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Study finds using electronic medical records in emergency room reduces unneeded lab tests, scans

It’s not just doctors and nurses who can make a difference for patients in the emergency room.

Make room for medical assistants.

It’s their computer work that makes them helpful, according to a study that analyzed the care of more than 2,000 emergency room patients at three local hospitals.

Doctors can drastically reduce unnecessary laboratory tests and radiology exams if they routinely check an electronics medical records system, the Brookings Institution study found.

But over the past decade, even with the federal government awarding about $550 billion in grants to build health information exchanges like HEALTHeLINK, the Western New York version, doctors rarely take the time to query the exchanges.

“The exchanges only work if physicians use them,” said Niam Yaraghi, a Brookings Institution fellow who authored the study.

The study, published in the Journal of the American Medical Informatics Association, focused on patient cases last year at Buffalo General Medical Center, Kenmore Mercy Hospital and Erie County Medical Center.

The research examined cases for 737 patients in which an assistant queried electronic records for patient medical histories and 1,275 patients in which assistants were not available.

The results were dramatic.

The number of lab tests ordered in the emergency departments was reduced by 52 percent and radiology exams, such as CT scans, by 36 percent, when assistants were used, the study found.

The study also suggested that employing medical assistants to look up patient histories on a computer can encourage doctors to use an information exchange and save enough money to justify the cost of hiring them.

“This study was completely unnecessary,” said Yaraghi, who serves as an unpaid consultant to HEALTHeLINK. “You don’t need such a detailed study to show that access to more patient information will help doctors. It is logical, like knowing that a parachute will prevent injury.”

HEALTHeLINK is a nonprofit consortium in Western New York that is building the system for sharing patient medical records from hospitals, insurers and medical groups in the region.

The thinking is that the electronic exchange of medical data will significantly reduce redundant, costly and often harmful medical tests and procedures.

Major barriers exist to the development and greater use of health information exchanges.

Taking time to go through the steps on a computer screen to access information is disruptive for doctors if they’re also talking to a patient. In addition, there is a lack of common standards among the different software hospitals, doctors and others in health care use for their electronic medical records.

Western New York is considered a pioneer in the development of a health information exchange. The progress of HEALTHeLINK, whose formation dates back to 2001, led the Office of the National Coordinator for Health Information Technology in 2010 to select the organization as one of 17 in the country to receive major federal grants in hopes of creating models for others to follow.

More than 730,000 patients in the region have given consent for their medical records to be included in HEALTHeLINK, and there were more than 1 million queries to the system last year.

“We know anecdotally that the exchange provides value. The study puts data around that,” said Daniel E. Porreca, executive director of the organization.

Indeed, the study arrives as experts call for more research into health information exchanges to figure out what works best.

“People are overinvesting in technology, thinking it will provide a solution,” said Dr. Michael Cropp, chief executive officer of Independent Health and a member of the HEALTHeLINK board of directors. “But if the technology doesn’t fit into the work processes, it doesn’t get used.”

Cropp said the use of personnel to gather patient histories from the exchange in advance of an initial visit to a primary care doctor or at the point of service in an emergency room can improve the quality and efficiency of care.

Proving that health information exchanges provide a sizable return on investment is important for other reasons. Communities must confront how to handle the major loss of revenue at their hospitals if the exchanges do dramatically reduce unnecessary tests and procedures.

“I don’t know any hospital CEO who would sacrifice quality for an extra X-ray,” said John Bartimole, president of the Western New York Healthcare Association, which represents many hospitals in the region.

He and others said a seismic shift is under way as Medicare and private insurers move away from fee-for-service payments and toward reimbursement tied to quality and value.

“There is no doubt that this will hurt in the short term,” said Bartimole. “Hospitals need to be rewarded for using the system. That will increase efficiency and result in a win-win for everyone in the long term.”