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EHR Sharing By EDs Cuts Costs; Scans Mixed

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Electronic sharing of patient information among all 12 major emergency departments in the Memphis, Tennessee, area resulted in annual savings of nearly $2 million, mostly because of reduced hospital admissions, according to a study published online last week in the Journal of the American Medical Informatics Association.

Interestingly, the study found that electronic health information exchange (HIE) use increased some types of imaging, notably chest X-rays.

Mark Frisse, MD, professor of biomedical informatics at Vanderbilt University Medical Center in Nashville, led the study. A Vanderbilt news release quoted him as saying:

This is the first study to show that, on a citywide basis, investments in technology can save medical costs by improving care. We took the ‘Tennessee simple’ approach and built a low-cost system that said, ‘Folks, if you do it simply and build it up, doing the right thing can save you money.’

ED physicians used the system, accessed through a secure Web portal, only when they thought it might be useful—which turned out to be 6.8 percent of the time.

Eleven EDs had full electronic access. The 12th did not until the very end of the study period. That hospital, which was the busiest (20 percent of total regional ED visits), relied on printed-out summaries and could inquire for more complete data. The study calls this the “mixed-access group.”

The 13-month study compared nine outcomes: ED-originated hospital admissions, admissions for observation, lab tests, head and body CT scans, ankle and chest X-rays, outpatient surgery, and echocardiograms. Each HIE-use patient was matched with a similar patient for whom doctors did not use the HIE.

Decreased admissions for the HIE-access cases over the 13 months saved $2,059,588, according to the study. CT scans also decreased, but not uniformly. At full-access EDs, head CTs and chest X-rays increased while body CTs and lab tests stayed flat. At the mixed-access hospital, head and body CTs and lab tests decreased while chest X-rays stayed flat.

The study (which is open-access) doesn’t comment on those differences except to say: “We speculate that the small but significant increase in chest X-ray use in inner-city ED within the direct access group is an example of differences in provider motivation.” Knowing the patient population each hospital serves would probably be enlightening, but the study does not identify the hospitals.

Patients could opt out of HIE participation, but only 1 percent to 3 percent did. Dr. Frisse said the system safeguards patient privacy. “It makes available only the information you choose, and it can only be used when you are needing care,” he said. “It is far more secure and useful than paper.”

He is definitely an enthusiast:

Our people believe that the savings from this study are less than 2 percent of the overall savings these technologies can afford if every physician’s office is connected. And we are absolutely convinced and committed to extending this approach to every health care setting.

Related seminar: National Diagnostic Imaging Symposium™

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