Influence of Previous Emergency Department Visit Information on Care of Current Patients.

Abstract

Introduction: Past patient data from health information exchanges (HIE) can enhance physician-patient interactions, although how and how often is unclear. We sought to determine how and how often past medical records provided by an HIE impacts current decision-making by emergency physicians.

Methods: We identified qualifying emergency department (ED) visits between September 24-26, 2022. The primary feature of a qualifying visit was a separate ED visit within three days prior at a separate hospital system. Fifty-five charts with essential details of each patient's most recent visit were reviewed in duplicate by 22 emergency medicine residents. Reviewers accessed prior medical records for each patient via an HIE clinical viewer. The primary outcome was the influence of knowledge from prior records on interactions during the most recent visit, measured with 11 Likert-scale ratings. Reviewer agreement was used as an indicator of confidence.

Results: Reviewers most frequently agreed that the information from the prior visit was valuable "a moderate amount" (25% of all reviewer pairs) and agreed that the information would cause them to change their approach (69%). They would adjust treatment protocols because of understanding what had been tried previously (67%) and ask the patient different questions (78%). There was also agreement that they would further compare laboratory tests or imaging between visits (67%) and better understand patient behavioral patterns (73%).

Conclusion: Access to patients' previous medical records (diagnoses, imaging reports, discharge reports, etc) via HIEs impacts how emergency physicians communicate with patients, evaluate cases, and make medical decisions.