Health Information Exchange Eyes Implementation of Emergency Department Information Exchange

HEALTHeLINK, the Regional Health Information Organization (RHIO) for the eight counties of Western New York, is considering a pilot program for Emergency Department Information Exchange (EDIE) as a supplement to the recently implemented Alert Notifications under the SHIN-NY (Statewide Health Information Network for New York).  HEALTHeLINK would be the first RHIO in New York State to offer EDIE as a RHIO service.

Alerts are subscription based notifications to providers from RHIOs.  A provider identifies their patients to the RHIO so that the RHIO can send an “Alert” to the provider when a patient of that provider is admitted, discharged or transferred among hospitals, or presents at a hospital emergency department. Providers using Alerts and EDIEs have the benefit of real time information about their patient so as to provide better continuity of care to the patient during and after a hospital visit.

In Washington State, a study has been completed indicating positive results in terms of improved care and reduced costs when an Emergency Department Information Exchange is implemented.

The EDIE is based on leveraging the following Emergency Room “Seven Best Practices”:

1. Track emergency department visits to avoid “ED” shopping;
2. Implement patient education;
3. Institute an extensive case management program;
4. Reduce inappropriate ED visits by collaborative use of prompt visits to primary care physicians;
5. Implement narcotic guidelines to discourage narcotic-seeking behavior;
6. Track data on patients prescribed controlled substances; and
7. Track progress of the plan to make sure steps are working.

Utilizing these best practices, a RHIO would “push” information to Emergency Departments on patients that have consented to use of HEALTHeLINK by participating providers.  Important information might include the history of emergency room visits and I-STOP information.

I-STOP is New York’s prescription monitoring program registry.

The EDIE report might also indicate which providers have subscribed to receive Alerts for a particular patient to facilitate care-coordination.  One larger-term goal would be to develop a Statewide patient care plan for frequent ER users, which would include patient education on appropriate alternative resources for care, thereby reducing ER visits.

Results for a statistical sample of Medicaid patients over a one year period in Washington State showed that ER visits were reduced by 9.9%, reduced visits by frequent clients were reduced by 10.7%, reduced visits resulting in a narcotic prescription were reduced by 24%, and low acuity visits were reduced by 14.2%.  The conclusion in Washington State is that these results show better care and significant savings.

HEALTHeLINK seeks to start a pilot EDIE program to achieve similar positive outcomes.