Can EHR Use Lower ER Use?

By Scott Harris

Patients who can get in touch with their regular providers outside of normal business hours don’t visit the emergency room as often as those who can’t, according to a new study.

A report published in December by the journal Health Affairs found patients who reported less difficulty reaching a clinician after hours visited the emergency department less frequently than those who had more difficulty (30.4 percent compared with 37.7 percent). Perhaps unsurprisingly, those with less difficulty also reported having lower rates of unmet medical need (6.1 percent versus 13.7 percent) than others.

“About one in five people had a really hard time reaching somebody,” said study author Ann S. O’Malley, MD, MPH, senior fellow at the Center for Studying Health System Change in Washington. “Those who had an easier time had lower rates of emergency room use.”

O’Malley noted that, in some instances, after-hours care may require more than making a nurse or two available to answer questions.

“Patients with chronic or complex conditions prefer to have direct contact with their doctor,” she said. “It’s important for patients, especially in bigger systems, to talk to someone who knows them, especially for complex or special-needs cases.”

In the study, O’Malley recommended more funding and support to help primary care practices provide after-hours care through a variety of tools, including phone, email, and in-person visits. Internally, better notification processes and “evidence-based triage protocols” can help on-call clinicians make better, quicker decisions and share information more efficiently, O’Malley said.

Perhaps one of the most effective tools, however, is the electronic health record (EHR). More practices are switching over, but because creating these systems can be expensive and time-consuming, larger operations like academic medical centers have been quicker to adopt them. FIU Health, the faculty practice of Herbert Wertheim College of Medicine at Florida International University, switched to EHRs in November. One of the specific goals of the switch was enhancing after-hours care, and though no one can take the place of a patient’s personal nurse or doctor, EHRs can help make clinicians more familiar with each individual situation.

“We have always had providers on call, and now they can easily look into the patient’s record,” said Amy Metula, RN, MBA, director of quality management for the college’s health care network. “You can see things like lab results right away, and that definitely makes a difference.”

Though the newness of the system precludes hard outcomes data for the time being, Metula said she believes it has improved both care and patient satisfaction with FIU Health.

“I believe it really does decrease the need to go to the ER,” Metula said. “It streamlines the process of getting and giving care for the patient and the provider, whether it’s after hours or normal hours.”

0 thoughts on “Can EHR Use Lower ER Use?

  1. When 80% or more of Emergency Department visits are for reasons that do not include emergencies or trauma and 60% are attributable to individuals who have a regular physician, the solution to ED over-utilization is not likely to be technological–as in expanding the use of EHR’s. It has long been known that the “emergency” driving a high proportion of ED visits is that the precipitating event occurs at a time outside usual medical office hours. Caregivers–whether physicians, medical groups, nurses, or other trained personnel functioning under even remote physician supervision–are not automatons. They need rest like the rest of us and they must be compensated for the time and knowledge expended in responding to a call or email from or on behalf of a patient. The reimbursement system for professional services has not evolved sufficiently in this regard so patients, with regular physicians, turn to the 24/7 source of care, the ED. This is a poor use of scarce resources to be sure, but if the solution to ED over utilization for the wrong reasons were to ensure the ability of patients to access an EHR, it would behoove society to provide smart phones and an 800 number or url to everyone.

    Complex problems are rarely, if ever, solved by simple solutions.

    James E. Lewis, Ph.D.