Emergency Medicine Informatics

              

Christine Carr, M.D.,         
CPE, FACEP                                      
                                           

The Informatics Section of the Department of Emergency Medicine (DoEM) is focused on the implementation, evaluation, and expansion of Health Information Exchange (HIE) in our region and state. Drs. Steven Saef and Christine Carr have lead these efforts for the past 13 years.

In 2008, the four major hospital systems (MUSC, Roper St. Francis, Trident, and East Cooper) serving greater Charleston, SC banded together to create an HIE, the Carolina eHealth Alliance (CeHA). Their goals in this effort were high: to address the problem of fragmented care, safely reduce duplicative testing, decrease ED lengths of stay (LOS), avoid preventable hospital admissions, and improve quality of care. CeHA was founded with a $2.8M grant from The Duke Endowment and enabled, for the first time ever, emergency physicians practicing in 11 EDs within the Charleston area to access patient data from all four competing hospital systems at the point of care. In early studies we demonstrated reductions in duplicative testing, admissions, and consults in 35 percent of these patients, resulting in an estimated cost avoidance of $1.4 million in 1 year across the EDs in our region (based on a utilization rate of only 2.3 percent.). Preliminary data also revealed a 45 percent reduction in ED LOS for discharged ED patients and a 25 percent reduction in the ED LOS for admitted patients. The combined impact of decreasing avoidable ED testing and decreasing ED LOS provided a much-needed increase in ED capacity at little or no added cost. 

Our innovative work on CeHA earned first place in the 2010 Modern Health care Case Study contest sponsored by Modern Health care Magazine. In 2014, we were the invited keynote speaker at the Pennsylvania e-Health Collaborative to speak on HIE. Our research in the DoEM has been highlighted in multiple IT publications, and we have been invited to speak around the country about the success and results of our research.

Drs. Saef and Carr lead a multidisciplinary research team including medical students, residents, health economists, statisticians, informaticists, and emergency physicians, and have published numerous peer-reviewed studies on the impact of HIE on quality, efficiency, user adoption barriers and care coordination. Saef and Carr are Co-Investigator’s on the team that won a second Duke Endowment grant ($600K) to expand the capacity of CeHA. Subsequent grant funded work has been presented at American College of Emergency Physicians (ACEP) and/or Society of Academic Emergency Medicine (SAEM) national meetings every year for the past 6 years. We are committed to education and have had dedicated students and/or residents on almost every publication, and they have presented at several of our national meetings.

Partnering with our colleagues in the MUSC BioMedical Informatics Center (BMIC) we have several grants that focus on using data from CeHA in an effort to improve health by using AI and predictive analytics to identify patients at risk for abuse, patients that didn’t get follow up or patients that had a missed opportunity in the ED.

In April 2016 as Co-PI, Dr. Carr was awarded a $25K CTSA Carolinas Collaborative grant (with Co-PI’s and Informaticists at the University of North Carolina (UNC), Wake Forest and Duke. “The HEART Pathway: a learning health system project, translating evidence into practice across the Carolinas”. This grant investigated the impact of informatics on ACS rates and Health care utilization by ED patients with acute chest pain across multiple health systems. The goal of the study was to develop informatics tools which can facilitate efficient, evidence-based interventions across the multiple hospitals in the Carolinas Collaborative. The HEART pathway uses a validated clinical decision aid and serial troponin measures to provide real-time decision support to providers. In prior studies, the HEART Pathway decreased hospitalizations, stress testing, and hospital length of stay, without increasing adverse events. These studies led to a learning health system project in collaboration with insurers, in which the HEART Pathway was fully integrated into the Wake Forest Baptist Hospital EHR. Preliminary results from WFBH demonstrate further reductions in hospitalizations and stress testing.

We are proud to say that almost every CeHA publication has included a junior faculty member, resident or medical student. Dr. Saef leads several Medical Student Research electives that allow the students to participate in research design, evaluation, presentation, and publication of our work. Many of these presentations have been nationally recognized.

Dr. Carr has mentored Masters students for the Division of Health Informatics in the College of Health Professions as a Capstone Leader for the MUSC Masters in Health Informatics program. These Masters students study and analyze the various proposed HIE Use Cases described above, as well as examine the architecture and design elements of HIE in our community.

Dr. Carr is the Chief Clinical Officer for Health Sciences South Carolina (HSSC), in this role she and HSSC hope to expand the Use Cases of CeHA to include Disaster Reunification, Capacity Management, Care Coordination/access to Advanced Directives/ePOLST and an EMS Pre-Hospital Access to Care project.  Recently, working in collaboration with DHEC, HSSC was able to leverage existing HIE infrastructure using CeHA to provide immediate, real-time access to Covid-19 results performed on any patient in the state of SC.   In the future we hope to study how improved coordination with HIE can improve health in the rural areas of our state. We envision linking HIE with TeleMed technology as a way to create an “immediate continuity of care document” and create less fragmented TeleHealth Care.  This would create an HIE enabled “single health record” that could identify gaps in care, allowing these to be remedied at any point-of-care (school, work or physician office). 

The aim of our section is to use science and investigation to demonstrate the benefits of sharing health information across disparate systems as we move toward a state and national health information network. Many challenges remain in the path to obtaining the cooperation necessary from major stakeholders in the Health care industry to accomplish this. We believe the studies we have completed barely scratch the surface of what can be accomplished; potential applications of HIE are in many ways limited only by imagination. We are anxious to collaborate with other investigators who are looking for ways in which HIE can be used to improve our patients’ lives and repair the Health care system in the United States.