Zachary M Grinspan1, Erika L Abramson2, Samprit Banerjee3, Lisa M Kern4, Rainu Kaushal5, Jason S Shapiro6. 1. Center for Healthcare Informatics and Policy, Weill Cornell Medical College, New York, NY ; Department of Public Health, Weill Cornell Medical College, New York, NY ; Department of Pediatrics, Weill Cornell Medical College, New York, NY ; New York Presbyterian Hospital, New York, NY. 2. Center for Healthcare Informatics and Policy, Weill Cornell Medical College, New York, NY ; Department of Public Health, Weill Cornell Medical College, New York, NY ; Department of Pediatrics, Weill Cornell Medical College, New York, NY ; New York Presbyterian Hospital, New York, NY ; Health Information Technology Evaluation Collaborative, New York, NY. 3. Department of Public Health, Weill Cornell Medical College, New York, NY ; Department of Statistical Science, Cornell University, Ithaca, NY. 4. Center for Healthcare Informatics and Policy, Weill Cornell Medical College, New York, NY ; Department of Public Health, Weill Cornell Medical College, New York, NY ; New York Presbyterian Hospital, New York, NY ; Health Information Technology Evaluation Collaborative, New York, NY ; Department of Medicine, Weill Cornell Medical College, New York, NY. 5. Center for Healthcare Informatics and Policy, Weill Cornell Medical College, New York, NY ; Department of Public Health, Weill Cornell Medical College, New York, NY ; Department of Pediatrics, Weill Cornell Medical College, New York, NY ; New York Presbyterian Hospital, New York, NY ; Health Information Technology Evaluation Collaborative, New York, NY ; Department of Medicine, Weill Cornell Medical College, New York, NY. 6. Department of Emergency Medicine, Mount Sinai Medical Center, New York, NY.
Abstract
CONTEXT: For people with epilepsy, the potential value of health information exchange (HIE) is unknown. METHODS: We reviewed two years of clinical encounters for 8055 people with epilepsy from seven Manhattan hospitals. We created network graphs illustrating crossover among these hospitals for multiple encounter types, and calculated a novel metric of care fragmentation: "encounters at risk for missing clinical data." RESULTS: Given two hospitals, a median of 109 [range 46 - 588] patients with epilepsy had visited both. Due to this crossover, recent, relevant clinical data may be missing at the time of care frequently (44.8% of ED encounters, 34.5% inpatient, 24.9% outpatient, and 23.2% radiology). Though a smaller percentage of outpatient encounters were at risk for missing data than ED encounters, the absolute number of outpatient encounters at risk was three times higher (14,579 vs. 5041). CONCLUSION: People with epilepsy may benefit from HIE. Future HIE initiatives should prioritize outpatient access.
CONTEXT: For people with epilepsy, the potential value of health information exchange (HIE) is unknown. METHODS: We reviewed two years of clinical encounters for 8055 people with epilepsy from seven Manhattan hospitals. We created network graphs illustrating crossover among these hospitals for multiple encounter types, and calculated a novel metric of care fragmentation: "encounters at risk for missing clinical data." RESULTS: Given two hospitals, a median of 109 [range 46 - 588] patients with epilepsy had visited both. Due to this crossover, recent, relevant clinical data may be missing at the time of care frequently (44.8% of ED encounters, 34.5% inpatient, 24.9% outpatient, and 23.2% radiology). Though a smaller percentage of outpatient encounters were at risk for missing data than ED encounters, the absolute number of outpatient encounters at risk was three times higher (14,579 vs. 5041). CONCLUSION:People with epilepsy may benefit from HIE. Future HIE initiatives should prioritize outpatient access.
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