Indiana ER Visits Highlight Need for Health Information Access

 Indiana is the first state to have its emergency care examined for patterns, and the findings could have an impact on health information exchange policy.

The three-year study by the Regenstrief Institute — a joint enterprise of the Regenstrief Foundation, Inc.; the Indiana University School of Medicine; and the Health and Hospital Corporation of Marion County, Indiana — found that 40% of emergency visits were by patients who visited more than one emergency department (ED).

According to researchers, the discovery challenges the concept that patients are bound to health systems and repeatedly visit local facilities.

The study revealed a wide range of the number of visits per patient to the ED, from one all the way to 385. And nearly all EDs in the state shared patients with almost every other ED.

Shaun Grannis, MD, MS, the senior study author, said the findings are important for strategies and technology being created to link medical information electronically. And the results do challenge “premises upon which health information exchange policy and technology have been based.”

“Since emergency departments can’t predict when patients will appear or know in what other places they have been seen, all EDs need instant access to information from wide swaths of geographic areas and actually the entire nation,” Grannis said.

Better electronic access to a patient’s information is especially important in the ED, where they can be too ill or injured to provide the necessary information — medications, medical history, allergy information, etc.

“What may appear to be a simple problem is no longer simple when someone comes in for a second or third ED visit for the same issue,” said Regenstrief Institute investigator John T. Finnell, MD, MS, an author of the study. “You are no longer thinking ear ache, you are thinking possible bone infection. Knowing that a patient who comes to the ED with chest pain had a recent clear cardiac scan will make a difference in treatment.”

Although specific to Indiana, Finnell said that ED use is likely to be similar in other states.