The impact of electronic health records on care of heart failure patients in the emergency room

• Published in: Journal of the American Medical Informatics Association : JAMIA 2012-05, Vol.19 (3), p.334-340
• Main Authors: Connelly, Donald P, Park, Young-Taek, Du, Jing, Theera-Ampornpunt, Nawanan, Gordon, Bradley D, Bershow, Barry A, Gensinger, Jr, Raymond A, Shrift, Michael, Routhe, Daniel T, Speedie, Stuart M
• Format: Article
• Language: English
• Subjects: Acuity; Adult; Age; Aged; Cross-Sectional Studies; Electronic Health Records; Emergencies; Female; Heart diseases; Heart Failure - therapy; Hospital Mortality; Hospitals; Humans; Informatics; Length of Stay; Logistic Models; Male; Medical Record Linkage; Minnesota; Mortality; Outcome Assessment (Health Care); Patient Admission; Races; Research and Applications; Retrospective Studies; Survival Analysis; Unnecessary Procedures - statistics & numerical data
• ISSN: 1067-5027; 1527-974X
• DOI: 10.1136/amiajnl-2011-000271

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). 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. 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. 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. An EHR may have the potential to be a valuable adjunct in the care of heart failure patients.