The implementation of a health information exchange can reduce the frequency of duplicative medical imaging and improve care while potentially lowering costs, according to a study published online in the American Journal of Managed Care.
One of the arguments in favor of HIEs has been that they may help reduce the amount of repeat imaging by making previous imaging studies readily available to providers. The authors, led by Joshua Vest, PhD, of the Department of Healthcare Policy and Research, Weill Cornell Medical College, wanted to test that proposition by measuring the frequency and timing of repeat imaging in a community-based setting, and to determine the association between provider usage of an HIE system and repeat imaging (including by modality).
The HIE in question was a system implemented by the Rochester Regional Health Information Organization (RHIO), which facilitates information exchange among 70 healthcare organizations in western New York. That system became fully operational in March 2009. At the time of the study (which took place in 2009-2010), the system had 1,318 users in 156 different outpatient, emergency, inpatient and long-term care settings.
For purposes of the study, the authors defined a single imaging procedure as the unique combination and body region on a particular day for a given patient. “Our outcome of interest was a repeat imaging procedure,” the authors wrote. “We applied a 90-day follow-up period to every index imaging procedure, and looked for the first occurrence of an additional imaging procedure using the same modality for the same body region. We selected 90 days as the primary time period for repeat imaging based on previous studies from the literature.”
The study cohort consisted of 196,314 patients. Looking at the healthcare claims from two commercial health plans the authors found that the first three months of claims for the study cohort included 68,296 for imaging procedures. After removing those claims that were associated with the same imaging procedure and had no body region identified, the researchers were left with 56,036 procedures.
About one out of every six patients (17.7%) had least one imaging procedure with the most common imaging modalities radiographs (43.7%), CT (16.4%), ultrasound (16.4%), mammography (10%) and MRI (6.8%).
Vest and his colleagues determined that 7.7% of medical imaging procedures were repeated within 90 days. That rate varied by modality with the rate for repeat imaging the highest for ultrasound (15.5%) and the lowest for MRI (2.5%). Over half of the repeated procedures occurred within the first 30 days after the initial medical imaging, and by 60 days 80% of the repeated procedures had occurred.
Concerning use of the HIE system, the authors found that providers accessed the system within 90 days after 11.8% of imaging procedures and that if the HIE system was accessed within that time the imaging procedures were less likely to be repeated (5.2% of the procedures were repeated when the HIE system was accessed, compared to 8% when the HIE wasn’t accessed).
“After controlling for patient characteristics and utilization, provider access of the HIE system after the initial imaging was independently associated with 25% lower odds of repeat imaging,” the authors wrote. “Given the rate of repeated imaging observed in this population (7.7%), out of every 36 images, HIE access would prevent 1 repeated image that would have occurred otherwise.” As for individual modalities, HIE use reduced the odds of a repeat ultrasound by 44% and a repeat radiography by 21%.
The study had some limitations. For example the study couldn’t determine the appropriateness of imaging procedures, and it’s known that some repeated procedures are clinically appropriate. In addition, while the researchers knew that providers accessed the HIE, they couldn’t tell which particular data element influenced their decisionmaking.
“This study demonstrates that a community-wide portal is effective for reducing the frequency of repeat imaging,” Vest and his colleagues concluded. “Thus suggesting a technology-driven improvement in care that represents both higher quality and potentially lower costs.”
Click here to see the full study.