HIE use leads to shorter lengths of hospital stay, lower chance of ED readmission
Hospitals in New York are finding big quality and efficiency gains thanks to the ability to access patient EHR data via a regional health information exchange.
A new study just released by HealthlinkNY, which operates the HIE connecting providers and patients in more than a dozen counties across the Hudson Valley and Southern Tier of New York, finds that use of the exchange reduced the patient's length of stay both in the ED and inpatient stay.
Moreover, according to the report – which examined 86,000 encounters at hospital EDs with access to patient records through the HIE – it also lowered the likelihood that patients would be readmitted to an ER within 30 days and reduced the number of physicians needed to examine them.
New York State exchange infrastructure comprises a public network of regional HIEs, stitched together through SHIN-NY, the Statewide Health Information Network of New York, enabling providers to exchange patient data statewide.
"The results of our study leave no doubt that HIE access improves quality of healthcare and operational efficiency," said study co-author Emre Demirezen, assistant professor of operations and supply chain management at SUNY Binghamton's School of Management.
"While common sense tells us that access to the patient's entire medical history would benefit both the patient and the healthcare provider, my co-authors and I have confirmed that it does by conducting one of the first empirical investigations into the benefits of HIE use at the individual patient level."
The study examined ED encounters at four different emergency rooms – comprising 46,270 patient visits and 326 number of attending doctors – over a period of 19 months from 2012 to 2014. All four had the ability to access the HealthlinkNY HIE.
"We chose to examine emergency room visits because ER clinicians deal with a diversity of clinical conditions in a very high-pressure environment, and they need to gather as much information about a patient as quickly as possible," said Demirezen.
The research homed in on three major gains in quality and efficiency: Length of stay, risk of readmission and number of physicians needed for each encounter.
Use of the HIE reduced the average length of stay in the hospital (including time spent both as an emergency department and inpatient patient) by 7.04 percent, from 22 hours and 23 minutes on average, to approximately 20 hours and 48 minutes.
Accessing patient records through the HIE reduced the odds of readmission to any emergency department, not just the initial facility, within 30 days of discharge by 4.5 percent, according to the researchers, who also compared readmission rates over a 60-day period, with the number remaining consistent.
And HIE use also reduced the odds of a patient being seen by multiple physicians by 12 percent. Often, attending physicians seeing patients with chronic conditions beyond their area of expertise, enlist a a specialist to help evaluate the patient. But if the attending physician can look up the patient's history and review recent encounters with the patient's own specialists, such consultations may not be necessary.
Demirezen noted that physicians who use the HIE regularly, and are therefore more comfortable in using it, exhibited better outcomes than novice users: "Providers should actively promote and support clinician use of the HIE and invest time and effort into training them on its use," he said.
Christina Galanis, president and CEO of HealthlinkNY said the results should give providers "the evidence they need to make HIE use a priority for their organizations."
She expects further ROI to come for New York hospitals, she said, noting that the report "clearly states that the benefits of using the HIE are greater when it contains a robust amount of patient data and when the physician has had experience using the HIE."