J Am Med Inform Assoc 19:328-333 doi:10.1136/amiajnl-2011-000394
  • Research and applications
  • Focus on health information technology, electronic health records and their financial impact

The financial impact of health information exchange on emergency department care

Open Access
  1. Qingxia Chen4
  1. 1Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
  2. 2Owen Graduate School of Management, Vanderbilt University, Nashville, Tennessee, USA
  3. 3Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
  4. 4Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
  5. 5Information Services, Tennessee Hospital Association, Nashville, Tennessee, USA
  1. Correspondence to Dr Mark Frisse, Vanderbilt Center for Better Health, 3401 West End Avenue, Suite 290, Nashville, TN 37203, USA; mark.frisse{at}
  • Received 24 May 2011
  • Accepted 5 October 2011
  • Published Online First 4 November 2011


Objective To examine the financial impact health information exchange (HIE) in emergency departments (EDs).

Materials and Methods We studied all ED encounters over a 13-month period in which HIE data were accessed in all major emergency departments Memphis, Tennessee. HIE access encounter records were matched with similar encounter records without HIE access. Outcomes studied were ED-originated hospital admissions, admissions for observation, laboratory testing, head CT, body CT, ankle radiographs, chest radiographs, and echocardiograms. Our estimates employed generalized estimating equations for logistic regression models adjusted for admission type, length of stay, and Charlson co-morbidity index. Marginal probabilities were used to calculate changes in outcome variables and their financial consequences.

Results HIE data were accessed in approximately 6.8% of ED visits across 12 EDs studied. In 11 EDs directly accessing HIE data only through a secure Web browser, access was associated with a decrease in hospital admissions (adjusted odds ratio (OR)=0.27; p<0001). In a 12th ED relying more on print summaries, HIE access was associated with a decrease in hospital admissions (OR=0.48; p<0001) and statistically significant decreases in head CT use, body CT use, and laboratory test ordering.

Discussion Applied only to the study population, HIE access was associated with an annual cost savings of $1.9 million. Net of annual operating costs, HIE access reduced overall costs by $1.07 million. Hospital admission reductions accounted for 97.6% of total cost reductions.

Conclusion Access to additional clinical data through HIE in emergency department settings is associated with net societal saving.


  • Funding This work was funded in part through Agency for Healthcare Research and Quality (AHRQ) contract 290-04-0006 and the State of Tennessee. This publication has not been approved by AHRQ.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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