New computer network helps EDs to reduce redundant test orders

Observers see significant savings, benefits in patient safety

A new pilot program that allows EDs and health care systems across Milwaukee to share patient information is expected to save thousands of dollars by eliminating redundant testing, while improving patient care. Officials of the Aurora Health Care System, one participant, estimate that they will save $400 every time they review test data from another hospital source and don't repeat the test.

The program, which is sponsored by the regional nonprofit group Wisconsin Health Information Exchange (WHIE), was launched in March 2008. So far, the EDs can share only what Kim Pemble, WHIE's executive director, calls "admitting transactions," including chief complaint. "In November, we will add Medicaid claims data: diagnosis, procedures, and medications paid for by Medicaid," he says. "In 2009, we will be adding lab results, pharmacy data, and transcribed documents."

Mary Paradero, RN, MSN, patient care manager for the ED at Aurora Sinai Medical Center, adds, "Right now, it tells us what other visits the patient has had, the date, which organization they went to, and how many visits they had."

Even though the program is just in the pilot phase, there are already patient safety benefits being seen, Paradero says. "Since we are able to see the prior chief complaints, if our case looks like a similar reason, we can call over to that hospital to strengthen continuity of care," she notes.

The participating EDs log onto the WHIE application just as they would any other software program. They are required to enter a password to open it, however. "What they see now is a list of the patients for whom they have a care relationship — those who have been admitted," says Pemble. "Our exchange gets the admitting information. We cross-match it around the community, aggregate the information, and put that in the history."

The ED gets to look at that information for 72 hours. "If the patient later returns to the same ED, they will again see all that history plus anything that has occurred since," Pemble explains. There was no "per-hospital" startup fee, says Pemble, although WHIE did receive a one-time contribution from the Wisconsin Hospital Association. The only ongoing contribution individual hospitals make, he adds, is "people time to support implementation of the system related to their institution."

One of the primary reasons Aurora is participating in the program is that it has already seen the benefits of its own systemwide electronic medical record (EMR), which it installed in 2006, says Paradero. "If a patient had been to another of our hospitals and, if they had a CT scan done and were back a week later, depending on what they presented with, we might not have to do another one and expose them to more radiation," she explains. Avoiding unnecessary tests also decreases a patient's length of stay, says Paradero.

The ED also is able to reinforce to the patient what had been done on the previous visit, she says. "If they were referred to a primary care physician, we can reinforce that and ask the patient if they saw 'Dr. Smith.'"

One of the tangible benefits of the EMR that Aurora has realized so far, says Paradero, is reducing the visits of patients who most frequently visited the ED in the past. "We tracked the ones we saw in 2006, developed care plans for them, and then tracked them in 2007," she recalls. "Their total annual visits dropped from 1,100 to 500, and the costs of treating them were also cut in half because they were encouraged to go to a primary care physician."