For repeat imaging, HIE may be the fix

'Timely sharing of patients' medical records may result in fewer repeated imaging tests.'
By Erin McCann
11:03 AM
Despite new data suggesting that only "low quality" and insufficient evidence exists for the costs savings and improved outcomes case for health information exchanges, new analysis focused on HIEs' relationship to repeat imaging may turn that on its head. 
After conducting a cohort study of nearly 200,000 patients, researchers at Weill Cornell Medical College found that participants whose medical records were accessed via a HIE – which was the Rochester Regional Health Information Organization – within 90 days were significantly less likely to have repeat imaging tests. In fact, for those with HIE access, 5 percent of patients saw redundant imaging tests compared to the 8 percent with no HIE access. A 3 percent reduction may not sound altogether impressive. But the number's significant. 
What's more, if the HIE system was accessed directly following the initial image procedure, those numbers are even more impressive. HIE was associated with 25 percent lowers odds of repeat imaging. Considering the nearly 8 percent rate of repeated imaging observed in this specific population, researchers calculated that one repeat image would be prevented out of 36 images. 
"Medical imaging has been an important diagnostic tool for decades, but unnecessary or repeat exams are costly and could potentially delay access for patients who truly need the tests," says Joshua Vest, MD, assistant professor of healthcare policy and research at Weill Cornell and the lead author of the study, in a Jan. 14 statement announcing report findings. "Our research shows that timely sharing of patients' medical records may result in fewer repeated imaging tests. Instant access to this information gives providers a better, more complete picture of a patient's health status." 
Though Weill Cornell researchers did not examine the cost savings aspect in their HIE cohort, other recent studies have found associated cost savings with HIE. 
The folks at HEALTHeLINK, the Western New York Clinical Information Exchange, for example, published data early last year found that utilizing lab ordering data from an HIE could save a whopping $1.3 million by eliminating unnecessary duplicate CT scans. After poring through HIE data, officials discovered there were 2,763 potential cases of unnecessary duplicate CT scans ordered, and 90 percent of the docs who ordered them never or infrequently used the HIE. 

[See also: No HIE means 'lost opportunity' for cash.]

January 2014 research conducted by Mathematica Policy and the University of Michigan also echoed these findings. Researchers compared imaging numbers at emergency departments connected to an HIE versus imaging numbers at EDs not yet connected to an HIE. What they found? The EDs connected to an HIE observed nearly a 9 percent decrease in repeat ultrasounds and 13 percent decrease in repeat chest X-rays. 
Not all research out on HIE is good news, however. A large-scale systematic review conducted by the RAND Corporation back in December, for instance, found that data suggesting HIEs save money and produce quality outcomes and satisfaction are "low quality" and have been "insufficiently evaluated" for any certain conclusion. In fact, many HIEs are struggling financially and have expressed concern over financial sustainability, with only 25 percent of them considering themselves sustainable.
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