Higher costs and utilization occurs among patients with diabetes mellitus when HbA1c results are not present in the electronic health record: a retrospective analysis (Preprint)

2021 ◽  
Author(s):  
Kimberly Anne Gudzune ◽  
Klaus Lemke ◽  
Anne K. Monroe ◽  
Jonathan P. Weiner
Keyword(s):  
Diabetes Mellitus ◽  
Emergency Department ◽  
Risk Stratification ◽  
Electronic Health Record ◽  
Information Exchange ◽  
Healthcare Costs ◽  
Population Level ◽  
Health Record ◽  
Laboratory Results ◽  
Electronic Health

BACKGROUND Clinical information may frequently be missing from the electronic health record (EHR), and contributes to delayed care, adverse events, and additional services, which may be costly. Missing laboratory data might be valuable marker for population-level risk stratification to help identify patients at risk of high cost and utilization. OBJECTIVE To determine whether absent hemoglobin HbA1c results in the EHR stratifies risk of high healthcare costs and utilization among adults with diabetes mellitus (DM). METHODS Retrospective U.S. cohort with EHR and claims data (2012-2013) of 6,270 continuously insured and care-engaged patients with DM who had ≥1 ambulatory visit in 2012. HbA1c availability defined as “HbA1c present” if ≥1 HbA1c EHR result was available in 2012 and otherwise as “HbA1c absent.” Patient’s annual healthcare costs, presence of any inpatient hospitalization, and presence of any emergency department (ED) visit in 2012 (concurrent) and 2013 (prospective).We used linear and logistic regression analyses, adjusting for age, gender and comorbidity, to determine associations with concurrent and prospective healthcare costs, emergency department (ED) visit, and hospitalization. RESULTS Overall, HbA1c result was absent from the EHR in 20.2%. Absent HbA1c status had significantly greater healthcare costs than HbA1c present (Concurrent difference: $5,081, p<0.001; Prospective difference: $5,489, p<0.001). Absent HbA1c status was significantly more likely to have an ED visit than HbA1c present (Concurrent: OR 1.44, p<0.001; Prospective: OR 1.29, p=0.01). No significant differences in hospitalization existed between groups. CONCLUSIONS Markers indicating absent laboratory results in the EHR, such as HbA1c availability, may be a promising population-level risk stratification approach. HbA1c availability appears to offer clinically relevant information associated with high healthcare costs and utilization. Future research might use markers identifying HbA1c or other laboratory results absent from the EHR to trigger various quality improvement interventions, such as health information exchange, clinical decision support, or care management.

scholarly journals Efficiency and Economic Benefits of a Payer-based Electronic Health Record in an Emergency Department

2010 ◽  
Vol 17 (8) ◽  
pp. 824-833 ◽  
Author(s):  
Gregory W. Daniel ◽  
Edward Ewen ◽  
Vincent J. Willey ◽  
Charles L. Reese IV ◽  
Farshad Shirazi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Electronic Health Record ◽  
Economic Benefits ◽  
Health Record ◽  
Electronic Health

Securing XML with Role-Based Access Control

2014 ◽  
pp. 334-365 ◽  
Author(s):  
Alberto De la Rosa Algarín ◽  
Steven A. Demurjian ◽  
Timoteus B. Ziminski ◽  
Yaira K. Rivera Sánchez ◽  
Robert Kuykendall
Keyword(s):  
Access Control ◽  
Electronic Health Record ◽  
Information Exchange ◽  
Security Policies ◽  
Health Record ◽  
Role Based Access Control ◽  
Future Trends ◽  
Security Framework ◽  
Electronic Health ◽  
Role Based

