By Lori Solomon, Editor, Diagnostic Testing & Emerging Technologies
Leveraging clinical data from a health information exchange (HIE) can significantly reduce the number of duplicate laboratory tests and radiology assessments performed in the emergency room, according to a pilot study published online in the Journal of the American Medical Informatics Association. In this study, the use of scribes (clinical liaisons) ensured efficient flow of HIE data to the treating clinicians, but in the future it is hoped that improved hospital information technology resources will enable seamless coordination of HIE data into clinical workflow without additional employee resources.
"The salient effects of querying the HIE on reducing the number of test and examination orders further highlights the importance of integrating HIE queries with the routine workflow of emergency department providers," writes study author Niam Yaraghi, Ph.D., from The Brookings Institution (Washington, D.C.). "A hundred percent rate of querying which was implemented in this trial can be achieved by reengineering the workflow processes and implementing automatic querying technologies."
From March 27 to May 24, 2014, a group of medical liaisons were trained on how to access the HIE database to query clinically relevant information from patients’ medical history. These medical liaisons shadowed a group of physicians and mid-level practitioners during all working shifts in the emergency department and provided them with relevant medical information from the HIE database (including previous test results, hospital admissions and discharge transcripts, operative reports, and medication history) using a tablet. For nearly 700 patients in the “treatment group” this HIE query data was applied clinically. For the 1,275 emergency department patients in the “control group” clinical liaisons did not shadow care providers and did not query the HIE. HEALTHeLINK, the regional HIE organization of Western New York conducted the pilot as a part of a series of internal quality improvement projects.
After controlling for provider and patient characteristics, as well as medical history, HIE data usage was associated with a 52 percent reduction in the total number of laboratory tests ordered per patient and a 36 percent reduction in the radiology examinations ordered per patient in the emergency department. A second participating emergency room saw less of an overall impact, but still a substantial reduction in duplicative tests (25 percent and 26 percent reduction, respectively).
Questions remain about the generalizability of the results. Firstly, not all other HIE efforts will have staff dedicated to facilitate provider access to information, the researchers say, which could lessen the impact of HIE data. Additionally, the researchers note that the state of New York’s higher than average investment in health information technology may not be representative of HIE interoperability nationally. In addition to the state’s commitment, the researchers say, an "exceptionally high" percentage of medical data providers have joined HEALTHeLINK making the available HIE data "a fairly comprehensive and longitudinal record of the patients."
“This study highlights just one component of the value of interoperability and doctors’ access to their patients’ data that HEALTHeLINK and health information technology can provide in improving the quality and efficiency of patient care and enhancing patient safety,” said Dan Porreca, executive director, HEALTHeLINK, in a statement. “While direct and indirect costs of these tests can vary by hospital and region, physicians ordering fewer tests because recent pertinent clinical information is available through HEALTHeLINK directly leads to overall costs savings for our local health care community."