Under a two-year grant from the Agency for Healthcare Research and Quality, the Regenstrief Institute is conducting the first study of health information exchange utilization in emergency departments at multiple institutions to determine whether it improves patient outcomes over time.
“Almost 70 percent of hospital admissions for Medicare beneficiaries originate in the ED, of which many may be avoidable if comprehensive information was available to clinicians,” states the AHRQ website regarding the grant.
Despite the fact that HIE is more frequently used in EDs than in any other healthcare setting, little research has been conducted to evaluate the impact of long-term use on emergency care, according to Brian Dixon, Regenstrief’s principal investigator on the study and an assistant professor of epidemiology at Indiana University’s Richard M. Fairbanks School of Public Health.
“There certainly hasn’t been a longitudinal look at HIE utilization over time,” contends Dixon. “Is utilization increasing, decreasing or remaining the same? And, what is the link to the outcomes that the patients experience, not just the decision-making processes? That evidence is necessary to inform how we continue to implement and adopt HIE in the emergency care setting.”
The Indiana Network for Patient Care (INPC), one of the nation’s largest inter-organizational clinical data repositories, will serve as the information source for Regenstrief investigators, who will review usage logs to ascertain the frequency with which the HIE was used in EDs, as well as the type of patient care rendered, by which providers, under what scenarios, what the outcomes were, and whether the patients were admitted to the hospital.
“Our hypothesis is that when HIE is utilized during the ED encounter, the provider has more background information on the patient and is able to treat them and release them, as opposed to admitting them for a bunch of tests and possible exploratory procedures to try to figure out what’s going on with them,” says Dixon. “When you don’t know a whole lot about a patient, you don’t necessarily want to release them until you are more confident in your diagnosis. So you may keep them for a longer period of time.”
In addition, investigators will study what specific parts of the electronic health records were accessed in the ED, such as imaging, lab results or medication lists. Patient level data over a six-year period will be linked to HIE usage by staff.
“The INPC offers a service to providers called CareWeb, an application that links to EHR systems and enables access to patient records from other institutions,” adds Dixon, who notes that the app has more than 130 participating entities and 9 billion pieces of clinical information. “Specifically, our project will look at the usage logs of the CareWeb application.”
Among other data, Dixon wants to know when HIE tends to be used in the EDs. “Does it tend to be used during the graveyard shift or used more from 8 a.m. to 5 p.m.? We’ll look at those types of usage patterns in the study,” he says. “Also, we’ll selectively interview providers to find out why they do or do not use the HIE, what the challenges are to using it and what they like about the CareWeb application.”
Dixon points out that INPC, developed by the Regenstrief Center for Biomedical Informatics, is the largest of three HIEs in the state and is operated by the Indiana Heath Information Exchange. “We started the HIE in the mid-1990s by connecting together two different emergency rooms on opposite sides of town, and that was the first use case,” he notes, adding that INPC now services around 90 EDs across the state.
The study will sample about 45 EDs in Indiana that have a diverse geographic mix that includes those in rural, suburban and urban locations, according to Dixon.
“There is a need to more accurately quantify the importance of delivering a comprehensive view of the patient,” adds Shaun Grannis, MD, director of the Regenstrief Center for Biomedical Informatics and an Indiana University School of Medicine associate professor of family medicine. “The INPC’s premier capabilities for standardizing disparate health data provide a real-world laboratory to study the clinical improvements realized by providing essential integrated clinical data at the point of care.”
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