The world of information technology is rapidly changing, yet changes in health care have been slow.1–3 The science supporting how information technology will affect regionalization is sparse in many areas, although it is growing. The purpose of this article is to report on the efforts of the 2010 Academic Emergency Medicine consensus conference workgroup tasked with exploring the research agenda for how to improve regionalization through electronic collaboration. We decided to focus on the following broad topics: electronic health record (EHR) implementation, regional health information exchange (HIE), Web-based collaborative tools, personal health records, and telemedicine.
When considering EHRs, it is necessary to consider the nationwide status of emergency department (ED) EHR implementation. The 2003 survey by Pallin et al.4 and the recent work of Landman et al.5 suggest low levels of full implementation, although recent publications suggest both improved efficiencies and financial gain can be achieved with comprehensive implementation of fully integrated EHRs.6,7 The question now is not if EDs will implement fully functioning EHRs, but when. The next wave of implementation work will involve ED EHR integration of prehospital data and should help answer whether capturing and sharing prehospital data improves the overall care of patients.
While EDs implement EHRs, will currently available technology be employed in other realms to enhance regional networks of care? We already know that regional stroke centers, trauma centers, and heart centers can improve outcomes.8–10 Perhaps simply sharing, comparing, and studying the protocols already in place that drive physician decision-making can affect care and quality across regions.
The other use of information technology currently being studied is the data obtained and shared in regional health information organizations (RHIOs). Improvements in efficiency and cost savings may be early benefits, with decreased duplicate testing and potentially avoidable admissions—with further benefits to the ED from that increased efficiency (i.e., decreased length of stay) and decreased invasive testing. Tests from transferring hospitals and other provider organizations would be readily available in a fully developed HIE implementation, obviating the need to repeat tests at the receiving facility. A functional HIE platform should bring about improved safety and quality at transitions of care, with the ability to view and reconcile medication lists, allergies, and more.
Promoting direct patient involvement in electronic records has been espoused by mainstream vendors such as Microsoft, Google, Intel, and WebMD, with their personal health records (PHR) products, as well as by ED information system (EDIS) vendors with their own version of PHRs. While hospital-based EHRs have made electronic health data more prevalent, sharing these data outside hospital walls has been a challenge. Regulations like those resulting from the Health Insurance Portability and Accountability Act (HIPAA), security concerns, and the general fear of liability have created obstacles for sharing of protected health information. Realization of potential benefits,11 and legislation like the American Recovery and Reinvestment Act of 2009 (ARRA) requiring health data to be shared with patients, will ensure increased acceptance of PHRs in the future.
Finally, electronic collaboration in regionalization means a more prominent role for telemedicine. Teleconsults have the potential to reduce admissions and length of stay, while expanding a specialist’s coverage area and improving patient satisfaction. The most appropriate form that telemedicine will take will likely depend on the patient—because of both the disease and the demographic. Incarcerated patients, nursing home and debilitated patients, rural patients, and school children are among the populations who could especially benefit from telemedicine. Already there are success stories and encouraging data, but significant challenges remain before robust telemedicine solutions can be employed in regionalized care networks.