During this brief one year period, we found that 25% of the patients with more than one visit also visited one of the other five hospital systems, accounting for 19% of all visits. Our estimates for the rates of patient flow among different hospital systems are likely fairly reliable given that the INPC “captured” an estimated 92% of all Indianapolis ED visits.
This is the first study to describe the pattern of ED usage in a large community setting. Over this one year period, almost one out of five patient encounters, 19%, had clinical data in another hospital system. Although only 7.6% of the total number of patients sought ED medical care in more than one hospital setting during this one year period, we found that 60% of these same ED patients had clinical data scattered in more than one hospital system over a longer period of time.
We made two decisions that could potentially limit our results. First, we only looked at one year of ED visit data and second, we made the assumption that records from a single healthcare system (with multiple EDs) would be available from within that hospital system. However, even with these limitations, if we were to extrapolate these “crossover” rates nationally, the CDC data suggests 20.6 million ED visits would have clinical information located in another, separate facility.
These results provide a single estimate of the additional clinical value a community clinical data exchange network may play in comparison to the alternative of multiple independent institutional EMRs. Further opportunities exist for a community clinical data exchange network to directly influence ED medical care. Our earlier findings suggest that such a community clinical data exchange network is potentially cost-saving.3
The fully realized value of such a system will be a complex function of crossover rates, the richness of the data available, and the presentation of the data.
We have indirectly evaluated the potential benefits of a community clinical data exchange network to individualized patient care. Such value will likely be ultimately assessed by multiple approaches -- e.g., adherence to standards of care, mortality, and cost savings.
In addition to individualized clinical care, such systems are likely to prove invaluable to epidemiologic and other forms of research. They can also help justify efforts necessary to identify unique patients, standardize messages, merge clinical data, and provide the underlying network necessary to construct and maintain such a network. Insofar as patients only visit a single hospital care system, an institution-wide EMR is completely adequate. Not surprisingly, we found evidence that the proportion of patients with such opportunities increased when we looked at a longer observation period and data generated in multiple care settings.
The Institute of Medicine report suggests regional computer based patient records could result in both time and cost savings for both the patient and physician. A community clinical data exchange network may well reduce diagnostic testing and its attendant discomfort and cost, better prescribing, as well as the epidemiologic research and outcomes management opportunities.7, 8
We are just beginning to realize the full potential of collecting such clinical information. Once these clinical information systems are integrated, data must be transformed into useful information and knowledge to guide clinical decision-making, continuous quality improvement, and reduce the cost of health care delivery.