Electronic Health Reporter

By Jennifer Devening, CEO, YourHealth.

In the controlled chaos of the emergency room (ER), time and accuracy are of the essence. Not only do they impact care outcomes, but also quality, safety, costs, and patient satisfaction. With wait times and costs for emergency care rising, the ER is a prime target for efficiency, productivity, and cost improvement strategies.

The state of the ER

Of the nearly 140 million annual ER visits reported by the Centers for Disease Control & Prevention, more than 13% resulted in admission. Less than half (~42%) of patients were seen in fewer than 15 minutes. What’s more, driven by staffing shortages and higher demand, ER wait times are creeping upwards, increasing to 2 hours and 40 minutes in 2022 from 2 hours and 35 minutes in 2021.

Those same headwinds are driving up ER costs. According to Syntellis, ER labor costs increased by nearly 50% between January 2020 and January 2023 even as ER visits declined by 9.5% over that same period. One casualty of overcrowded and understaffed ERs is accuracy, particularly when it comes to patient histories.

One recent study concluded that medication histories performed in the ER are largely inaccurate and incomplete after finding discrepancies in 27% of medication lists obtained during triage. Of those, nearly 10% involved discontinued medications and nearly 28% involved missing medications. Thirty-eight percent of patients reported taking a non-prescription medication not listed in their electronic medical record.

Given the percentage of ER visits resulting in admission, errors made during ER triage carry through to impact safety and outcomes for inpatients. One study found that up to 67% of patients admitted to a general medical ward had at least one error associated with their medication history.

Further, inaccurate or incomplete medication histories can lead to adverse drug reactions (ADRs), which can prolong hospital stays by anywhere from 1.5 days to nearly five days, according to the U.S. Department of Health and Human Services. ADRs are attributed to approximately 6.5% of all hospital admissions, many involving drug-drug, herbal, and/or supplement interactions.

Many of these medical safety errors result from inadequate reconciliation during admission, with one medical center estimating that approximately one in 10 patients with inaccurate medication lists are likely to suffer an adverse drug event (ADE) that causes physical or mental harm or loss of function. ADEs are also associated with longer hospital stays and higher care costs.

There are many reasons in addition to care safety and outcomes that hospitals and health systems would want to focus on ER triage in any improvement strategy. One is that ER wait times are a key performance metric for hospitals, so finding ways to speed patient throughput by shaving even a minute off the median triage-to-patient administration time of five minutes without impacting care quality and outcomes would carry significant value.

Also, reducing ADRs related to incomplete or inaccurate medication histories gathered during ER triage carries a significant cost benefit. According to one study, ADRs can prolong hospital stays by anywhere from eight to 12 days, incurring an additional cost of $16,000-$24,000 per patient.  Annually, drug-related events cost the healthcare system up to $136.8 billion.

The Solution is an Empowered Patient

The solution to the time and safety issues related to ER triage lies with empowered patients. Specifically, the efficiency and accuracy of patient histories would be substantially impacted by ensuring patients have unfettered access to their accurate and up-to-date medical data.

Imagine the time saved if patients came to the ER armed with an accurate snapshot of their current conditions and medications from multiple sources, eliminating the need to scroll through the lengthy and often outdated medication lists in their electronic medical record. Imagine if that same information was readily available to emergency medical services (EMS) personnel to guide decisions in the field and then passed along to ER staff for ongoing care decisions.

While EHRs and patient portals provide some insights into a patient’s medical history, the reality is that they are limited to just a slice of information. Nor do they represent a consolidated view of critical care needs. Further, the typical patient has multiple providers using multiple disparate information systems – making it impossible for patients to easily aggregate, update, and share their health information.

Even traditional personal health records (PHRs) fall short due to access limitations. An unconscious patient can’t log into their PHR – assuming Wi-Fi or data networks are available when that access is needed.

Improving upon the piecemeal approach offered by EHRs, PHRs and patient portals – without requiring any technology investment on the part of the provider or patient – is the concept of a cloud-based patient-facing solution where patients can consolidate and manage their health information and wellness needs.

For example, the patient logs onto a secure website and creates a summary of their critical care needs (e.g., medical conditions, medications, allergies, etc.) and defines who can access that information and for what purposes. They also set up a care circle of trusted people to support them and/or provide care in an emergency. This would include a primary physician, care champion or medical advocate, and a neighbor, family member, or acquaintance to handle non-emergency needs if a patient is hospitalized.

Patients would be able to change, delete or update their information as needed. They could also include information on vitamins, supplements, and over-the-counter treatments that may interact with other medications, as well as important medical instructions and directives such as DNR, DNI, and religious guidance.

For optimal convenience and usability, this health information could be linked to personal QR codes that could be printed and affixed to the patient’s health insurance card, car dashboard, back of a cell phone – wherever first responders or other medical personnel are trained to look when seeking a patient’s identification or emergency information. When the QR code is scanned, it would display the appropriate healthcare information as previously determined by the patient.

Ready Information Access

Despite patient care spending reaching $4.5 trillion in 2022, little focus has been paid to providing patients with control of their own health information – information that can help drive down care costs, reduce medical errors, shorten triage times, improve patient outcomes, and simply make patients’ lives a little easier.

The technology tools needed to put this information at patients’ and providers’ fingertips already exist. Importantly, its adoption and use are free of any financial or technical burden.

It’s an approach to patient-controlled health information that gives EMTs and ER personnel a more complete health picture of critical, summarized information so the patient gets the right treatment when time matters most. It’s a subtle change that can have a big impact on triage times as well as patient safety and outcomes – and patient satisfaction.