As hospitals and doctors' offices throughout the country race to join online systems that enable them to share medical information securely, a new study proposes that these systems may already be reducing and cutting unnecessary care.
Based on new findings by University of Michigan researchers published online in the journal Medical Care, fewer emergency patients received second round medical scans when they were admitted to a hospital that partakes in a health information exchange, or HIE.
And although the study concentrates specifically on scans performed on patients who have gone through two different emergency departments in a 30-day period, the authors note that the findings serve as a good sample case for the effectiveness of HIEs. The study is one of the first of its kind to demonstrate, with concrete data that HIEs may provide the increased efficiency they pledge.
"The researchers chose to examine emergency care because emergency department teams need information quickly in order to diagnose and treat a patient," said senior author and U-M Medical School emergency physician, Keith Kocher, M.D.
"The ability to log in to a computer and pull up that patient's previous records from other hospitals through an HIE; instead of ordering duplicate tests or scans, holds great promise. But until now, large-scale studies haven't been done," he added.
The findings reveal that the use of repeat CT scans, chest X-rays, and ultrasound scans was considerably lower when patients had both their emergency visits at two different hospitals that participated in an HIE. The data comes from two large states that were among the early adopters of HIEs: California and Florida.
Patients were 59 percent less likely to have a superfluous CT scan, 44 percent less likely to get a duplicate ultrasound, and 67 percent 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, Ph.D., 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. The fact that we find that there is a decrease is in and of itself significant." said Lammers.
The federal government has incentivized participation in HIEs, offering states grants to form them, and medical providers extra money if they sign on. In Michigan, several HIEs have emerged, 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," says 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, from 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 amassed as part of the Healthcare Cost and Utilization Project of the federal Agency for Healthcare Research and Quality.
All in all, they discovered that patients in the two states received 20,139 repeat CT scans, meaning that 14.7 percent of those who had a CT scan in their first emergency visit had another one at their second emergency visit at another, different hospital within a month.
Additionally there were also 13,060 repeat ultrasounds, which were planned for 21 percent of those who had had ultrasounds at their first visit, and 29,703 repeat chest X-rays, ordered for 19.5 percent of those who had an X-ray at their first emergency visit.
While the researchers couldn't exactly tell that doctors at the second emergency department had accessed the patient's records from the first ED, or that it influenced 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 note that the rates of repeat scanning were higher when an HIE was absent than when one was. They also projected that if applied nationwide, HIE could reduce health care costs by $19 million annually 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. We can't say yet how generalizable these results will be to other settings, but these are definitely interesting empirical findings," said Kocher.
Kocher also notes that other types of patient records, such as recent lab test results, can also make a significant difference in what an emergency doctor chooses to do when presented with an emergency patient.
While Lammers notes that not all states report the pertinent data to the HCUP system, and that more broad reporting could make research on the impact of HIEs easier as the systems become more common nationwide. The data allows researchers to see the activity of individual patients across their different medical encounters, while preserving patient privacy.
