The increasing use of electronic health records (EHRs) and health information exchanges (HIEs) has proven their value — in health and wealth — to doctors and patients. By giving physicians access to patients’ EHRs through HIEs, studies show that fewer repeat procedures are being conducted with fewer medication errors reported. Data also indicates diagnostic tests and follow-up visits fall while cost savings increase with greater use and exchange of EHRs.
In January, the University of Michigan released an analysis that found patients visiting emergency rooms using EHRs and connected to an HIE were 59 percent less likely to have a redundant CT scan, 44 percent less likely to get a duplicate ultrasound and 67 percent less likely to have a repeated chest X-ray. A St. Luke’s Hospital (Cedar Rapids, IA) study found use of HIE reduced hospital readmissions by 14 percent in their 500-bed hospital with more than 17,000 annual admissions. A study published in Applied Clinical Informatics found the odds of a hospital admission were 30 percent lower when HIE was accessed during the patient’s emergency department visit. These statistics alone show the value of EHRs and HIEs. But the benefits are not only in health and wellness.
Researchers from the Medical University of South Carolina reported in October 2013 that HIE use resulted in total savings for the state’s patients of $1,035,654, based on Medicare-allowable charges, or $1,947 per patient. They found that having access to an HIE for emergency patients produced savings that included $476,840 from reduced radiology testing (298 patients) and $551,282 as a result of patients avoiding admission to the hospital (56 patients). The study also found that nearly 90 percent of the 231 participating clinicians said using HIE improved the quality of patient care, with 82 percent saying valuable time was saved, reporting a mean time savings of 105 minutes per patient.
Sharing of electronic health information across every major emergency department in the Memphis, TN area resulted in reduced hospital admissions, reduced radiology tests and an annual cost savings of nearly $2 million, according to a Vanderbilt University study released by the Journal of the American Medical Informatics Association. A 2011 study from Humana and the Wisconsin Health Information Exchange found that with a $10 savings per impacted patient, the total decrease in emergency department expenditures under conservative estimates was still over $4 million.
An analysis from the Rochester (NY) Regional Health Information Organization (RHIO) found that when health care providers use the RHIO to query patient information as part of care, the likelihood of duplicate image testing is reduced by 35 percent. The RHIO also found that when it is accessed by health care providers after hospital discharge, there is a 55 percent reduction in 30-day readmission rates. Furthermore, when the RHIO is accessed in emergency departments, the odds of being admitted to the hospital from the ED are reduced by 30 percent.
In addition to the cost savings of HIEs, their value in providing immediate access to vital patient health information can be a critical tool in delivering timely and appropriate care. Research published by the National Center for Biotechnology Information shows that having complete patient information available at the point of care reduces adverse drug events and patient safety errors. According to the study, incomplete information at the point of care has been shown to adversely affect care in 44 percent of clinic visits and delay care in 59 percent of visits. The report found that 18 percent of patient safety errors and 70 percent of adverse drug events could be eliminated if the right information were consistently available at the right time. The findings concluded that poor communication of medical information at transition points is responsible for as much as 50 percent of all medication errors and up to 20 percent of adverse drug events.
Research from the Rochester RHIO found that participating practices save three hours per day when they access patient records electronically. A study published in the International Journal of Medical Informatics found that one central login to a query-based HIE portal system (as opposed to logging into separate EHR systems) contributed to higher overall HIE usage.
A 2013 study published in BMC Medical Informatics and Decision Making found that when external medical histories were consulted, the likelihood of seven-day readmissions decreased 48 percent overall and by 27.2 percent when compared with viewing only information available in the local electronic medical record system.
Studies reflect the growing satisfaction with the improved quality of care resulting from the use and exchange of EHRs. An Accenture survey from 2012 found that 53 percent of doctors surveyed also believe the introduction of electronic health records improved the quality of care for their patients. Research published in the Journal of General Internal Medicine found in a study of small group practices that electronic access to laboratory results across the exchange network was associated with higher performance on preventive care, chronic disease management and patient satisfaction.
A National Center for Health Statistics study found 85 percent of the physicians who use EHR systems reported being satisfied with their system. Seventy-four percent believe that using their system enhanced overall patient care in areas such as being alerted to critical lab values (52 percent), identifying potential medication errors (43 percent) and ordering fewer tests because lab results were available (30 percent). Ninety-two percent of patients were happy with e-prescribing and 63 percent reported fewer medication errors.
Clearly, the growing use of EHRs and HIEs within the medical industry is proving to be a key driver of improved quality within a more efficient health system, with a side benefit of significant cost savings. As more hospitals and doctors adopt EHRs and connect to HIEs, all parties to the doctor-patient relationship — as well as the entire health care system — stand to benefit.