Advancing Quality Measurement and Care Improvement with Health Information Exchange

Crowding of emergency departments (EDs) is worsening with visits increasing and many already operating at maximum capacity. Worsening the situation has been the closing of some EDs. Crowding is associated with increased morbidity and mortality and greater risk of poor quality of care. Currently, most quality measurement is not shared nor compared between institutions. Health information exchanges (HIEs) make it possible to measure quality across institutions in a patient-centric manner by gathering data wherever a patient seeks care, thus more accurately reflecting the overall healthcare system.

The goal of this project was to validate two HIE-enabled quality measures for potentially preventable ED visits: 1) early ED returns (within 72 hours) and 2) frequent ED users. The project was implemented with Healthix, one of the largest HIEs in the country. Because Healthix spans most of the major hospitals in New York City, it provides an ideal mechanism for implementing and evaluating these measures.

The specific aims of the project were as follows:

• Validate the use of HIE data for two quality measures when compared with site-specific EHR data. 
• Retrospectively measure the change in ability to employ these measures using HIE data. 
• Implement these HIE-enhanced measures and prospectively measure changes in their performance. 

Researchers retrospectively compared measures using HIE data to site-specific EHR data provided by four hospitals to validate use of the Healthix data. They also conducted retrospective observational studies comparing use of HIE-wide to site-specific data for both measures. Additionally, they built, implemented, and measured the performance of 1) a monthly HIE-based early ED returns report in an existing quality assurance program and 2) a real-time HIE-based frequent ED user notification service. The number of patients identified in the HIE report versus an EHR-based notifications report were compared.

Investigators increased their ability to identify frequent ED users using HIE-wide data compared with site-specific data by 16 percent. By employing HIE data, researchers also increased their ability to identify 72-hour ED returns by an average of 11.16 percent. Using the HIE notifications, investigators identified 34 percent more frequent ED users than when using the EHR-based report. In this study, investigators validated the secondary use of community-wide, real-time clinical data from an HIE, significantly increasing the ability to identify early return visits and frequent ED user populations. The researchers believe that additional studies and new use cases will be found for this data created through the implementation of query-based HIEs.