The impact of electronic health records on care of heart failure patients in the emergency room.
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.
- SourceAvailable from: Joshua C DennyJournal of the American Medical Informatics Association 12/2013; 20(e2):e206-11. · 3.57 Impact Factor
- Annals of emergency medicine 07/2013; · 4.33 Impact Factor
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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).