HIE cuts costs, but more savings may be possible

2014 01 23 14 51 33 773 Data Stream 200

Health information exchange (HIE) systems may modestly lower costs by helping to avoid repeat imaging studies, but more savings could be realized by further reducing the number of repeated CT or MRI exams, according to researchers from Weill Cornell Medical College in New York City.

After reviewing two years of data from the Rochester Regional Health Information Organization (RHIO), a research team led by Hye-Young Jung, PhD, concluded that HIE could save $2.57 per patient each year by avoiding repeat imaging studies. While avoided repeat CT or MRI exams contributed half of these cost savings, they made up only 13% of the overall imaging procedures that were avoided

"This suggests that HIE systems will need to be leveraged in ways that facilitate greater reductions in advanced imaging to achieve appreciable cost savings," Jung told AuntMinnie.com.

The cost of repeat imaging

Imaging procedures produce a large portion of U.S. healthcare expenditures; Medicare, for example, spends $10 billion each year on medical imaging. Repeat imaging contributes substantially to those costs, Jung said.

Hye-Young Jung, PhD, of Weill Cornell Medical College.Hye-Young Jung, PhD, of Weill Cornell Medical College.

Following up on a prior Weill Cornell study that found HIE to be associated with fewer repeat imaging exams, the research team sought to examine the effect of these reductions on cost savings. Jung; co-author Dr. Joshua Vest, PhD; and other colleagues from Weill Cornell evaluated a sample of adult patients enrolled in the Rochester RHIO. The 12,620 patients included in the study were enrolled in the two largest commercial health plans in a 13-county region of western New York served by the Rochester RHIO.

For the purposes of the study, the primary outcome was a continuous measure of costs associated with repeat imaging. HIE use was defined as the system being accessed after the initial imaging procedure and before repeat imaging (Journal of the American College of Radiology, November 25, 2015).

Of the 804 (6.4%) imaging studies that were repeated, 213 (5.5%) occurred in patients for which the HIE system was accessed for their index imaging study; the remaining 591 (6.7%) were not accessed via the HIE. The difference was statistically significant (p = 0.12).

Use of the HIE system after an index imaging procedure was associated with 19% lower odds of a study being repeated within 90 days, according to the group.

Modest savings

The researchers estimated that using the HIE yielded overall annual savings of $32,460 by avoiding repeat imaging studies, representing modest savings of $2.57 per patient. Basic imaging exams such as radiography, ultrasound, and mammography produced 85.1% of the estimated avoided cases of repeat imaging and 46.7% of the cost savings, while advanced imaging studies such as MR and CT made up only 12.8% of the avoided repeat imaging cases but 50.1% of the estimated savings.

"To achieve more substantial savings through HIE, additional mechanisms that complement HIE will need to be developed to further reduce repeated advanced imaging procedures," the authors wrote.

Jung noted that at the time of the study, the Rochester RHIO's HIE system provided contextual information in the form of patient demographics and conditions, as well as written radiology reports. Providers were not able to access images through the HIE during the study period.

"The magnitude of the difference between reductions in the use of basic versus advanced imaging may have been due to the availability of reports only," she said.

Next phase

In the current study, the researchers were not able to determine which images were appropriately repeated and which could have been avoided if the provider had access to the index image, Jung said.

"We would like to develop ways to identify appropriate and inappropriate imaging to better gauge the degree to which repeat imaging can be reduced," she said. "Additionally, as more providers initiate participation in HIE across the country it will be important to see if similar reductions in repeat imaging and associated costs are found among later adopters of the technology."

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