Study finds that HIE reduces duplicate imaging, provides cost savings

One of the arguments justifying the costs associated with establishing broad-based health information exchange (HIE) is that it is not only expected to produce gains in healthcare quality, it’s expected to result in cost savings as well.

A study out of the University of Michigan and published in the journal Medical Care has determined that the adoption of HIE is associated with a decrease in repeat imaging in emergency departments (EDs) and could save the healthcare system millions of dollars annually.

In the study the authors, led by Eric J. Lammers, PhD, an assistant professor of emergency medicine at the University of Michigan, specifically assessed whether HIE between unaffiliated EDs reduces duplicate imaging. They looked at emergency department discharge data from the State Emergency Department Databases for Californian and Florida (early adopters of HIE) together with information on hospital HIE participation and affiliation from the Health Information Management Systems Society annual survey.

The authors compared 37 EDs that initiated HIE participation during the study period with 410 that didn’t participate in HIEs during that period. They focused on the three most common types of imaging studes in EDs: computed tomography (CT), ultrasound, and chest X-rays, and defined a repeat image for a given patient as the same body region performed within 30 days at unaffiliated EDs.

The authors found that repeat CT scans, ultrasound scans, and chest X-rays were significantly reduced when patients had emergency visits at two unaffiliated hospitals that took part in an HIE.  According to the study, in those situations patients were 59 percent less likely to have a redundant CT scan, 44 percent less likely to get a duplicate ultrasound, and 67 less likely to undergo a duplicate chest X-ray.

What do the results suggest as far as the impact on utilization and cost? According to the authors, if all hospital-based EDs in California and Florida fully participated in HIE, it would result in over $2.9 million potential savings by reducing duplicate ED ultrasounds, chest X-rays and CT scans. An extrapolation of those numbers across the nation suggests the healthcare system could realize annual savings of $19 million.

“More broadly, our findings speak to the ongoing challenges of misaligned incentives and an uncertain business model facing HIE efforts,” the authors wrote. They pointed out that while the direct beneficiaries of reduced utilization are payers, providers have been faced with the substantial costs associated with adopting HIE. On the other hand, payers have been reluctant to support HIE since they are unconvinced that HIEs will realize benefits.

“By providing evidence that HIE leads to reduced repeat utilization, our findings should help reassure payers that they may realize savings,” the authors wrote, adding that the results of the study “should also motivate greater provider investment in HIE, particularly as the country moves toward global payments for episodes of care, which will invoke strong incentives for reducing redundant imaging.”

“Our findings support the widely-held notion that HIE can reduce redundant medical services and thereby produce cost savings,” the authors concluded. “To ensure continued support for HIE, it will be critical to demonstrate beneficial effects across the full range of care utilization and delivery settings.”