  
  
  
  Retrospective noninterventional analysis of patients in an academic ED. The primary independent variable was whether the patient had a prior EHR at the study hospital. Main outcomes were throughput time, number of advanced diagnostic imaging studies (CT, MRI, ultrasound), and the associated cost of these imaging studies. A set of controls, including age, gender, ICD9 codes, acuity measures, and NYU ED algorithm case severity classifications, was used in an ordinary least-squares (OLS) regression framework to estimate the association between EHR availability and the outcome measures.
  
  
  
  A patient with a prior EHR experienced a mean reduction in CT scans of 13.9 percent ([4.9, 23.0]). There was no material change in throughput time for patients with a prior EHR and no difference in utilization of other imaging studies across patients with a prior EHR and those without. Cost savings associated with prior EHRs are $22.52 per patient visit.
  
  
  
  EHR availability for ED patients is associated with a reduction in CT scans and cost savings but had no impact on throughput time or order frequency of other imaging studies.
authors.affiliation: Bureau of Economic Analysis, Office of the Chief Economist, Suitland, MD.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Knepper
authors.affiliation: Department of Emergency Medicine, University of California, San Diego, La Jolla, CA.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Castillo
authors.affiliation: Department of Emergency Medicine, University of California, San Diego, La Jolla, CA.
authors.forename: Theodore C
authors.initials: TC
authors.lastname: Chan
authors.affiliation: Department of Emergency Medicine, University of California, San Diego, La Jolla, CA.
authors.forename: David A
authors.initials: DA
authors.lastname: Guss
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000706:statistics & numerical data; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003952:Diagnostic Imaging / Q000191:economics / Q000706:statistics & numerical data*; D017598:Efficiency, Organizational / Q000191:economics / Q000706:statistics & numerical data*; D057286:Electronic Health Records / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D062072:Patient Acuity; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors
keywords: Electronic Health Records; advanced imaging; health IT; throughput time