BMC Med Inform Decis Mak - The impact of EHR and HIE on reducing avoidable admissions: controlling main differential diagnoses.

Tópicos

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Resumo

CKGROUND: Many medical organizations have invested heavily in electronic health record (EHR) and health information exchange (HIE) information systems (IS) to improve medical decision-making and increase efficiency. Despite the potential interoperability advantages of such IS, physicians do not always immediately consult electronic health information, and this decision may result in decreased level of quality of care as well as unnecessary costs. This study sought to reveal the effect of EHR IS use on the physicians' admission decisions. It was hypothesizing the using EHR IS will result in more accurate and informed admission decisions, which will manifest through reduction in single-day admissions and in readmissions within seven days.METHODS: This study used a track log-file analysis of a database containing 281,750 emergency department (ED) referrals in seven main hospitals in Israel. Log-files were generated by the system and provide an objective and unbiased measure of system usage, Thus allowing us to evaluate the contribution of an EHR IS, as well as an HIE network, to decision-makers (physicians). This is done by investigating whether EHR IS lead to improved medical outcomes in the EDs, which are known for their tight time constraints and overcrowding. The impact of EHR IS and HIE network was evaluated by comparing decisions on patients classified by five main differential diagnoses (DDs), made with or without viewing the patients' medical history via the EHR IS.RESULTS: The results indicate a negative relationship between viewing medical history via EHR systems and the number of possibly redundant admissions. Among the DDs, we found information viewed most impactful for gastroenteritis, abdominal pain, and urinary tract infection in reducing readmissions within seven days, and for gastroenteritis, abdominal pain, and chest pain in reducing the single-day admissions' rate. Both indices are key quality measures in the health system. In addition, we found that interoperability (using external information provided online by health suppliers) contributed more to this reduction than local files, which are available only in the specific hospital. Thus, reducing the rate of redundant admissions by using external information produced larger odds ratios (of the ? coefficients; e.g. viewing external information on patients resulted in negative associations of 27.2% regarding readmissions within seven days, and 13% for single-day admissions as compared with viewing local information on patients respectively).CONCLUSIONS: Viewing medical history via an EHR IS and using HIE network led to a reduction in the number of seven day readmissions and single-day admissions for all patients. Using external medical history may imply a more thorough patient examination that can help eliminate unnecessary admissions. Nevertheless, in most instances physicians did not view medical history at all, probably due to the limited resources available, combined with the stress of rapid turnover in ED units.

Resumo Limpo

ckground mani medic organ invest heavili electron health record ehr health inform exchang hie inform system improv medic decisionmak increas effici despit potenti interoper advantag physician alway immedi consult electron health inform decis may result decreas level qualiti care well unnecessari cost studi sought reveal effect ehr use physician admiss decis hypothes use ehr will result accur inform admiss decis will manifest reduct singleday admiss readmiss within seven daysmethod studi use track logfil analysi databas contain emerg depart ed referr seven main hospit israel logfil generat system provid object unbias measur system usag thus allow us evalu contribut ehr well hie network decisionmak physician done investig whether ehr lead improv medic outcom ed known tight time constraint overcrowd impact ehr hie network evalu compar decis patient classifi five main differenti diagnos dds made without view patient medic histori via ehr isresult result indic negat relationship view medic histori via ehr system number possibl redund admiss among dds found inform view impact gastroenter abdomin pain urinari tract infect reduc readmiss within seven day gastroenter abdomin pain chest pain reduc singleday admiss rate indic key qualiti measur health system addit found interoper use extern inform provid onlin health supplier contribut reduct local file avail specif hospit thus reduc rate redund admiss use extern inform produc larger odd ratio coeffici eg view extern inform patient result negat associ regard readmiss within seven day singleday admiss compar view local inform patient respectivelyconclus view medic histori via ehr use hie network led reduct number seven day readmiss singleday admiss patient use extern medic histori may impli thorough patient examin can help elimin unnecessari admiss nevertheless instanc physician view medic histori probabl due limit resourc avail combin stress rapid turnov ed unit

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