Faster access to patient information results in improved emergency care

Electronic access to prior medical records results in a better, less costly patient experience in the emergency department on a number of fronts, according to new University of Michigan research.

In a study on the effectiveness of recent federal efforts to increase electronic sharing of patient health records, U-M researchers found that when information requests from external organizations were returned electronically instead of by fax, the information was seen by a doctor an hour faster—cutting a patient's time in the emergency department by nearly 53 minutes.

That hour of faster return also reduced diagnostic tests like MRI, x-rays and CT by 1.6-2.5 percentage points, and lowered the likelihood of hospital admission by 2.4 percentage points. Average costs for care also were $1,187 lower.

"What we found is that, when doctors have electronic access to information from external providers, the doctors can see that information much faster than if they have to wait for a fax," said first author Jordan Everson, doctoral candidate in Health Services, Organization and Policy at the U-M School of Public Health. "When they see that information faster, they can make informed decisions faster, with the ability to order fewer repeat tests and get patients out of the ED faster."

The study, conducted over one year at the U-M Health System, used information from 4,451 adult and pediatric emergency department visits. For some patients, prior health information was able to be accessed electronically as part of the EPIC System's Care Everywhere platform. Care Everywhere is used in about 20 percent of health care systems nationwide. For all other patients, prior health information had to come back via fax.

As part of the 2009 HITECH Act, the federal government incentivized the adoption of electronic health records and health information exchange capabilities so that the fragmented U.S. health care system could have quicker, easier access to patient records, in order to provide more seamless care and reduce costs.   

"What's most interesting about this study is that these benefits from electronic information sharing have always been hypothesized. This is among the first studies that actually show that when this information gets in front of the doctor sooner, care is markedly better," said senior author Julia Adler-Milstein, associate professor in the School of Information and School of Public Health. "It's not a shocking finding, it's what we always thought was going to happen. But now we have a much clearer sense of just how large the benefits are."

The challenge, however, is ensuring that such electronic connectivity is universal. Everson and Adler-Milstein note that the free market approach allowing various vendors of electronic record systems to develop their own approaches to record keeping and sharing has created a "patchwork of connectivity," which remains one of the biggest challenges to fulfilling the original goals of HITECH.

"If electronic information exchange was more widespread and usability issues were addressed, the benefits we're seeing from getting this information faster would likely be substantially greater," Everson said. "But the billion-dollar question is: given the fragmented way electronic sharing has developed, can we get all patient information into a seamless network of networks? That's still an enormous challenge."

Researchers point out that in their study only 1 in 5 requests for information from external providers was able to be accessed electronically, which likely means benefits could have been greater with more widespread electronic connectivity.

Dr. Keith Kocher of the U-M Department of Emergency Medicine also authored the study. He and Adler-Milstein are affiliated with the Institute for Healthcare Policy and Innovation.