The transition to EMR systems has been a bumpy road. However, there is no denying the potential benefits that can come from storing medical information so that it can be exchanged quickly and easily between different providers. Further, while total interoperability has yet to be achieved, states and localities have made progress toward this goal with the adoption of health information exchanges (HIE). These are technology platforms that facilitate the exchange of medical information between different providers, including labs, pharmacies, hospitals, and physician practices that generally are located with a specific geographic region.
The Health Information Technology for Economic and Clinical Health (HITECH) Act provided incentives for the adoption of HIEs. Many states and localities have moved rapidly to establish these platforms for regions of various sizes. Investigators report that this move has delivered, providing important benefits to busy ED providers. In particular, they have found a link between HIE adoption and a reduction in the average length of stay (LOS) for patients who are treated and released, a group that comprises about 80% of all ED visits.
Examining data from the Healthcare Cost and Utilization Project that included 7.4 million treat-and-release visits to 63 EDs in Massachusetts, researchers found that HIE adoption is associated with a 10.2% reduction in LOS. Further, they reported that this reduction in LOS increases to nearly 15% in an integrated healthcare system, which has stronger incentives for using an HIE.1 Study co-author Mehmet Ayvaci, PhD, MS, an assistant professor of information systems in the Naveen Jindal School of Management at the University of Texas in Dallas, observes that this finding is a welcome indicator of value, given the increasing need for efficiency in the emergency medicine setting.
“The number of ED visits in the United States has been increasing over the past two decades while the number of EDs has been decreasing,” he explains. This mismatch between resources and demand leads to crowding, which affects care quality, patient satisfaction, and profitability, Ayvaci notes.
The use of an HIE can affect the time a patient spends in the ED in two primary ways, according to Ayvaci.
“First, the providers can have access to prior tests, labs, and other patient-related information ... so if you don’t have to repeat an X-ray or a lab test, that is a direct time savings,” he says.
Secondly, with all the historical information about a patient on hand, including previous diagnoses, tests, and more, providers can make better decisions about care, Ayvaci observes.
“It may decrease [LOS] because the provider is aware of an underlying problem and can make a quick assessment, or providers may realize that more needs to be done. Therefore, it may increase the time a patient spends in the ED,” he explains. There also is an indirect mechanism — a spillover effect — that occurs when patients require less time in the ED.
“When a patient who is seen by the provider spends less time with the provider, that means that if I am waiting in the waiting area, then I am also going to spend less time in the ED,” Ayvaci explains. “Especially if you are in a crowded situation, there is going to be some spillover effects to all of those patients [in the waiting room].”
One other factor that can come into play when hospitals use many different technologies, including HIEs, is information overload, Ayvaci acknowledges.
“This can disrupt the workflow and make providers spend even more time in front of the computer,” he says. “Our study identifies this tradeoff: There are reasons [HIEs] may increase [patient] time in the ED, but overall, the average effect is that HIEs are helping to reduce LOS.”
- Ayer T, Ayvaci M, Karaca Z, Vlachy J. The impact of health information exchanges on emergency department length of stay. Production and Operations Management 2018. https:doi.org/10.111/poms.12953.