EHRs & HIEs Enable Care Coordination and Improve Patient Outcomes at Brookdale University Hospital

The Brookdale University Hospital and Medical Center is one of New York’s most innovative hospitals on the forefront of health IT. As one of Brooklyn’s largest voluntary nonprofit teaching hospitals with 530 inpatient beds and a regional tertiary care center, Brookdale provides general and specialized inpatient care to hundreds of thousands of people every year. In addition, the medical center provides 24-hour emergency services, numerous outpatient programs, and long-term specialty care. Brookdale is one of Brooklyn’s largest, and most experienced full-service emergency departments and a regionally recognized Level I Trauma Center that receives more than 100,000 visits a year.

Brookdale University Hospital and Medical Center has come to rely on two main resources to seamlessly and securely access patient data and medical history.  

Brooklyn Health Information Exchange (BHIX) is a Regional Health Information Organization (RHIO) devoted to developing, deploying, operating and promoting innovative uses of health information technology to facilitate patient-centric care in Brooklyn and surrounding areas. BHIX was established in 2007 as a community-driven collaboration between providers and payers interested in improving patient care across healthcare settings.

RHIOs, such as BHIX, maintain medical records that are continually updated by participating healthcare providers, who can then access the accumulated data with a patient’s consent.

As one of the largest and busiest full-service emergency departments in Brooklyn and a regionally recognized Level I Trauma Center with more than 100,000 visits a year, Brookdale University Hospital and Medical Center has a demonstrable need to instantly and securely access accurate patient data from a multitude of sources. In an emergency situation, access to critical patient data such as medical history, medication usage, and allergies can often make the difference between life and death.

“I believe that Health Information Exchange will have the biggest impact on improving healthcare and population health in decades,” says Dr. Lewis W. Marshall, Jr., Chairman, Department of Emergency Medicine, Brookdale University Hospital and Medical Center.

In addition, the coordination of a patient’s care once they are discharged from the emergency room is a critical factor to delivering better outcomes and ensuring patients do not end up back in the emergency room.

The Statewide Health Information Network of New York (SHIN-NY) is a secure network for sharing clinical patient data across New York State amongst dozens of hospitals, healthcare providers, clinics, and laboratories via RHIOs, such as BHIX. The SHIN-NY is coordinated by NYeC in conjunction with the New York State Department of Health, and the state’s 11 RHIOs.

The ability to send out information to a patient’s primary care provider and coordinate follow-up care after a patient is discharged from the emergency room are key challenges the SHIN-NY and RHIOs such as BHIX are designed to solve.

The impact of BHIX and the SHIN-NY at Brookdale University Hospital and Medical Center are evident in the multitude of cases in which patient outcomes and safety were greatly improved through secure and fast access to clinical data. For example:

1. A patient, 48-year-old male, came into the Brookdale Emergency Room for what was thought to be pneumonia. The patient had blood work and a chest x-ray which all came back negative.  The patient was diagnosed with bronchitis and was sent home. A few weeks later, the patient returned complaining of similar chest symptoms and had a second x-ray, which showed a foreign object in his lungs. The object turned out to be a guide wire from a past vascular procedure. Personnel at Brookdale could not locate a record of the patient having a procedure at Brookdale or another hospital and the patient could not remember where their procedure had taken place and had no records of their own to share with Brookdale.

The Brookdale staff utilized the BHIX to find out where the patient had been in the interim to have the procedure and worked with the outside hospital to return the patient and help enable their continuity of care.

2. A 78-year-old woman with diabetes and hypertension was admitted to Brookdale’s Emergency Room, unresponsive and unable to provide details about her medical history. The first responders who had collected her name from a family member and medical personnel at Brookdale utilized BHIX to find her medical history, list of medications, and were alerted to the fact that she had sepsis. Because the patient had previously given consent to share her data, the critical information learned and the timeliness in which medical personnel were able to access the patient’s data enabled them to treat her swiftly and properly.

3. In addition to his position at Brookdale University Hospital and Medical Center, Dr. Marshall has a private medical practice in Queens. One of his private patients, a 68 year-old female with diabetes and hypertension, found themselves in a life-threatening emergency situation and was admitted to an emergency room at a Brooklyn hospital. The patient was unable to remember the tests administered and their results while in the ER and could not provide Dr. Marshall with a clear and accurate history of the encounter. Unfortunately, the patient had not provided consent to share their health records with outside healthcare providers, so their health records could not be exchanged and obtained through a RHIO.

Patient consent is imperative to allowing for the exchange of health information, and currently stands as one of the major obstacles to HIE adoption and usage. It is the health care provider’s responsibility to educate patients and ask for consent during regular doctor visits. For emergency situations, a “break the glass” emergency protocol has been established, in which emergency responders are able to override a lack of patient consent in situations where the patient is incapacitated (and thus unable to give consent at that moment), and information from an HIE could be life-saving.

Moving forward, health information exchange (HIE) and electronic health records (EHRs) will continue to play a leading role in revolutionizing healthcare by enabling healthcare providers to streamline their work and improve efficiency – while enhancing the quality of care they offer patients due to the availability of real-time, consolidated life-saving health information.                                             

Content provided by the New York eHealth Collaborative (NYeC).

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