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Information exchange yields better decisions
Redundant tests curtailed, drug seekers ID'd
The Wisconsin Health Information Exchange (WHIE), which has enabled EDs in the Milwaukee area to electronically access patient data for about three years, has helped the participants save time and make better-informed patient care decisions, according a recent study from the Medical College of Wisconsin in Milwaukee.1
The study, which was based on data from 10 EDs and several outpatient facilities, found that:
"We decided that a collaboration of all the health systems in Milwaukee was required to come up with a solution for patients who are coming to several different hospitals," says John Whitcomb, MD, FACEP, an ED physician and medical director for patient access at Aurora Sinai Hospital, one of the founding participants. "That results in fragmented medical care, which is often not to the patient's advantage and is also expensive."
At the time of his interview with ED Management, Whitcomb was seeing one patient who had had 200 visits to 11 Milwaukee EDs in 2010. "Another has had 40 visits to five hospitals, and none of the 13 doctors in my group had ever seen this patient before," he says. "Nobody gets to the bottom of what their core problems are, and it's extraordinarily expensive to keep repeating CT scans and other costly tests because you have no way of knowing how many prior tests had been given."
When a patient enters the ED of a participating facility, registrars print a "face sheet" that provides information on previous ED visits in the area, explains Marlene D. Melzer-Lange, MD, medical director of emergency services at Children's Hospital of Wisconsin. "It's almost like having another abbreviated medical record," Melzer says. "You can't see the full record, but you can see when they were at other EDs and why they came." So, for example, if a child comes in with injuries that lead the physician to suspect child abuse, they can look in the electronic record to see if there had been previous injuries of concern. "Sometimes that's not such an easy decision to make i.e., calling a social worker so this helps by giving you more information than you would normally have had," Melzer says.
Each facility is required to have a dedicated computer and space in the ED. "Finding a place to put the computer can be complicated," Whitcomb says. "And you have to have the staff committed to training on flow."
For the system to be effective, the doctor has to have the sheet put in his or her hands, Whitcomb says. "Someone has to be trained to pull it out and put it there," he says. "It has to become part of the culture."
Melzer says, "We needed to change processes in the ED. We decided it was best to print out a list of other ED visits every time a patient came in so it became part of the standard registration process." At her facility, she says, that task is performed by the registration clerk.
WHIE has definitely led to a decrease in testing, Melzer says. "Dad or Mom may not always know all the tests their child has had," she explains.
Melzer also believes it has improved outcomes. "We need to study that in a more scientific way, but there have been a few instances where it encouraged me to report child abuse, and a few others when teenagers told me they were not sexually active but I saw that they had been to Planned Parenthood." One of the systems' reproductive health clinics is part of the system. This type of information provides more insight and enables her to give such a patient better care, Melzer says.
WHIE uncovers drug seekers
One of the key benefits of the Wisconsin Health Information Exchange (WHIE), which has enabled EDs in the Milwaukee area to electronically access patient data for about three years, is that it can help ED physicians identify drug seekers, according to John Whitcomb, MD, FACEP, an ED physician and medical director for patient access at Aurora Sinai Hospital, one of the founding participants.
"We prescribe narcotics in good faith to take care of patients in pain," Whitcomb says. "Some patients use that mandate to put us in the position of providing the drugs."
Now, he says, when he sees someone who has been treated at five hospitals for five painful conditions, "it gives me a feeling for their character, as opposed to someone who has gone to one doctor or health system and follows a specific plan of care."
If you see a patient with ED visits for non-identifiable painful conditions three times in the last year, says Whitcomb, please don't give them narcotics. "Insist on their seeing someone else who can vouch for their medical care."
For more information on electronic health information exchanges, contact: