Health information exchange cuts repeat imaging studies

2014 01 23 14 51 33 773 Data Stream 200

While image sharing via health information exchange (HIE) systems has yet to achieve widespread adoption, the experience of the Rochester Regional Health Information Organization (RHIO) in New York shows that it can be worth the effort, yielding quantifiable reductions in repeat imaging studies.

A research team led by Joshua Vest, PhD, from Weill Cornell Medical College found that physicians who accessed a patient's prior imaging study in the RHIO's HIE system had 25% lower odds of ordering a repeat study, compared with providers who didn't use the system.

Avoiding repeat imaging saves time: Providers don't have to reorder images and wait for the results, and patients don't have to undergo the extra exams, Vest told The study findings were published online January 14 in the American Journal of Managed Care.

Focus on imaging

In terms of health policy, more attention has been directed toward imaging in recent years, according to Vest.

"It is an area of healthcare where improved access to patient information should help providers," he said.

HIE systems -- which provide access to patient clinical information, such as radiology images and reports, across healthcare organizations -- have been implemented in several U.S. communities. However, previous studies in the literature have reported mixed results on the effectiveness of HIEs for reducing repeat imaging studies, according to the group.

Joshua Vest, PhD, from Weill Cornell Medical College.Joshua Vest, PhD, from Weill Cornell Medical College.

As a result, the researchers sought to evaluate repeat imaging in a community-based setting. Their goal was to examine the association between HIE use and repeat imaging performed within 90 days of the initial imaging study. They also wanted to explore the effect by type of imaging.

Vest and colleagues performed a longitudinal-cohort study of patients and their imaging procedures in 2009 and 2010 in the Rochester, NY, region. They studied an HIE system used by the Rochester RHIO, a nonprofit organization that offers information exchange between more than 70 healthcare organizations in western New York.

The study included healthcare claims from two commercial health plans that represented approximately 60% of the Rochester-area population. The researchers then matched the claims with log files from the RHIO's HIE system to determine utilization and the effect on repeat imaging.

Over a six-month period, 28.7 imaging procedures were performed for every 100 patients. Of these, 7.7% were repeated within 90 days; nearly 50% of repeat studies occurred within 30 days and 80% were conducted within 60 days.

Repeat rates for imaging studies by modality were as follows:

  • Ultrasound: 15.5%
  • Radiography: 8.6%
  • Mammography: 4.7%
  • CT: 3.8%
  • MRI: 2.5%

Although 23 total modalities were considered, these five produced more than 90% of the 56,306 imaging procedures included in the study, according to the researchers.

Fewer repeat studies

If the HIE system was accessed by providers, 5.2% of imaging procedures were repeated, compared with 8% when it 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" (odds ratio = 0.75, 95% confidence interval: 0.65-0.87), the authors wrote. "Given the rate of repeated imaging observed in this population (7.7%), out of every 36 images, HIE access would prevent one repeated image that would have occurred otherwise."

The group did find some variation in repeat imaging rates by modality. For example, access to the HIE reduced the adjusted odds of a repeat ultrasound study by 44% and a repeat radiography study by 21%. However, "HIE usage was not associated with the odds of a repeat CT, although the sample size of repeat CTs was much smaller than that of the other two tests, limiting power for that comparison," the authors wrote.

The reasons for the variation in repeat studies by modality are unclear.

"We know from prior studies that the type and amount of existing patient information providers need depends on the situation," Vest said. "We need additional research to explore how using HIE for imaging information can benefit different types of patients, conditions, and modalities."

The researchers did not assess the appropriateness of the imaging procedures performed in the study. Vest did note, though, that not all repeat imaging studies are bad.

"Some images should be repeated," he said. "HIE is a way to get providers access to recent imaging results."

Raising awareness

There are a few steps that can be taken to improve physicians' use of HIE to further decrease repeat imaging, including raising the level of awareness of what HIEs can offer, Vest said.

"Many HIE systems, like the one in Rochester, have lots of patient information from lots of sources, making it a rich source of patient information," he said. "The other area is integrating into workflow, and that requires a lot of collaboration. HIE organizations are working to make the technology easier to use, healthcare organizations need to provide the in-house support to make usage easier for providers, and providers needs to work usage into their workflows."

The research team is currently taking a deeper look into how providers access images and reports, Vest said.

A number of HIEs have struggled to take hold, and questions remain about their long-term sustainability without continued government funding. However, the ability to help avoid repeat imaging is a great example of the value of HIEs, Vest said.

"It saves resources, it saves providers from having to request films, and it saves patients from additional imaging," he said. "We have interviewed numerous physicians, nurses, physician assistants, and nurse practitioners about HIE. They all love the ability to access images and reports."

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