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Health Information Exchanges between Hospitals Benefit the Patient

By MedImaging International staff writers
Posted on 10 Feb 2014

As hospitals and physicians’ offices in the United States hurry to join online systems that allow them to share medical information securely, a new study suggests that these systems may already be helping slash unnecessary care.

Fewer emergency patients received repeated medical scans when they went to a hospital that takes part in a health information exchange (HIE), according to new findings by the University of Michigan (U-M; Ann Arbor, USA) researchers, which were published online January 2014 in the journal Medical Care.

Moreover, although the project focuses specifically on scans conducted on patients who went to two different emergency departments in a 30-day period, the researchers reported that the findings serve as a good test case for the effectiveness of HIEs. The study is one of the first to demonstrate that with comprehensive data, HIEs may deliver the increased efficiency they promise. The researchers chose to examine emergency care, according to senior author and U-M Medical School emergency physician Keith Kocher, MD, because emergency department teams require information quickly in order to diagnose and treat a patient.

The capability to log in to a computer and open up that patient’s earlier records from other hospitals through an HIE instead of ordering duplicate tests or scans holds a lot of potential, he noted. But until now, large-scale studies have not been done. The findings show that the use of repeat computed tomography (CT) scans, chest X-rays and ultrasound scans was significantly lower when patients had both their emergency visits at two unaffiliated hospitals that took part in an HIE. The data come from two large US states that were among the early adopters of HIEs: California and Florida.

Patients were 59% less likely to have a redundant CT scan, 44% less likely to get a duplicate ultrasound, and 67% less likely to have a repeated chest X-ray when both their emergency visits were at hospitals that shared information across an HIE.

Kocher worked with Eric Lammers, PhD, who performed the analysis for his doctoral work at the U-M School of Public Health and is now working at Mathematica Policy Research. “The emergency department is an important test case for whether we would see any impact from HIEs on rates of repeat imaging,” said Dr. Lammers. “The fact that we find that there is a decrease is in and of itself significant.”

The US government has incentivized participation in HIEs, offering states grants to form them, and medical providers extra money if they sign on. Several HIEs have emerged in Michigan, and the two largest just announced plans to merge. HIEs are a key extension of the electronic health records that hospitals and practices are also being incentivized to adopt.

“There has been a lot of hope, and some hype, that these systems will enable more efficiency in how care is provided across unaffiliated providers,” stated Dr. Lammers. The availability of several years of data from various sources in two HIE early-adopter states gave the chance to do the study, he notes.

The researchers collected information from the California and Florida State Emergency Department Databases, for 2007 through 2010, and information on hospital HIE participation and affiliation from the Health Information Management Systems Society annual survey. The state ED databases were compiled as part of the Healthcare Cost and Utilization Project of the federal Agency for Healthcare Research and Quality.

The investigators discovered that patients in the two states underwent 20,139 repeat CT scans, meaning that 14.7% of those who had a CT scan in their first emergency visit had another one at their second emergency visit at another, unaffiliated hospital within one month. There were also 13,060 repeat ultrasounds, which were ordered for 21% of those who had had ultrasounds at their first visit, and 29,703 repeat chest X-rays ordered for 19.5% of those who had an X-ray at their first emergency visit.

While the researchers could not determine specifically that physicians at the second emergency department had accessed the patient’s records from the first ED, or that it impacted their decision-making if they did, the presence of an HIE at both hospitals means it would have been possible to do so. And they did see that the rates of repeat scanning were higher when an HIE was not present than when one was. They also estimated that if adopted nationwide, HIE might reduce healthcare costs by USD 19 million yearly for these types of repeat imaging tests in the ED.

“Our data allowed us to study a very specific type of care where HIE was associated with reducing what would potentially be a redundant test by half, which we think is pretty meaningful,” said Dr. Kocher. “We can’t say yet how generalizable these results will be to other settings, but these are definitely interesting empirical findings.”

Dr. Kocher noted that other types of patient records, such as recent lab test results, can also make a major difference in what an emergency physician chooses to do when presented with an emergency patient.

Dr. Lammers noted that not all states report the relevant data to the HCUP system, and that more wide-reaching reporting could make research on the impact of HIEs easier as the systems become more common nationwide. The data allow researchers to see the activity of individual patients across their different medical encounters, while preserving patient privacy.

