Efficiency and Economic Benefits of a Payer-based Electronic Health Record in an Emergency Department

Authors

  • Gregory W. Daniel PhD, MPH,

    1. From HealthCore, Inc. (GWD, VJW), Wilmington, DE; the Department of Medicine, Christiana Care Health System (EE), Newark, DE; the Department of Emergency Medicine, Christiana Hospital, Christiana Care Health System (CLR), Newark, DE; the Department of Emergency Medicine, University of Arizona College of Medicine (FS), Tucson, AZ; and the University of Arizona College of Pharmacy (DCM), Tucson, AZ. Dr. Willey is currently with the Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, Philadelphia, PA.
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  • Edward Ewen MD,

    1. From HealthCore, Inc. (GWD, VJW), Wilmington, DE; the Department of Medicine, Christiana Care Health System (EE), Newark, DE; the Department of Emergency Medicine, Christiana Hospital, Christiana Care Health System (CLR), Newark, DE; the Department of Emergency Medicine, University of Arizona College of Medicine (FS), Tucson, AZ; and the University of Arizona College of Pharmacy (DCM), Tucson, AZ. Dr. Willey is currently with the Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, Philadelphia, PA.
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  • Vincent J. Willey PharmD,

    1. From HealthCore, Inc. (GWD, VJW), Wilmington, DE; the Department of Medicine, Christiana Care Health System (EE), Newark, DE; the Department of Emergency Medicine, Christiana Hospital, Christiana Care Health System (CLR), Newark, DE; the Department of Emergency Medicine, University of Arizona College of Medicine (FS), Tucson, AZ; and the University of Arizona College of Pharmacy (DCM), Tucson, AZ. Dr. Willey is currently with the Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, Philadelphia, PA.
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  • Charles L. Reese, IV MD,

    1. From HealthCore, Inc. (GWD, VJW), Wilmington, DE; the Department of Medicine, Christiana Care Health System (EE), Newark, DE; the Department of Emergency Medicine, Christiana Hospital, Christiana Care Health System (CLR), Newark, DE; the Department of Emergency Medicine, University of Arizona College of Medicine (FS), Tucson, AZ; and the University of Arizona College of Pharmacy (DCM), Tucson, AZ. Dr. Willey is currently with the Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, Philadelphia, PA.
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  • Farshad Shirazi MD, PhD,

    1. From HealthCore, Inc. (GWD, VJW), Wilmington, DE; the Department of Medicine, Christiana Care Health System (EE), Newark, DE; the Department of Emergency Medicine, Christiana Hospital, Christiana Care Health System (CLR), Newark, DE; the Department of Emergency Medicine, University of Arizona College of Medicine (FS), Tucson, AZ; and the University of Arizona College of Pharmacy (DCM), Tucson, AZ. Dr. Willey is currently with the Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, Philadelphia, PA.
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  • Daniel C. Malone PhD

    1. From HealthCore, Inc. (GWD, VJW), Wilmington, DE; the Department of Medicine, Christiana Care Health System (EE), Newark, DE; the Department of Emergency Medicine, Christiana Hospital, Christiana Care Health System (CLR), Newark, DE; the Department of Emergency Medicine, University of Arizona College of Medicine (FS), Tucson, AZ; and the University of Arizona College of Pharmacy (DCM), Tucson, AZ. Dr. Willey is currently with the Philadelphia College of Pharmacy, University of the Sciences in Philadelphia, Philadelphia, PA.
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  • Presented at the International Society for Pharmacoeconomics and Outcomes Research, 14th Annual International Meeting, Orlando, FL, May 19, 2009, “Best Podium Presentation.”

  • Supervising Editor: Lowell W. Gerson, PhD.

Address for correspondence and reprints: Gregory W. Daniel, PhD, MPH; e-mail: gdaniel@healthcore.com.

Abstract

ACADEMIC EMERGENCY MEDICINE 2010; 17:824–833 © 2010 by the Society for Academic Emergency Medicine

Abstract

Objectives:  The objective was to evaluate the use of a payer-based electronic health record (P-EHR), which is a clinical summary of a patient’s medical and pharmacy claims history, in an emergency department (ED) on length of stay (LOS) and plan payments.

Methods:  A large urban ED partnered with the dominant health plan in the region and implemented P-EHR technology in September 2005 for widespread use for health plan members presenting to the ED. A retrospective observational study design was used to evaluate this previously implemented P-EHR. Health plan and electronic hospital data were used to identify 2,288 ED encounters. Encounters with P-EHR use (n = 779) were identified between September 1, 2005, and February 17, 2006; encounters from the same health plan (n = 1,509) between November 1, 2004, and March 31, 2005, were compared. Outcomes were ED LOS and plan payment for the ED encounter. Analyses evaluated the effect of using the P-EHR in the ED setting on study outcomes using multivariate regressions and the nonparametric bootstrap.

Results:  After covariate adjustment, among visits resulting in discharge (ED-only), P-EHR visits were 19 minutes shorter (95% confidence interval [CI] = 5 to 33 minutes) than non-P-EHR visits. Among visits resulting in hospitalization, the P-EHR was associated with an average 77-minute shorter ED LOS (95% CI = 28 to 126 minutes), compared to non–P-EHR visits. The P-EHR was associated with an average of $1,560 (95% CI = $43 to $2,910) lower total plan expenditures for hospitalized visits. No significant difference in total payments was observed among discharged visits.

Conclusions:  In the study ED, the P-EHR was associated with a significant reduction in ED LOS overall and was associated with lower plan payments for visits that resulted in hospitalization.

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