The impact of electronic health records on care of heart failure patients in the emergency room
- Donald P Connelly1,2,
- Young-Taek Park3,
- Jing Du4,
- Nawanan Theera-Ampornpunt2,5,
- Bradley D Gordon6,7,
- Barry A Bershow8,
- Raymond A Gensinger Jr2,9,10,
- Michael Shrift11,
- Daniel T Routhe1,
- Stuart M Speedie2
- 1Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
- 2Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota, USA
- 3Division of Healthcare Finance Analysis and Research, Health Insurance Review and Assessment Service, Seoul, South Korea
- 4Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
- 5Health Informatics Division, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- 6Department of Emergency Medicine, Regions Hospital, St. Paul, Minnesota, USA
- 7HealthPartners Medical Group and Clinics, St. Paul, Minnesota, USA
- 8Bershow Consulting, LLC, Chanhassen, Minnesota, USA
- 9Corporate Services, Fairview Health Services, Minneapolis, Minnesota, USA
- 10Departments of Medicine and Nursing, University of Minnesota, Minneapolis, Minnesota, USA
- 11Clinical Decision Support, Allina Hospitals and Clinics, Minneapolis, Minnesota, USA
- Correspondence to Dr Donald P Connelly, University of Minnesota, MMC 609, Rm 775 Mayo Memorial Bldg, 420 Delaware St. SE, Minneapolis, MN 55455, USA;
- Received 22 March 2011
- Accepted 13 October 2011
- Published Online First 9 November 2011
Objective To evaluate if electronic health records (EHR) have observable effects on care outcomes, we examined quality and efficiency measures for patients presenting to emergency departments (ED).
Materials and methods We conducted a retrospective study of 5166 adults with heart failure in three metropolitan EDs. Patients were termed internal if prior information was in the EHR upon ED presentation, otherwise external. Associations of internality with hospitalization, mortality, length of stay (LOS), and numbers of tests, procedures, and medications ordered in the ED were examined after adjusting for age, gender, race, marital status, comorbidities and hospitalization as a proxy for acuity level where appropriate.
Results At two EDs internals had lower odds of mortality if hospitalized (OR 0.55; 95% CI 0.38 to 0.81 and 0.45; 0.21 to 0.96), fewer laboratory tests during the ED visit (−4.6%; −8.9% to −0.1% and −14.0%; −19.5% to −8.1%) as well as fewer medications (−33.6%; −38.4% to −28.4% and −21.3%; −33.2% to −7.3%). At one of these two EDs, internals had lower odds of hospitalization (0.37; 0.22 to 0.60). At the third ED, internal patients only experienced a prolonged ED LOS (32.3%; 6.3% to 64.8%) but no other differences. There was no association with hospital LOS or number of procedures ordered.
Discussion EHR availability was associated with salutary outcomes in two of three ED settings and prolongation of ED LOS at a third, but evidence was mixed and causality remains to be determined.
Conclusions An EHR may have the potential to be a valuable adjunct in the care of heart failure patients.
- Electronic health records
- emergency department
- heart failure
- clinical outcomes
- health IT adoption
- people and organizational issues
- emergency medicine
- medical informatics
- measuring/improving patient safety and reducing medical errors
- classical experimental and quasi-experimental study methods (lab and field)
- methods for integration of information from disparate sources
- supporting practice at a distance (telehealth)
- data models
- data exchange
- aintegration across care settings (inter- and intra-enterprise)
- human-computer interaction and human-centered computing
Funding This project was funded in part under grant number UC1 HS16155 from the Agency for Healthcare Research and Quality, Department of Health and Human Services.
Competing interests None.
Ethics approval The institutional review boards of the University of Minnesota (which also covers Fairview Health Services), Allina, and Health Partners approved this study.
Provenance and peer review Not commissioned; externally peer reviewed.