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57 (!!!!! 5577.0874023438): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND published='1' LIMIT 1

58 (127.07710266113): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND published='1' LIMIT 1

59 (!!!!! 2807.8556060791): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND published='1' LIMIT 1

60 (967.02575683594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND published='1' LIMIT 1

61 (!!!!! 3256.08253479): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

62 (!!!!! 1185.1787567139): SELECT fid FROM jos_deeppockets WHERE id=294750623 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294750623 AND published='1' LIMIT 1

63 (!!!!! 1816.987991333): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=216 ORDER BY `ordering`

64 (!!!!! 1576.9004821777): select jos_twitters.link from jos_twitters where cat=10

65 (!!!!! 1056.1943054199): select jos_facebook.link from jos_facebook where cat=10

66 (!!!!! 1302.0038604736): select jos_google_plus.link from jos_google_plus where cat=10

67 (582.93342590332): select jos_linkedin.link from jos_linkedin where cat=10

68 (827.07405090332): SELECT fid FROM jos_deeppockets WHERE id=294750623 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294750623 AND published='1' LIMIT 1

69 (477.07557678223): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=216 ORDER BY `ordering`

70 (544.78645324707): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294750623 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (411.03363037109): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294750623 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (229.83551025391): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (!!!!! 1170.8736419678): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (366.2109375): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (82.969665527344): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (329.01763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (623.94142150879): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (273.9429473877): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (580.0724029541): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (!!!!! 1260.0421905518): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (308.03680419922): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (169.03877258301): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (320.9114074707): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (182.8670501709): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (411.9873046875): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (307.08312988281): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 1812.9348754883): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294750623 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (185.01281738281): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294750623 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (496.14906311035): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (60.796737670898): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (!!!!! 2274.9900817871): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (!!!!! 3931.999206543): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (88.930130004883): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (48.160552978516): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (138.99803161621): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND published='1' LIMIT 1

105 (149.01161193848): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND published='1' LIMIT 1

106 (141.85905456543): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294750623 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (121.8318939209): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294750623 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (932.93190002441): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND published='1' LIMIT 1

109 (172.85346984863): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND published='1' LIMIT 1

110 (464.20097351074): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294750623 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (646.11434936523): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294750623 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (545.97854614258): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (475.16822814941): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (128.03077697754): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND published='1' LIMIT 1

115 (64.849853515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND published='1' LIMIT 1

116 (192.88063049316): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND published='1' LIMIT 1

117 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND published='1' LIMIT 1

118 (128.03077697754): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND published='1' LIMIT 1

119 (80.82389831543): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND published='1' LIMIT 1

120 (418.90144348145): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 66770.076751709): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

122 (!!!!! 3718.1377410889): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND published='1' LIMIT 1

123 (84.877014160156): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND published='1' LIMIT 1

124 (495.19538879395): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294750623 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294750623 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 1162696.1231232): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (!!!!! 830615.04364014): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (487.08915710449): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (67.949295043945): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (495.91064453125): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (362.87307739258): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (66.041946411133): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (46.968460083008): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (!!!!! 1497.9839324951): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (411.03363037109): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (271.08192443848): SELECT name FROM jos_deeppockets WHERE id=216

136 (171.89979553223): SELECT name FROM jos_deeppockets WHERE id=216

137 (713.10997009277): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))216((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

138 (608.92105102539): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))216((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

139 (!!!!! 2007.007598877): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND published='1' LIMIT 1

140 (476.83715820312): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND published='1' LIMIT 1

141 (!!!!! 15505.075454712): TRUNCATE TABLE jos_trademed_module

142 (!!!!! 2062.0822906494): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294750623 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (!!!!! 1112.9379272461): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294750623 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (660.18104553223): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (115.87142944336): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (199.79476928711): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND published='1' LIMIT 1

147 (147.10426330566): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND published='1' LIMIT 1

148 (!!!!! 1177.0725250244): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

149 (182.8670501709): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND published='1' LIMIT 1

150 (238.89541625977): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND published='1' LIMIT 1

151 (802.04010009766): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294750623 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294750623 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (87.976455688477): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=216 or channel_id is null)

153 (149.01161193848): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=216 or channel_id is null)

154 (92.029571533203): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (246.04797363281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND published='1' LIMIT 1

156 (459.90943908691): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294750623 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294750623 AND published='1' LIMIT 1

157 (865.93627929688): select jos_twitters.link from jos_twitters where cat=10

158 (56.028366088867): select jos_facebook.link from jos_facebook where cat=10

159 (33.855438232422): select jos_google_plus.link from jos_google_plus where cat=10

160 (30.994415283203): select jos_linkedin.link from jos_linkedin where cat=10

161 (307.08312988281): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 3628.0155181885): insert into jos_banners_delta values (14615,'2025-06-18 08:45:08','216.73.216.120','view'),(14202,'2025-06-18 08:45:08','216.73.216.120','view'),(14203,'2025-06-18 08:45:08','216.73.216.120','view')

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