Health Information Exchange Enhances Decision Making

A study by the Medical College of Wisconsin finds that emergency room doctors who have electronic access to patient data via a health information exchange spend less time gathering information and make better-informed clinical decisions in treating patients.

The study surveyed emergency room doctors about 185 patient encounters in three sites involved with the initial launch of the Wisconsin Health Information Exchange, which has been in operation for about three years in Milwaukee County and is currently being used in 10 emergency departments and several outpatient care facilities.

Doctors using the WHIE reported that electronic access to patient data reduced the time they spent gathering pertinent information about patients and helped the doctors gain a more comprehensive perspective on patients, enabling faster and better informed treatment decisions.

Sources contributing data to the WHIE include 42 area hospitals, all which provide data for public health department surveillance. Twenty-two of the participating hospitals belong to five integrated delivery networks that are sharing patient clinical data to the exchange in addition to public health related data.

Other sources providing data to the exchange include Wisconsin state Medicaid, which is contributing claims, pharmacy, and patient encounter information. Also sharing data are several health clinics and a federally qualified health clinic in southeastern Wisconsin.

The health information exchange uses Microsoft's Amalga unified intelligence system to aggregate data from the multiple sources and provides doctors at the point of care with a unified view of patient medical history data.

It's this electronic view of patient data, which includes information such as lab procedures, prescribed medications, and patients' chief complaints, previous visits, and treatments, that helps emergency room doctors reduce the time it takes to gather information and make decisions for safer and appropriate care, said Kim Pemble, executive director of the WHIE.

"Doctors are telling us the exchange is important in treating patients," he said. Not only does the point-of-care access help reduce the time spent in emergency rooms collecting information about patients, but also helps doctors avoid ordering redundant or unnecessary tests, or prescribing medications that could cause adverse reactions in some patients, such as those with allergies or taking other drugs.

Dr. John Whitcomb, an emergency department doctor at Aurora Sinai Hospital in Milwaukee, said that the use of the health exchange goes further than that.

Whitcomb said use of exchange information is helping the hospital identify patients who overuse or misuse the emergency room for medical issues that can be better and more affordably addressed in other care venues, such as by a primary care physician.

"With the health exchange, I can see right away how many times a patient has been to an ER in the region," he said. Among recent individuals seeking care at Aurora Sinai was a patient who had visited emergency rooms in the region 38 times over the last year for ear problems.

The use of the exchange is helping Aurora Sinai find "medical homes" for such patients who are in need of a regular, long-term care by a primary care physician or other specialist, not frequent emergency room visits for non-emergency situations.

"Every ER visit costs $1,000," he said. The use of unnecessary emergency room care is not only wasteful, but it taps resources that can better allocated to patients who are true need of emergency services, he said.

Also, use of the exchange -- because it provides real-time data on all ER encounters a patient has -- helps ER doctors like Whitcomb identify patients who have drug abuse problems or are possibly illegally reselling narcotic drugs prescribed by ER doctors during the patient's many visits "for pain" to different emergency departments in the region, he said.

"The number one cause of death of teenagers is diverted drugs," he said. "This helps shed a light" on those problems, he said.

The ability to pull up electronic patient data at point-of-care allows Whitcomb to address patient issues and make clinical decisions more quickly "than waiting an hour for a paper chart to be pulled," he said.

Preliminary survey results based on responses from physicians at three sites using the WHIE found that there was a 42% reduction in time spent gathering data; workup or treatment of patient was altered 42% of the time; and the time to disposition decision decreased approximately 50% of the time, according to the WHIE.

To date, WHIE has received about $2.5 million in funding through several grants, said Pemble.

In addition, health insurer Humana -- which provides health benefits to many individuals employed by companies in Milwaukee County -- recently renewed a relationship with WHIE in which Humana pays a transaction fee whenever healthcare providers use the exchange to check member medical data at point of care, said Pemble.

To date, WHIE contains records for nearly 1 million patients and 4.15 million encounters. Approximately 50,000 real-time transactions take place daily on the exchange, according to WHIE.

As for Microsoft, its Amalga product is also being used in several other health information exchanges across the U.S., including in Washington D.C. and Hawaii, said Dr. Edward Barthell, director of Microsoft health solutions group.