The impact of EHR and HIE on reducing avoidable admissions: controlling main differential diagnoses

BackgroundMany medical organizations have invested heavily in electronic health record (EHR) and health information exchange (HIE) information systems (IS) to improve medical decision-making and increase efficiency. Despite the potential interoperability advantages of such IS, physicians do not always immediately consult electronic health information, and this decision may result in decreased level of quality of care as well as unnecessary costs. This study sought to reveal the effect of EHR IS use on the physicians' admission decisions. It was hypothesizing the using EHR IS will result in more accurate and informed admission decisions, which will manifest through reduction in single-day admissions and in readmissions within seven days.MethodsThis study used a track log-file analysis of a database containing 281,750 emergency department (ED) referrals in seven main hospitals in Israel. Log-files were generated by the system and provide an objective and unbiased measure of system usage, Thus allowing us to evaluate the contribution of an EHR IS, as well as an HIE network, to decision-makers (physicians). This is done by investigating whether EHR IS lead to improved medical outcomes in the EDs, which are known for their tight time constraints and overcrowding. The impact of EHR IS and HIE network was evaluated by comparing decisions on patients classified by five main differential diagnoses (DDs), made with or without viewing the patients' medical history via the EHR IS.ResultsThe results indicate a negative relationship between viewing medical history via EHR systems and the number of possibly redundant admissions. Among the DDs, we found information viewed most impactful for gastroenteritis, abdominal pain, and urinary tract infection in reducing readmissions within seven days, and for gastroenteritis, abdominal pain, and chest pain in reducing the single-day admissions' rate. Both indices are key quality measures in the health system. In addition, we found that interoperability (using external information provided online by health suppliers) contributed more to this reduction than local files, which are available only in the specific hospital. Thus, reducing the rate of redundant admissions by using external information produced larger odds ratios (of the β coefficients; e.g. viewing external information on patients resulted in negative associations of 27.2% regarding readmissions within seven days, and 13% for single-day admissions as compared with viewing local information on patients respectively).ConclusionsViewing medical history via an EHR IS and using HIE network led to a reduction in the number of seven day readmissions and single-day admissions for all patients. Using external medical history may imply a more thorough patient examination that can help eliminate unnecessary admissions. Nevertheless, in most instances physicians did not view medical history at all, probably due to the limited resources available, combined with the stress of rapid turnover in ED units.

[1]  George R. Bergus,et al.  Medical Decision Making: Medical Decision Making , 2008 .

[2]  Satheesh Ramachandran,et al.  Data Mining in Military Health Systems - Clinical and Administrative Applications , 2007, 2007 IEEE International Conference on Automation Science and Engineering.

[3]  H G Welch,et al.  Readmission after surgery in Washington State rural hospitals. , 1992, American journal of public health.

[4]  Hardeep Singh,et al.  Improving the Effectiveness of Electronic Health Record-Based Referral Processes , 2012, BMC Medical Informatics and Decision Making.

[5]  Yusuf Nagree,et al.  The impact of early emergency department allied health intervention on admission rates in older people: a non-randomized clinical study , 2012, BMC Geriatrics.

[6]  Joshua R. Vest,et al.  Health Information Exchange and Healthcare Utilization , 2009, Journal of Medical Systems.

[7]  Eric C. Pan,et al.  The value of health care information exchange and interoperability. , 2005, Health affairs.

[8]  Suzanne Bakken,et al.  Review of health information technology usability study methodologies , 2011, J. Am. Medical Informatics Assoc..

[9]  Adam Webb,et al.  Avoidable 30-Day Readmissions Among Patients With Stroke and Other Cerebrovascular Disease , 2012, The Neurohospitalist.

[10]  Anton E. Lawson,et al.  Inferences of clinical diagnostic reasoning and diagnostic error , 2011, J. Biomed. Informatics.

[11]  James H. Andrews,et al.  Testing using log file analysis: tools, methods, and issues , 1998, Proceedings 13th IEEE International Conference on Automated Software Engineering (Cat. No.98EX239).

[12]  M. Tripathi,et al.  Engaging patients for health information exchange. , 2009, Health affairs.

[13]  S. Ather,et al.  The Association Between Hospital Readmission and Insurance Provider Among Adults with Asthma , 2004, The Journal of asthma : official journal of the Association for the Care of Asthma.

[14]  Michael A Choti,et al.  Patient readmission and mortality after colorectal surgery for colon cancer: impact of length of stay relative to other clinical factors. , 2012, Journal of the American College of Surgeons.

[15]  Ofir Ben-Assuli,et al.  Using Electronic Medical Record Systems for Admission Decisions in Emergency Departments: Examining the Crowdedness Effect , 2012, Journal of Medical Systems.

[16]  Moshe Leshno,et al.  The value of information for decision-making in the healthcare environment. , 2007, Studies in health technology and informatics.

[17]  Joshua R. Vest,et al.  Factors motivating and affecting health information exchange usage , 2011, J. Am. Medical Informatics Assoc..

[18]  James M. Walker,et al.  Electronic medical records and health care transformation. , 2005, Health affairs.

[19]  M. Cooke,et al.  Use of emergency observation and assessment wards: a systematic literature review , 2003, Emergency medicine journal : EMJ.

[20]  P Bingham,et al.  A confidential enquiry into emergency hospital admissions on the Isle of Wight, UK. , 1997, Journal of epidemiology and community health.

[21]  E. Brynjolfsson,et al.  Paradox Lost? Firm-Level Evidence on the Returns to Information Systems Spending , 1996 .

[22]  Jason Young,et al.  The perception of medical professionals and medical students on the usefulness of an emergency medical card and a continuity of care report in enhancing continuity of care , 2011, Int. J. Medical Informatics.

[23]  E. Yeoh,et al.  Measuring and preventing potentially avoidable hospital readmissions: a review of the literature. , 2010, Hong Kong medical journal = Xianggang yi xue za zhi.

[24]  Ofir Ben-Assuli,et al.  Using Electronic Medical Records in Admission Decisions: A Cost Effectiveness Analysis , 2013, Decis. Sci..

[25]  G. Chapman,et al.  [Medical decision making]. , 1976, Lakartidningen.