JAMIA: HIE in EDs slashes costs

Widespread hospital support for health information exchange (HIE) and initial deployment only in emergency department (ED) settings can lower overall societal costs and reduce hospital admissions, according to a study published in the May edition of the Journal of the American Medical Informatics Association.

Mark E. Frisse, MD, from the department of biomedical informatics at Vanderbilt University in Nashville, Tenn., and colleagues sought to examine the financial impact of HIE in EDs.

The researchers studied all ED encounters over a 13-month period in which HIE data were accessed in all major emergency departments in Memphis, Tenn. As of October 1, 2010, clinicians had access to over 7.5 million encounter records on 1.7 million patients, 4.9 million chief complaints, 45 million laboratory tests, 5 million radiology reports and 2.1 million other reports and documents. HIE access encounter records were matched with similar encounter records without HIE access. Outcomes studied were ED-originated hospital admissions, admissions for observation, laboratory testing, head CT, body CT, ankle radiographs, chest radiographs and echocardiograms.

HIE data were accessed in approximately 6.8 percent of ED visits across 12 EDs studied, according to the authors. In 11 EDs directly accessing HIE data only through a secure web browser, access was associated with a decrease in hospital admissions (191 fewer admissions than would have been predicted to  occur without HIE use).”The calculated annual financial savings from the 11-hospital direct access group were approximately $796,085,” the authors wrote.

In a 12th ED relying more on print summaries, HIE access was associated with a decrease in hospital admissions (221 fewer admissions) and statistically significant decreases in head CT use, body CT use, and laboratory test ordering. The calculated annual financial savings from the mixed access site were approximately $1.1 million, according to the authors.

“Applied only to the study population, HIE access was associated with an annual cost savings of $1.9 million,” the authors wrote. “Net of annual operating costs, HIE access reduced overall costs by $1.07 million. Hospital admission reductions accounted for 97.6 percent of total cost reductions.”

“If care delivery within a region is highly fragmented, collaborative HIE among an entire community may confer far greater benefit by improving care coordination, measuring and addressing hospital readmissions, and collectively developing more comprehensive quality metrics for both individuals and populations,” concluded the authors. “As has been our own experience, we assume that basic HIE services can be provided inexpensively and that HIE, once established, can expand at relatively low cost to encompass a broader array of clinicians employing certified EHR.”