Providing Electronic Access to Clinical Information Across a Community May Support Patient Care and Help Improve the Health Care System
Emergency department physicians are less likely to admit patients to the hospital when they have readily available electronic access to those patients' health records, Weill Cornell Medical College researchers have found.
Their study, published March 12 in Applied Clinical Informatics, illustrates the value of combining multiple providers' digital patient charts into a single source for health care providers — particularly in an urgent setting like the emergency department. With information such as previous test results, prescriptions and other patient history immediately accessible, providers are able to treat patients more efficiently and effectively than when they lack that data.
"New York State has made significant investments in health information exchange," said Dr. Joshua Vest, an assistant professor at Weill Cornell and the lead author on the study. "Our study shows that providing physicians, nurses and allied health care professionals such as physician assistants real-time access to community-wide, longitudinal health records does in fact benefit patients."
With federal and New York State government backing, hospitals and medical practices across the state are investing millions of dollars to make health records sharable among physicians when they need the information. The digitized charts contain doctors' notes from every patient visit; family medical history; immunization records; lab results; medication history; allergies; reminders for preventative care and more.
All of that data was once scattered among the various doctors that patients have seen over the years. The centralized digital chart can be viewed through a password- protected, web-based portal that is subject to HIPAA privacy laws.
The Rochester regional health information organization operates this shared information system, called the Virtual Health Record. With a patient's consent, the Virtual Health Record combines all of the patient's recent and historical medical information from local health care providers through a process called health information exchange. With the Virtual Health Record, Rochester-area providers with the proper clearance have instant access to critical patient information that in the past would have been difficult, time consuming or impossible to get.
Experts were convinced that electronic health records would benefit patients by enabling better communication between providers and giving them a complete picture of a patient's history before settling on a treatment plan. While anecdotal evidence supported those assumptions, there was no rigorous analysis that proved electronic health records are beneficial.
Using claims information collected from seven emergency departments in Rochester, the researchers found that physicians and health care professionals who had access to patient data were better able to avoid hospitalizing patients who didn't need inpatient care. For example, a patient exam in the emergency department might produce an abnormal electrocardiogram reading, but the doctor suspects that the reading is actually the normal baseline for the patient. Rather than admitting the patient for further tests, the physician can consult the Rochester RHIO's system, which includes prior electrocardiograms that confirm the hypothesis.
"Emergency department physicians need to treat patients every day, even when they don't have complete medical information on those patients," said Ted Kremer, head of the Rochester RHIO, which implemented the technology. "This study suggests that providing physicians with more clinical information helps prevent hospital admissions."
"The possibility for health information exchange efforts to improve the quality of health care for New Yorkers and across the country is substantial," added senior investigator Dr. Rainu Kaushal, chair of the Department of Healthcare Policy and Research at Weill Cornell Medical College. "Thoughtful and innovative approaches to the implementation and support of these technologies, like those by the Rochester regional health information organization, are crucial to their success."