EFFICIENCY AND ECONOMIC BENEFITS ASSOCIATED WITH THE USE OF A PAYER-BASED ELECTRONIC HEALTH RECORD IN AN EMERGENCY DEPARTMENT AMONG A HEALTH INSURED POPULATION
Author(s)
Gregory W. Daniel, PhD, MPH, Director, Government and Academic Research1, Edward Ewen, MD, FACP, Director of Informatics, Center for Outcomes Research2, Vincent J Willey, PharmD, Associate Professor of Pharmacy3, Mazda Shirazi, MD, PhD, FAECP, Assistant Professor of Clinical Emergency Medicine4, Daniel C Malone, RPh, Ph, D, Professor51HealthCore, Inc., Wilmington, DE, USA; 2 Christiana Care Health System, Newark, DE, USA; 3 University of the Sciences, Philadelphia, PA, USA; 4 University of Arizona College of Medicine, Tucson, AZ, USA; 5 University of Arizona College of Pharmacy, Tucson, AZ, USA
OBJECTIVES Health information exchange technologies are being implemented widespread with goals of improving efficiency and costs of care. The need for timely, accurate, and pertinent information is most critical in the emergency department (ED). This study evaluated the use of a payer-based electronic health record (P-EHR), which includes a clinical summary of a patient's medical and pharmacy claims, in an ED on length of stay (LOS) and costs of care among a commercially insured population. METHODS A large urban hospital implemented a P-EHR in the ED. The P-EHR was evaluated using administrative claims and supplemental hospital data. Encounters with P-EHR use were identified from claims between September 1, 2005 and February 17, 2006. Accounting for seasonal variation, historical comparison encounters were identified from November 1, 2004 to March, 31, 2005. Outcomes included ED LOS and cost for the ED encounter. Control variables included age, gender, pre-encounter six month health care utilization and costs, comorbidity burden, plan type, day of week (weekend vs weekday), primary diagnosis, triage severity scores, and ED census. Analyses used multivariate generalized linear models and non-parametric bootstrap for standard errors of predictions. RESULTS A total of 2288 ED encounters were analyzed (779 P-EHR/1,509 comparison). ED-only P-EHR encounters were discharged 19 minutes quicker (95%CI:5-33 minutes) as compared to encounters not associated with the P-EHR. Among encounters resulting in hospitalization, the P-EHR was associated with a 77 minute reduction in LOS (95%CI:28-126 minutes) as compared to non-P-EHR encounters. The use of the P-EHR was also associated with $1560 (95% CI:$43-$2910) savings in total plan expenditures for encounters resulting in hospitalization. No significant difference in costs was observed among ED-only encounters. CONCLUSIONS This study highlights that a P-EHR can have a meaningful impact on ED throughput and costs. These benefits may translate into improvement in the care provided to patients and their satisfaction.
Conference/Value in Health Info
2009-05, ISPOR 2009, Orlando, FL, USA
Value in Health, Vol. 12, No. 3 (May 2009)
Code
HM1
Topic
Economic Evaluation, Health Service Delivery & Process of Care, Real World Data & Information Systems
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Health & Insurance Records Systems, Hospital and Clinical Practices
Disease
Multiple Diseases
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