Division of General Internal Medicine, Department of Medicine, University of Tennessee Health Science Center, 956 Court Avenue, Coleman D222, Memphis, TN 38163, USA.
J Gen Intern Med. 2013 Feb;28(2):176-83. doi: 10.1007/s11606-012-2092-7. Epub 2012 May 31.
Health information exchange (HIE) is advocated as an approach to reduce unnecessary testing and improve quality of emergency department (ED) care, but little evidence supports its use. Headache is a specific condition for which HIE has theoretical benefits.
To determine whether health information exchange (HIE) reduces potentially unnecessary neuroimaging, increases adherence with evidence-based guidelines, and decreases costs in the emergency department (ED) evaluation of headache.
Longitudinal data analysis
All repeat patient-visits (N = 2,102) by all 1,252 adults presenting with headache to a Memphis metropolitan area ED two or more times between August 1, 2007 and July 31, 2009.
Use of a regional HIE connecting the 15 major adult hospitals and two regional clinic systems by authorized ED personnel to access the patient's record during the time period in which the patient was being seen in the ED.
Diagnostic neuroimaging (CT, CT angiography, MRI or MRI angiography), evidence-based guideline adherence, and total patient-visit estimated cost.
HIE data were accessed for 21.8 % of ED patient-visits for headache. 69.8 % received neuroimaging. HIE was associated with decreased odds of diagnostic neuroimaging (odds ratio [OR] 0.38, confidence interval [CI] 0.29-0.50) and increased adherence with evidence-based guidelines (OR 1.33, CI 1.02-1.73). Administrative/nursing staff HIE use (OR 0.24, CI 0.17-0.34) was also associated with decreased neuroimaging after adjustment for confounding factors. Overall HIE use was not associated with significant changes in costs.
HIE is associated with decreased diagnostic imaging and increased evidence-based guideline adherence in the emergency evaluation of headache, but was not associated with improvements in overall costs. Controlled trials are needed to test whether specific HIE enhancements to increase HIE use can further reduce potentially unnecessary diagnostic imaging and improve adherence with guidelines while decreasing costs of care.
健康信息交换（HIE）被倡导为一种减少不必要检测并提高急诊部门（ED）护理质量的方法，但几乎没有证据支持其使用。头痛是 HIE 具有理论优势的特定病症。
确定健康信息交换（HIE）是否减少潜在的不必要神经影像学检查，增加对循证指南的依从性，并降低头痛急诊评估的成本。
纵向数据分析
2007 年 8 月 1 日至 2009 年 7 月 31 日期间，孟菲斯都会区 ED 两次或两次以上就诊的所有 1252 名成人中，所有重复就诊患者（N=2102）。
在 ED 就诊期间，授权的 ED 工作人员使用连接 15 家主要成人医院和两个区域诊所系统的区域 HIE 访问患者的记录。
诊断性神经影像学（CT、CT 血管造影、MRI 或 MRI 血管造影）、循证指南的依从性和总患者就诊估计费用。
HIE 数据被访问用于 21.8%的头痛 ED 就诊患者。69.8%的患者接受了神经影像学检查。HIE 与降低诊断性神经影像学的可能性（优势比 [OR] 0.38，置信区间 [CI] 0.29-0.50）和增加对循证指南的依从性（OR 1.33，CI 1.02-1.73）相关。行政/护理人员 HIE 的使用（OR 0.24，CI 0.17-0.34）在调整混杂因素后也与神经影像学检查减少相关。总体 HIE 使用与成本无显著变化相关。
HIE 与头痛急诊评估中降低诊断成像和增加循证指南依从性相关，但与总体成本的改善无关。需要进行对照试验，以测试是否可以通过特定的 HIE 增强功能来进一步减少潜在的不必要诊断成像，并提高对指南的依从性，同时降低护理成本。
