Itamar Shabtai

Using Electronic Medical Record Systems for Admission Decisions in Emergency Departments: Examining the Crowdedness Effect

Many medical organizations have deployed electronic medical record (EMR) information systems (IS) to improve medical decision-making and increase efficiency. Despite their advantages, however, EMR IS may make less of a contribution in the stressful environment of an emergency department (ED) that operates under tight time constraints. The high level of crowdedness in the EDs itself can cause physicians to make medical decisions resulting in more unnecessary admissions and fewer necessary admissions. Thus this study evaluated the contribution of an EMR IS to physicians by investigating whether EMR IS leads to improved medical outcomes in points of care in EDs under different levels of crowdedness. For this purpose a track log-file analysis of a database containing 3.2 million ED referrals in seven main hospitals in Israel (the whole population in these hospitals) was conducted. The findings suggest that viewing medical history via the EMR IS leads to better admission decisions, and reduces the number of possibly avoidable single-day admissions. Furthermore, although the ED can be very stressful especially on crowded days, physicians used EMR IS more on crowded days than on non-crowded days. These results have implications as regards the viability of EMR IS in complex, fast-paced environments.

EHR in Emergency Rooms: Exploring the Effect of Key Information Components on Main Complaints

This study characterizes the information components associated with improved medical decision-making in the emergency room (ER). We looked at doctors’ decisions to use or not to use information available to them on an electronic health record (EHR) and a Health Information Exchange (HIE) network, and tested for associations between their decision and parameters related to healthcare outcomes and processes. Using information components from the EHR and HIE was significantly related to improved quality of healthcare processes. Specifically, it was associated with both a reduction in potentially avoidable admissions as well as a reduction in rapid readmissions. Overall, the three information components; namely, previous encounters, imaging, and lab results emerged as having the strongest relationship with physicians’ decisions to admit or discharge. Certain information components, however, presented an association between the diagnosis and the admission decisions (blood pressure was the most strongly associated parameter in cases of chest pain complaints and a previous surgical record for abdominal pain). These findings show that the ability to access patients’ medical history and their long term health conditions (via the EHR), including information about medications, diagnoses, recent procedures and laboratory tests is critical to forming an appropriate plan of care and eventually making more accurate admission decisions.

Using electronic health record systems to optimize admission decisions: The Creatinine case study

Many medical organizations have implemented electronic health record (EHR) and health information exchange (HIE) networks to improve medical decision-making. This study evaluated the contribution of EHR and HIE networks to physicians by investigating whether health information technology can lead to more efficient admission decisions by reducing redundant admissions in the stressful environment of emergency. Log-files were retrieved from an integrative and interoperable EHR that serves seven main Israeli hospitals. The analysis was restricted to a group of patients seen in the emergency departments who were administered a Creatinine test. The assessment of the contribution of EHR to admission decisions used various statistical analyses and track log-file analysis. We showed that using the EHR contributes to more efficient admission decisions and reduces the number of avoidable admissions. In particular, there was a reduction in readmissions when patient history was viewed. Using EHR can help respond to the international problem of avoidable hospital readmissions.

The connection between viewing medical historical information and using-clinical tests

Health information exchange HIE interoperable networks are rapidly becoming the preferred infrastructure for transferring medical data and information between healthcare organisations. This study explored whether the use of interoperable networks such as HIE that provide physicians with medical history affects the rate of ordering tests and using imaging services. The database contains admissions to all interim and surgical departments in two hospitals. Results show that, the use of historical information did not reduce the rate of ordering imaging services. In fact, the rate increased for tomography, ultrasound, etc. Further analysis showed that test order rate depends on the diagnosis type of insurance, and age. Thus, physicians make use of historical information, and are aware of its importance. There was a positive relationship between using medical history on medical tests and current ordering. Hence, the likelihood of using tests performed in the past increases when the medical history is reviewed.