Does health information exchange reduce redundant imaging? Evidence from emergency departments
Abstract
BACKGROUND: Broad-based electronic health information exchange (HIE), in which patients' clinical data follow them between care delivery settings, is expected to produce large quality gains and cost savings. Although these benefits are assumed to result from reducing redundant care, there is limited supporting empirical evidence.
OBJECTIVE: To evaluate whether HIE adoption is associated with decreases in repeat imaging in emergency departments (EDs).
DATA SOURCE/STUDY SETTING: ED discharge data from the State Emergency Department Databases for California and Florida for 2007-2010 were merged with Health Information Management Systems Society data that report hospital HIE participation.
METHODS: Using regression with ED fixed effects and trends, we performed a retrospective analysis of the impact of HIE participation on repeat imaging, comparing 37 EDs that initiated HIE participation during the study period to 410 EDs that did not participate in HIE during the same period. Within 3 common types of imaging tests [computed tomography (CT), ultrasound, and chest x-ray), we defined a repeat image for a given patient as the same study in the same body region performed within 30 days at unaffiliated EDs.
RESULTS: In our sample there were 20,139 repeat CTs (representing 14.7% of those cases with CT in the index visit), 13,060 repeat ultrasounds (20.7% of ultrasound cases), and 29,703 repeat chest x-rays (19.5% of x-ray cases). HIE was associated with reduced probability of repeat…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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