The impact of electronic health records on care of heart failure patients in the emergency room

Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota 55455, USA.
Journal of the American Medical Informatics Association (Impact Factor: 3.5). 11/2011; 19(3):334-40. DOI: 10.1136/amiajnl-2011-000271
Source: PubMed

ABSTRACT To evaluate if electronic health records (EHR) have observable effects on care outcomes, we examined quality and efficiency measures for patients presenting to emergency departments (ED).
We conducted a retrospective study of 5166 adults with heart failure in three metropolitan EDs. Patients were termed internal if prior information was in the EHR upon ED presentation, otherwise external. Associations of internality with hospitalization, mortality, length of stay (LOS), and numbers of tests, procedures, and medications ordered in the ED were examined after adjusting for age, gender, race, marital status, comorbidities and hospitalization as a proxy for acuity level where appropriate.
At two EDs internals had lower odds of mortality if hospitalized (OR 0.55; 95% CI 0.38 to 0.81 and 0.45; 0.21 to 0.96), fewer laboratory tests during the ED visit (-4.6%; -8.9% to -0.1% and -14.0%; -19.5% to -8.1%) as well as fewer medications (-33.6%; -38.4% to -28.4% and -21.3%; -33.2% to -7.3%). At one of these two EDs, internals had lower odds of hospitalization (0.37; 0.22 to 0.60). At the third ED, internal patients only experienced a prolonged ED LOS (32.3%; 6.3% to 64.8%) but no other differences. There was no association with hospital LOS or number of procedures ordered.
EHR availability was associated with salutary outcomes in two of three ED settings and prolongation of ED LOS at a third, but evidence was mixed and causality remains to be determined.
An EHR may have the potential to be a valuable adjunct in the care of heart failure patients.

Download full-text


Available from: Nawanan Theera-Ampornpunt, Sep 26, 2015
16 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Medical organizations adopt electronic health record (EHR) and health information exchange (HIE) interoperable technologies in order to provide vital medical information needed for medical decision-making. The use of such interoperable information may lead to increased quality of care and reduced unnecessary costs. The goal of this study was to characterize the specific data components that improve the process of medical decision-making in an emergency department (ED). The outcome measures were the decision to admit/discharge a patient and differences in single-day admission rates with/without using an interoperable EHR. A database containing 3.2 million ED referrals from seven main Israeli hospitals was subjected to log-file analysis. We found that viewing medical history via the interoperable EHR significantly affects admission decisions. The data show a reduction in the number of avoidable single-day admissions, but also an increase in the rate of prolonged admissions. Previous admissions, laboratory tests, imaging and previous surgeries were the most influential information components.
    Health and Technology 03/2013; 3(1). DOI:10.1007/s12553-013-0039-6
  • [Show abstract] [Hide abstract]
    ABSTRACT: Many medical organizations have deployed electronic medical record (EMR) information systems (IS) to improve medical decision-making and increase efficiency. Despite their advantages, however, EMR IS may make less of a contribution in the stressful environment of an emergency department (ED) that operates under tight time constraints. The high level of crowdedness in the EDs itself can cause physicians to make medical decisions resulting in more unnecessary admissions and fewer necessary admissions. Thus this study evaluated the contribution of an EMR IS to physicians by investigating whether EMR IS leads to improved medical outcomes in points of care in EDs under different levels of crowdedness. For this purpose a track log-file analysis of a database containing 3.2 million ED referrals in seven main hospitals in Israel (the whole population in these hospitals) was conducted. The findings suggest that viewing medical history via the EMR IS leads to better admission decisions, and reduces the number of possibly avoidable single-day admissions. Furthermore, although the ED can be very stressful especially on crowded days, physicians used EMR IS more on crowded days than on non-crowded days. These results have implications as regards the viability of EMR IS in complex, fast-paced environments.
    Journal of Medical Systems 04/2012; 36(6):3795-803. DOI:10.1007/s10916-012-9852-0 · 2.21 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: To assess the overall impact of access to the electronic medical record (EMR) on anatomic pathology performance. Methods: We reviewed the results of all use of the EMR by 1 pathologist over an 18-month period. Results: Of the 10,107 cases (913 cytology and 9,194 surgical pathology) reviewed, the EMR (excluding anatomic pathology records) was accessed in 222 (2.2% of all cases, 6.5% of all cytology cases, and 1.8% of all surgical pathology cases). The EMR was used to evaluate a critical value in 20 (9.0%) cases and make a more specific diagnosis in 77 (34.7%) cases, a less specific diagnosis in 4 (1.8%) cases, and a systemic rather than localized diagnosis in 4 (1.8%) cases. The percentage of cases in which the physician was contacted decreased from 7.3% for the prior 18 months to 6.7%, but this change was not significant (P = .13). Twelve cases were subsequently sent for interinstitutional consultation, and no disagreements were identified. Conclusions: The EMR was accessed in 2.2% of all surgical pathology and cytology cases and affected the diagnosis in 48% of these cases.
    American Journal of Clinical Pathology 07/2013; 140(1):109-11. DOI:10.1309/AJCP1ZQA0NDMVDPE · 2.51 Impact Factor
Show more