Even with the significant investments made by the federal government, hospitals, and physicians over the past 10 years, it is critical to remember that health information exchange is an evolution, not a revolution.¹ The migration from paper to electronic records has been fraught with difficulty, resulting in decreased productivity among physicians during implementation and clunky user interfaces and possibly contributing to burnout—but it has changed the practice of medicine for good. Instead of making clinical care easier, physicians now only spend 49 percent of their time with patients. The majority of their time is spent striking the keys behind the computer.²

Physicians truly display a love-hate relationship with health information technology in the clinical setting. On one hand, charts are legible, it is easy to look up old visits, and macros make documentation easier. On the other, there is an inordinate amount of useless text in the notes; the system is built for billing, not medical care; and it is nearly impossible to figure out how to order an insulin drip these days.

Yet the electronic takeover of health care does come with some tangible benefits to patients and to the overall health care system. Two recently reviewed studies, applicable to health information exchange in the emergency department setting, demonstrate shorter emergency department visits and decreased utilization of CT scans, MRIs, radiographs, and hospital admission.^3,4

According to the ACEP revised policy, “Health Information Technology Standards,” emergency physicians demand “seamless integration of data” and request that patient information is available in a “timely, usable, and secure manner.”⁵ As these data demonstrate, when these goals are achieved by an electronic health record, patient visits are more efficient and less costly. Patients faced charges that were nearly $1,200 lower when clinicians used the electronic medical record (EMR) than with paper records.

ACEP additionally recommends that its members become proponents of interoperable systems prior to institutions implementing expensive platforms that do not suit the needs of emergency physicians. If there is a system you think is especially useful, let your C-suite know about it before it invests in a product that will relegate you to being a disgruntled data-entry monkey.

Policymakers, hospital executives, and EMR entrepreneurs should all heed the words of Louis Yu, MD, MA, from our EMRA+PolicyRx Health Policy Journal Club: “Better, faster, and more interconnected systems for information exchange have the potential to make a difference in patient care and in the cost of care provided.”⁶Another EMRA+PolicyRx Health Policy Journal Club article, reprinted here, examines the effect of health information exchanges on several patient-oriented outcomes.

Dr. Dark is assistant professor of emergency medicine at Baylor College of Medicine in Houston and executive editor of PolicyRx.org.

References

1. Douglas M. Misadventures in interoperability. Policy Prescriptions website. Accessed Dec. 14, 2018.
2. Jacobs R. Docs spend too much time behind a computer. Policy Prescriptions website. Accessed Dec. 14, 2018.
3. Goldstein E. Is there benefit to HIE in the ED? Policy Prescriptions website. Accessed Dec. 14, 2018.
4. Medford-Davis L. Less is more: HIE prevents repeat tests. Policy Prescriptions website. Accessed Dec. 14, 2018.
5. American College of Emergency Physicians. Health information technology standards. ACEP website. Accessed Dec. 14, 2018.
6. Yu L. Sharing is caring. Policy Prescriptions website. Accessed Dec. 14, 2018.