• Improving Health Information Exchange Utilization in an Emergency Department

      Schoenbaum, Anna (2016)
      Background: The healthcare industry is under pressure to improve the health of populations, enhance the patient experience, and lower cost across the continuum of care. Care coordination is the catalyst for improving interoperability in health data sharing especially in the emergency departments (EDs) where 136 million patients visit annually. Health information exchanges (HIEs) provide a longitudinal data record on patients, which can promote care coordination . The Prescription Drug Monitoring Program (PDMP), which is a separate database of the patient’s history of prescribed and dispensed controlled substance drugs, is not always included in the HIE. The patient’s prescription history is critical in delivery of care; therefore, it is recommended PDMP with HIE’s. The state of Maryland offers a HIE called CRISP. In January 2016, the target hospital ED implemented an embedded link in their electronic health record (EHR) to provide direct access to CRISP; however, access to the PDMP was not offered. Purpose: The purpose of this scholarly project was to develop, implement, and evaluate the impact of having HIE/PDMP data accessible in the EHR for ED providers. Methods: A health information technology innovation project was conducted mid-May to August 2016 in the ED of a 300-bed community hospital. The implementation involved PDMP registration; technical development to display PDMP when launching CRISP HIE button within the EHR; and training/communication. Data were collected pre-post HIE/PDMP implementation related to utilization, readmission, lab, imaging, and narcotic prescribing rates. Results: Findings indicated HIE utilization three months post PDMP implementation (M=238) was higher than the three months pre PDMP (M= 90.75). CRISP HIE registration of ED providers increased from 34% to 100%. Of the CRISP button users, HIE usage increased significantly with the PDMP implementation (M=33.83 to M=78.88, t (22) = -7.75, p <.001). A significant main effect of the CRISP HIE button indicated that access to the system changed narcotic prescription ordering at ED discharge (F (1, 23) = 30.583, p < .001) and narcotic ordering during the ED visit (F(1, 23) = 182.230, p < .001). There were no main effects or any interactions involving PDMP. Conclusion: Through streamlining PDMP registration, access, and clinical workflow, this scholarly project increased HIE/PDMP usage, which may potentially improve care coordination and patient outcomes. This project supports the need for technology advancement to improve accessing and viewing HIE/PDMP data.