Health Information Exchanges May Remedy Long Emergency Stays

Hospitals that adopt health information exchanges can reduce the amount of time patients stay in emergency departments, according to a new study from the Naveen Jindal School of Management at The University of Texas at Dallas.

Health information exchanges (HIEs) are technology platforms that ease the exchange of patient information between different health care providers and settings, including labs, hospitals, physician practices and pharmacies, said Dr. Mehmet Ayvaci, an assistant professor of information systems.

HIEs are expected to improve information coordination in emergency departments, but whether and when they are associated with better operational outcomes is poorly understood. Ayvaci and his co-authors explored how the adoption of HIEs affect the length of stay in emergency departments, an important measure of operational performance.

For the study, the length of stay is the recorded time between when a patient signs in and leaves the emergency department. The study focuses on treat-and-release patients — those sent home after they visit the emergency department — who account for about 80 percent of all emergency visits.

“Health information exchanges help mitigate the length of stay because physicians have access to information from prior visits,” Ayvaci said. “They will be able to make better and timelier decisions. They can avoid repeat procedures. For example, they will know what kind of drugs the patient is taking and what care they have already received.”

The study, published online last September in Production and Operations Management, is forthcoming in a print edition of the journal.

Ayvaci said the number of emergency departments has decreased during the past two decades even as more people seek emergency care.

“Length of stay is very important for many reasons,” he said. “First, it is a matter of patient satisfaction. If a patient spends more time in the emergency department, it is not a pleasant experience. Second, the length of stay is an indicator of care quality because the time a patient spends waiting for service is associated with clinical outcomes. Third, length of stay also means lost revenue for hospitals. The longer the emergency department wait is, the more likely the patient is to leave the hospital before receiving care.”

HIEs were not widespread until 2009 when federal legislation helped accelerate the adoption of health information technology, Ayvaci said. This led to a program that aims to increase the use of electronic health records and HIEs to improve quality, safety, efficiency and care coordination, and reduce health disparities.

Since then, the adoption of HIEs has grown rapidly. The percentage of hospitals with a functional HIE increased from 41 percent in 2008 to 76 percent in 2014.

Using a data set from the Healthcare Cost and Utilization Project consisting of about 7.4 million treat‐and‐release visits at 63 emergency departments in Massachusetts, the researchers found that the adoption of HIEs is associated with a 10.2 percent reduction in the length of stay. That number increases to 14.8 percent with an integrated health system, which has stronger financial incentives for using HIEs.

The researchers found that when HIE is widespread and its use is more likely, its benefits would increase for the individual health care providers.

The study also determined that the relationship between HIE and the length of stay is moderated by various factors:

• In terms of length of stay, teaching hospitals are more likely to benefit from HIEs than non-teaching hospitals.
• The reduction of length of stays by HIEs had little or no effect in crowded emergency departments, where patients spend more time on average.
• Patients with severe conditions or patients with two or more chronic diseases or conditions on average spend less time in the emergency department when an HIE is available.

Not everyone supports the adoption of HIEs. Ayvaci said there is some debate about introducing technology to the health care industry because some providers believe it disrupts the workflow, and HIEs are not an exception.

If health care administrators are going to invest in the technology, they need to know its value, he said.

“Our study shows that the adoption of health information exchanges correlates with actual outcomes,” Ayvaci said. “For hospital managers, a reduction in length of stay means more money and more patients. It also indicates better quality of care and increased patient satisfaction. Patients are going to be happier, and perhaps they will prefer these providers more.”

The researchers said their findings have important implications and may inform policymakers regarding the nationwide adoption of such exchanges and their relation to health reforms on access, cost control and care coordination.

Co-authors of the study are Dr. Turgay Ayer and doctoral student Jan Vlachy, both of the Georgia Institute of Technology, and Dr. Zeynal Karaca of the Agency for Healthcare Research and Quality at the U.S. Department of Health and Human Services.