Electronic Patient Records Lead to More Sharing, Less Testing

April 19--The facial tics of Dr. Paul Satterlee's patient were vexing -- maybe it was a neck injury, or bad strep throat? -- until the ER doctor used a record-checking system to view the patient's records from a competing hospital and discovered the young man had recently received a double dose of antipsychotic drugs.

What could have been hours of tests and monitoring ended with a quick script to treat drug-induced dystonia.

"All I had to do was give him Benadryl," Satterlee said, "and it was over in five minutes."

Anecdotes such as Satterlee's have long been the only evidence that electronic record-sharing achieves a common goal of hospitals, insurers, politicians and others of avoiding unnecessary tests. But new data from Allina Health is providing some of the first hard proof that it actually pays off.

Examining the care provided in 2012 to 1,419 ER patients at four Allina Hospitals, Satterlee and other researchers found that 560 tests and procedures were avoided when doctors first checked their patients' records at other hospitals and clinics. Four angiograms, 115 CT scans and 58 ultrasounds were among the procedures avoided because they were recently performed elsewhere, according to the study results, released Thursday.

Duplicate tests never used to be a concern for emergency room doctors rushing to diagnose new patients, but skyrocketing health care costs demand less waste, Satterlee said. "Emergency departments have always been able to bury their heads ... when it comes to efficiency. 'Oh, it's an emergency. Everything is off the table. You can do whatever you want.' We just can't practice in a vacuum anymore."

Most health care systems in Minnesota have record-keeping systems that allow for in-house communication; Allina's clinics and hospitals all have access to the same electronic patient records. But communicating between electronic systems isn't as common.

While 91 percent of hospitals can share records within their own systems, only 46 percent can share information electronically with other hospitals, according to 2012 survey results by the Minnesota Department of Health.

The survey is tracking the progress of medical providers to meet a 2015 state mandate to have electronic record-keeping systems in place. At a minimum, hospitals and clinics will need to be able to share records with other providers via secure e-mail by next year.

"The good news is that we're making progress," said Marty LaVenture, director of health informatics for the Minnesota Department of Health.

It wasn't long ago that LaVenture and his wife were carting their parents' paper medical records from one clinic across the street to another clinic, because electronic record sharing didn't exist, he recalled.

Analyzing ER visits over six months in 2012, researchers found that Allina's Care Everywhere record-sharing system was only used in 1.46 percent of cases. In some cases, a lookup was unnecessary because patients only used Allina doctors. In others, doctors or nurses were too rushed or didn't feel it was necessary.

Researchers knew when ER doctors declined to perform duplicate tests because they often documented why they didn't perform them for liability reasons, said Tamara Winden, a lead author of the study, published in the Journal of Applied Clinical Informatics.

A follow-up study will estimate the savings of sparing these tests, which Winden said could be substantial when considering that one angiogram costs around $4,000.

A barrier to electronic information-sharing has been the use of different record-keeping systems that couldn't communicate with one another. At the time of the study, Allina could only draw information from other hospital providers such as Fairview and HealthPartners that also used Epic record-keeping systems.

State health officials at one point were planning a statewide hub to translate patient records between hospitals with different systems, but LaVenture said federal funding was lacking and advances in technology made it unnecessary.

Allina now has the ability to obtain electronic patient records from any system, Winden said.

Satterlee said hospitals need to adapt their practices to make the lookup system more useful, perhaps by having front-desk personnel or nurses ask patients right away whether they have recently visited other hospitals or clinics. But the results are already superior to what he got in year's past when he called other hospitals for patient records.

"In the middle of the night, medical record places are pretty thinly staffed," he said. "Five years ago, you were calling, hoping somebody would pick up the phone, and then they'd send you 30 pages of faxes."

Copyright 2014 - Star Tribune (Minneapolis)