Study highlights how health information exchange can cut costs

Giving physicians timely access to the patient information they need at the point of care proved to be financially beneficial to 12 hospitals in the Memphis area.

The May issue of the Journal of the American Medical Information Association includes a study of the members of the MidSouth eHealth Alliance in Memphis. During a 13-month period in which emergency physicians were given access to patient information through a health information exchange, there were reduced admissions and costs associated with cases for which the HIE was accessed.

The results were a testament to the act of exchanging information, said Mark Frisse, MD, one of the study’s authors. Physicians from any specialty can benefit from timely access to the information they need to provide better care, he said.

A health information exchange is an organized, regional network of hospitals, physicians and others who can upload and access information. The exchanges, which may be funded by grants or fees for participants, are considered the underpinning for a nationwide HIE. However, electronic exchange of health information can be done even if a formal HIE is not involved.

For the JAMIA study, Dr. Frisse and seven other researchers examined every ED encounter that occurred at 12 Memphis hospitals between July 2007 and September 2008 in which HIE data were accessed. After some were excluded from the study, researchers ended up with 15,798 HIE encounters and matched the same amount of encounters for which HIE data was not accessed. They found that nearly $2 million was saved with HIE data use, with reduced admissions accounting for 97.6% of the total savings.

Physicians at 11 of the 12 hospitals had Web access to the information for the entire 13 months. Physicians at a 12th hospital, which was responsible for 20% of all emergency encounters in the region, had Web access only for the last three months. The first 10 months they used printed paper summaries of the information in the HIE. Savings at the first 11 hospitals was $796,086 and $1.1 million at the 12th hospital.

Dr. Frisse said the main lesson was that if you give physicians access to needed information, “they will do the right thing.” Physicians in the study were not required to use the HIE. They accessed the HIE about 6.8% of the time. Dr. Frisse said the low utilization did not surprise him given the dynamics of the ED environment.

Information found in the HIE included any digital information collected on a patient from any of the participating organizations in the MidSouth eHealth Alliance, including problem lists, lab results, radiology reports and encounter records.

Since the data used for the study were collected several years ago, a lot has changed. Not only in Memphis, but also in communities across the country, more physicians are adopting electronic health record systems that make the two-way exchange of information possible.

Ted Chan, MD, medical director of emergency services at University of California, San Diego, said one of the biggest frustrations from an emergency physician’s standpoint is not being able to access information about a patient, particularly because so many come from out of network.

Dr. Chan is helping to spearhead the Beacon Community project in San Diego, part of a program by the Dept. of Health and Human Services to strengthen health information technology infrastructures and build up exchange capabilities.

Because hospitals were more likely to have sophisticated EHR systems, Dr. Chan said, they were generally the ones populating HIEs. That’s starting to change now that more physicians are adopting the technology. The result will be better care, since there’s a lot of useful data created in the outpatient setting.

For primary care physicians, the act of exchanging health information can be done in many ways. Physicians can participate in HIE organizations in their communities, across their states, or in local HIEs that connect physicians to their hospitals and labs.

Just as the emergency physicians in Memphis found, primary care physicians won’t need to access HIE data with every patient for every visit. But having the option to do so could mean numerous benefits.

Jim Morrow, MD, founder of Morrow Family Medicine in Cumming, Ga., said the biggest benefit he has seen by participating in his local HIE has been the time savings, which leads to cost savings and patient satisfaction. The biggest change, he said, has been in the way the practice operates each Monday.

Every family doctor, Dr. Morrow said, has a similar Monday routine: They learn of patients who were hospitalized over the weekend who were instructed to get follow-up care upon discharge. Before that patient comes in for the follow-up, the primary care physician’s staff is on the phone with the hospital, the lab, radiology and every other department involved in treating and diagnosing that patient over the weekend. The primary care physician’s choice is either to have their staff stay on the phone half the day or to rerun many of the same tests already done at the hospital. All of that went away with the HIE, Dr. Morrow said.

Dr. Morrow participates in an exchange with the local hospital on a system that interfaces with a local imaging center. Any services done at any facility in the network will be available for viewing by any doctor who encounters that patient.

Though payers “save a ton of money” by not paying for unnecessary tests, he said, patients also are saving time. And he is saving money, too, because of the staff time involved in tracking down that information the old-fashioned way.