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Efficiency and Economic Benefits of a Payer‐based Electronic Health Record in an Emergency Department
Author(s) -
Daniel Gregory W.,
Ewen Edward,
Willey Vincent J.,
Reese, IV Charles L.,
Shirazi Farshad,
Malone Daniel C.
Publication year - 2010
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/j.1553-2712.2010.00816.x
Subject(s) - medicine , emergency department , electronic health record , health plan , confidence interval , health records , pharmacy , medical record , observational study , payment , propensity score matching , family medicine , emergency medicine , medical emergency , health care , nursing , world wide web , computer science , economics , economic growth
ACADEMIC EMERGENCY MEDICINE 2010; 17:824–833 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives: The objective was to evaluate the use of a payer‐based electronic health record (P‐EHR), which is a clinical summary of a patient’s medical and pharmacy claims history, in an emergency department (ED) on length of stay (LOS) and plan payments. Methods: A large urban ED partnered with the dominant health plan in the region and implemented P‐EHR technology in September 2005 for widespread use for health plan members presenting to the ED. A retrospective observational study design was used to evaluate this previously implemented P‐EHR. Health plan and electronic hospital data were used to identify 2,288 ED encounters. Encounters with P‐EHR use ( n = 779) were identified between September 1, 2005, and February 17, 2006; encounters from the same health plan ( n = 1,509) between November 1, 2004, and March 31, 2005, were compared. Outcomes were ED LOS and plan payment for the ED encounter. Analyses evaluated the effect of using the P‐EHR in the ED setting on study outcomes using multivariate regressions and the nonparametric bootstrap. Results: After covariate adjustment, among visits resulting in discharge (ED‐only), P‐EHR visits were 19 minutes shorter (95% confidence interval [CI] = 5 to 33 minutes) than non‐P‐EHR visits. Among visits resulting in hospitalization, the P‐EHR was associated with an average 77‐minute shorter ED LOS (95% CI = 28 to 126 minutes), compared to non–P‐EHR visits. The P‐EHR was associated with an average of $1,560 (95% CI = $43 to $2,910) lower total plan expenditures for hospitalized visits. No significant difference in total payments was observed among discharged visits. Conclusions: In the study ED, the P‐EHR was associated with a significant reduction in ED LOS overall and was associated with lower plan payments for visits that resulted in hospitalization.