The use of an electronic health information exchange (HIE) system in an ambulatory setting within 30 days of hospital discharge can help prevent readmissions, according to a study online August 6 in the Journal of the American Medical Informatics Association.
According to the study authors, led by Joshua Vest, PhD, of the department of healthcare policy and research, Weill Cornell Medical College, poor information exchange between providers after discharge is a contributing factor to readmission rates that range from 18 to 25 percent of admissions and cost the healthcare system about $17 billion a year.
The use of HIE has been identified as a way of reducing hospital admissions, but the results of studies on this matter have been mixed, mainly because they have varied in settings, patient populations, types of exchange partners and technology platforms. So the researchers wanted to determine the association between HIE usage and readmissions by controlling for factors related to patients’ discharge healthcare utilization and the hospitals’ organizational characteristics.
They studied hospital readmission rates using data obtained via the Rochester Regional Health Information Organization in western New York. More than two-thirds of the region’s 24 hospitals and physicians participate in the exchange, which became fully operational in 2009 and included data on more than 800,000 patients at the time of the study.
The study involved looking at readmission within 30 days of discharge for the same cause as the index hospitalization, with the primary independent variable being HIE usage. That usage was defined as any access of a patient’s information through a web-based portal after discharge and before the date of readmission.
Vest and his colleagues found that access of patient information from an HIE after discharge was associated with 57 percent lower odds of a 30-day same-cause readmission after controlling for patient, utilization and hospital factors.
The reason? The authors suggested that the HIE system enables more timely provider access to relevant clinical information after a patient is discharged, such as up-to-date discharge summaries, complete medication lists, recent lab and radiology results, as well as pending lab and radiology tests. Having timely access to medication information is likely to improve medication safety and prevent readmissions related to adverse drug events. At the same time, having timely access to lab and radiology reports can facilitate appropriate follow-up care for patients.
The study was subject to several limitations. For example, the researchers said the results may not translate to other settings when one considers this study was based on HIE usage in a single community that has a robust, functional HIE with data that reflected the post-discharge experience of commercially insured, as well as Medicare and Medicaid managed care patients from a small set of hospitals. The study sample was small, as well, and the researchers didn’t have the opportunity to look at specific readmission conditions.
That said, Vest and his colleagues suggested that the study’s results—keeping in mind the important of readmission rates to patients, doctors and policymakers—“represents a potentially valuable application of HIE.”