Today’s applications are often constructed by bringing together functionality from multiple systems that utilize varied technologies (e.g. application programming interfaces, Web services, cloud computing, data mining) and alternative standards (e.g. XML, RDF, OWL, JSON, etc.) for communication. Most such applications achieve interoperability via the eXtensible Markup Language (XML), the de facto document standard for information exchange in domains such as library repositories, collaborative software development, health informatics, etc. The use of a common data format facilitates exchange and interoperability across heterogeneous systems, but challenges in the aspect of security arise (e.g. sharing policies, ownership, permissions, etc.). In such situations, one key security challenge is to integrate the local security (existing systems) into a global solution for the application being constructed and deployed. In this chapter, the authors present a Role-Based Access Control (RBAC) security framework for XML, which utilizes extensions to the Unified Modeling Language (UML) to generate eXtensible Access Control Markup Language (XACML) policies that target XML schemas and instances for any application, and provides both the separation and reconciliation of local and global security policies across systems. To demonstrate the framework, they provide a case study in health care, using the XML standards Health Level Seven’s (HL7) Clinical Document Architecture (CDA) and the Continuity of Care Record (CCR). These standards are utilized for the transportation of private and identifiable information between stakeholders (e.g. a hospital with an electronic health record, a clinic’s electronic health record, a pharmacy system, etc.), requiring not only a high level of security but also compliance to legal entities. For this reason, it is not only necessary to secure private information, but for its application to be flexible enough so that updating security policies that affect millions of documents does not incur a large monetary or computational cost; such privacy could similarly involve large banks and credit card companies that have similar information to protect to deter identity theft. The authors demonstrate the security framework with two in-house developed applications: a mobile medication management application and a medication reconciliation application. They also detail future trends that present even more challenges in providing security at global and local levels for platforms such as Microsoft HealthVault, Harvard SMART, Open mHealth, and open electronic health record systems. These platforms utilize XML, equivalent information exchange document standards (e.g., JSON), or semantically augmented structures (e.g., RDF and OWL). Even though the primary use of these platforms is in healthcare, they present a clear picture of how diverse the information exchange process can be. As a result, they represent challenges that are domain independent, thus becoming concrete examples of future trends and issues that require a robust approach towards security.

Implementation of Electronic Health Record (EHR) System in the Healthcare Industry

2016 ◽  
pp. 1001-1016
Author(s):  
Robert P Schumaker ◽  
Kavya P. Reganti
Keyword(s):  
Electronic Health Record ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Health Management ◽  
Healthcare Delivery ◽  
Healthcare Services ◽  
Health Record ◽  
Healthcare Industry ◽  
Efficient Delivery ◽  
Electronic Health

The purpose of this research is to demonstrate the efficiency of the Electronic Health Record (EHR) software that is adopted in the healthcare industry to provide better patient care. The authors examine the impact of EHRs on the efficient delivery of healthcare services. More specifically, they detail the origin of EHR, its significance in modern healthcare delivery along with the selection and implementation criteria for EHR software. They present a survey on the extent of adoption of EHR by clinicians. They also highlight the challenges and barriers faced by organizations in adopting EHR software such as cost, workflow impact and data security. Finally, the authors contemplate the future of EHR, its role in the implementation of health information exchange and its implementation in the cloud. They conclude that the implementation of EHR in the cloud is an important step towards better health management across the population with the end-goal of better health outcomes.

Electronic Health Record–Assisted Reflex Urine Culture Testing Improves Emergency Department Diagnostic Efficiency

2019 ◽  
Vol 35 (3) ◽  
pp. 252-257 ◽  
Author(s):  
Ryan F. Coughlin ◽  
David Peaper ◽  
Craig Rothenberg ◽  
Marjorie Golden ◽  
Marie-Louise Landry ◽  
...  
Keyword(s):  
Emergency Department ◽  
Decision Support ◽  
Electronic Health Record ◽  
Urine Culture ◽  
Diagnostic Yield ◽  
Secondary Outcome ◽  
Health Record ◽  
Diagnostic Efficiency ◽  
Ed Visits ◽  
Electronic Health

The authors evaluated the effectiveness of an electronic health record (EHR)-based reflex urine culture testing algorithm on urine test utilization and diagnostic yield in the emergency department (ED). The study implemented a reflex urine culture order with EHR decision support. The primary outcome was the number of urine culture orders per 100 ED visits. The secondary outcome was the diagnostic yield of urine cultures. After the intervention, the mean number of urine cultures ordered was 5.95 fewer per 100 ED visits (9.3 vs 15.2), and there was a decrease in normal, or negative, cultures by 2.42 per 100 ED visits. There also was a statistically significant decrease in urine culture utilization and an increase in the positive proportion of cultures. Simple EHR clinical decision-support tools along with reflex urine culture testing can significantly reduce the number of urine cultures performed while improving diagnostic yield in the ED.

65 EMF The Impact of Electronic Health Record Implementation on Emergency Department Operations

2012 ◽  
Vol 60 (4) ◽  
pp. S25 ◽  
Author(s):  
M.J. Ward ◽  
C. Froehle ◽  
K.W. Hart ◽  
S.P. Collins ◽  
C.J. Lindsell
Keyword(s):  
Emergency Department ◽  
Electronic Health Record ◽  
Health Record ◽  
Electronic Health ◽  
The Impact
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